Maintenance of Certification (MOC) status has been positively linked with physician performance scores, according to an article published in the Annals of Internal Medicine.1The study follows intensive questioning of the MOC program as a marker of physician quality.

Bradley Gray, PhD, of the American Board of Internal Medicine (ABIM) in Philadelphia, Pennsylvania, and colleagues used ABIM administrative data to compare Healthcare Effectiveness Data and Information Set (HEDIS) measures in physicians who either did or did not maintain certification in the 20 years following their initial certification.

General internists certified in 1991 (n=1260) were included in the study. This group provided care for 85,931 Medicare patients between 2009 and 2012. Within this group of physicians, 786 maintained their certification; 474 did not.

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Researchers assessed the care provided to people with diabetes by these physicians. Among physicians who maintained their certification, 58.4% of patients completed a semiannual HbA1c test, 83.1% of patients met the annual standard for low-density lipoprotein cholesterol measurements, and 46% of patients met all 3 diabetic standards. Patients cared for by this physician group also more frequently underwent biennial mammography screening (72%). Patients of physicians who did not achieve MOC were less likely to hit all of these markers (54.4%, 80.5%, 41.6%, and 67.8%, respectively).

“There are several possible explanations for our findings,” Dr Gray and colleagues noted. “MOC status may have identified physicians who stayed current with their medical knowledge throughout their careers, which in turn may be related to adherence to guidelines.”

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The researchers added, “Yet, the magnitude of adherence to the HEIDIS measures that we analyzed among both physicians who maintained their certification and those did not suggests that both groups have room for improvement.”

In an accompanying editorial, Lee Goldman, MD, MPH, of the Vagelos College of Physicians and Surgeons at Columbia University in New York, notes that following complaints from physicians, the American College of Physicians, and subspecialty societies, the ABIM “ultimately agreed to explore focusing on ‘subset of knowledge relevant to specific practice types,’” we well as instituting an option for at-home testing and an “open-book” approach to be implemented in 2018.2

Dr Goldman suggested that Dr Gray and colleagues did not do an adequate job of assessing how the relative importance of MOC compares with other equally common measures of qualification.

Dr Goldman concluded, “The medical profession would be better off if its certifying bodies…focused on how the recertification process can add the most true value to the public and their physician constituencies. The recertification glass is not entirely empty, but we all wish it were more full.” 

Disclosures: Drs Gray and Lipner and Mr Vandergrift report employment with the American Board of Internal Medicine. Dr Reschovsky reports a consulting arrangement with the American Board of Internal Medicine and Dr Landon reports receiving personal fees. Financial and Material support for this study were provided by the ABIM.


  1. Gray B, Vandergrift J, Landon B, Reschovsky J, Lipner R. Associations between American Board of Internal Medicine Maintenance of Certification status and performance on a set of healthcare effectiveness data and information set process measures [published online June 12, 2018]. Ann Intern Med. doi:10.7326/M16-2643
  2. Goldman L. Maintenance of Certification: glass not entirely empty? [published online June 12, 2018]. Ann Intern Med. doi:10.7326/M18-1459