ACC Member Perceptions of MOC New York Chapter

1. ACC Member Perceptions of MOCNew York Chapter May 2014

2. Methodology • Online survey distributed by U.S. ACC Chapters to chapter members. • Survey live April 23 – May 26, 2014. At least one reminder emails sent. • Completes: • n=4,406 ACC members completed the survey • n=304 New York ACC Chapter members completed the survey

3. Respondent Composition

4. Key Findings • Overall, ACC New York Chapter Members mirror those in the rest of the U.S. with respect to attitudes toward MOC. • While most members who responded to the survey are aware of the recent MOC changes, they are not as familiar with all of the particulars. • There is strong opposition to the changes and opposition is universal, cutting across generation. Much of this opposition is driven by the high financial and time costs associated with the new requirements and lack of perceived value. • Members want the ACC to work with ABIM to revise the MOC requirements – to remove the MOC requirement, assume certification responsibilities, revert to pre-2014 requirements and/or remove practice improvement modules from the process.

5. Awareness of 2014 MOC Requirements Q. Are you aware of the changes that American Board of Internal Medicine (ABIM) made to its Maintenance of Certification (MOC) program as of January 2014?

6. Description of MOC On January 1, 2014, the American Board of Internal Medicine (ABIM) implemented changes to its Maintenance of Certification (MOC) program. The changes to the new MOC requirements are extensive and will apply to all certified physicians, including those originally grandfathered. Changes to ABIM’s MOC program requirements are designed to engage all ABIM diplomates in MOC activities on a more frequent, or continuous, basis to demonstrate that physicians are maintaining their certification and “Meeting MOC Requirements.” Meeting MOC Requirements will be defined as passing a secure examination after training and maintaining a 10-year certification contingent upon completing MOC activities as follows: • Some MOC Part 2 or Part 4 activities are required every 2 years • 100 MOC points are required every 5 years (20 points minimum in both Part 2 and Part 4) • Completing patient safety and patient survey modules required every 5 years • Secured reexamination required every 10 years (Part 3)

7. 2014 MOC Familiarity Total New York Very Familiar56%47% Not Familiar 19%22% Q. How familiar are you with all of the changes that the ABIM has made to its certification / recertification process?

8. 2014 MOC Favorability Total New York Total Favor4% 4% Total Oppose 87%87% Q. Do you favor or oppose the new ABIM MOC requirements?

9. Perceptions of Cost Q. Do you think that the cost associated with the MOC and recertification programs is:

10. MOC Effect on Future Plans Total New York Total Yes 32%27% Total No 37%35% Q. Have these recent MOC requirements affected your planning for the future, specifically thoughts of retirement, part-time practice or transitioning out of the practice

11. Recommended MOC Process Revisions Q. If you were tasked with revising the MOC process for cardiologists, which of the following would you recommend? Please select all that apply.

12. Recommended ACC Support Remove MOC requirements Assume certification Q. Recognizing that the ABIM is a completely separate and independent entity from the ACC, how could the ACC best serve its members regarding the MOC requirement changes from ABIM? Please select all that apply.

13. CardioSource.org Helpfulness Total New York Very Helpful 35%25% Not Helpful 13%12% Q. The ACC currently provides resources on CardioSource.org to assist members in meeting the ABIM MOC requirements. Using the following scale, how helpful are these CardioSource.org resources?]

14. Strongly oppose MOC … Time aware from patient care Disappointed in ACC Eliminate MOC Ridiculous Evidence? Too Expensive ABIM Out of Control Practice Relevance Burdensome Onerous ABIM is a Monopoly ABIM Money Grab ACC Should Certify Eliminate PIM Waste of Time Stand Up for ACC Members *ALL Q. And lastly, please provide any final comments that you would like ACC leadership to know concerning RESPONSES the 2014 ABIM revised requirements concerning Maintenance of Certification.

15. From the Mouths of Members … • 1-all or none ( no grandfathering) 2- no formal exam (lots of expense and time wasted) 3-abim can run internet based programs for mandated cme to maintain certification! More cost time effective and achieves mandated learning goals • 1. PIMs and surveys are an insult to practicing physicians and cardiologists. Remove them with immediate effect. 2. It is the grandfathered physicians/cardiologists who need to take the MOC exam most, as they are the ones most outdated in terms of knowledge. What a strange logic: the most outdated are the ones exempt from taking the exam. The MOC industry needs to be dismantled root and branch, as they are imposing their own agenda to earn millions, at great cost to physicians whose lives, en masse, have already been destroyed due to the pressures being imposed on the profession from all sides and on so many fronts. • ABIM is a profit making organization which needs a reality check. It is expensive and costs a lot both in terms of money and time. I learn lot more attending a review course like the one MGH offers than ABIM mandates. If they are so concerned about our knowledge let them give modules free. • ABIM is a self serving enterprise that has a conflict with revenue generation for themselves and the consulting physicians. • ABIM is an out of control organization which has no basis in reality. • ABIM is the certification body and ACC leadership should work with them! I personally have retired but MOC Is merely a natter of pride. • ABIM is unreasonable in terms of its expectations and cost. Expectations for MOC are completely unreasonable. This is extortion on many levels. • ABIM is using their monopoly to their financial advantage. • ABIM needs to stop It is very obvious that all these new requirements are just an excuse to make more money for them selves. I really did not become a physician just to take and retake tests and convince people to do the PIM just to keep a board certification. They must remember we have lives to live not just to satisfy their other issues. • Abusive • acc must take full responsibility • ACC PIMS are more burdensome than the ABIM ones-simplify it!! • ACC should ask ABIM not to self impose more burden on working cardiologists. • ACC should be more in tune with membership opinion on this topic PRIOR to any major changes such as these are enacted. ABIM should be more interested in our opinions on ways to improve CME, not simply make an edict. • ACC should take this over. • All these requirements are compromising patient care, they do nothing to enhance pt care. Its a money and power grab by the ABIM • Another bureaucracy , paper work ,useless/ Q. And lastly, please provide any final comments that you would like ACC leadership to know concerning the 2014 ABIM revised requirements concerning Maintenance of Certification.

16. From the Mouths of Members … • as expected, physicians are again being unfairly asked both from a time and financial perspective to be taxed unfairly given the already growing constraints against us. We NEED more representation for doctors to the powers that matter for change • As usual, the ACC is powerless to deal with the issues that practicing physicians feel are important. I don't know why i bother paying dues. AT some point, perhaps soon, the old adage will finally apply to the ACC: "Lead, follow, or get out of the way!" • Board Certifications, CMEs , MOC , Hospital meetings ,Daily ACC Newsletter reading , office meetings etc. Is one allowed to have a family life ? Hobbies ? WOW Just getting to be too Much • Board certified cardiologists do not need this kind of financial and intellectual harassment. There is no evidence that any of the MOC activities make any difference in patient care. If board certified physicians cannot be trusted to take responsibility for keeping up to date, then they can't be trusted to care for patients. Stop treating physicians like kindergarteners • Cardiologist are frustrated and weary of increasing demands that preclude them from any semblance of home life years after they proved their capacity to meet requirements of the boards. Our profession has been divided into multiple parts for which we are required to maintain separate boards rather than one board exam for what we do. In addition to a humiliating and daunting board exam every ten years we now have the added burden of keeping tract of our learning and proving we are keeping up with medical knowledge in cook book MOC requirements. At the same time our pay is steadily declining and other parties are demanding we spend time to prove our quality for payment. We spend much more time than ever before completing electronic records. We have courses and exams for malpractice insurance, State license, hospital privileges and it never seems to end. Cardiologist are taking boards that qualify them for "consultations" but our society could not prevent the elimination of the consultation codes for CMS. We now have separate CME requirements and costs of certifying our echocardiogram and nuclear medicine facilities. I would like to see MOC replace the secure exam or allow a choice between MOC or the secure exam. • CME credits required for medical license renewals might be used as a basis of meeting MOC requirements. Or if MOC requirements are to be continued then CME credits requirement for license renewals should be abolished. • CME requirements re: credentialing for Hospitals, malpractice insurance etc. PLUS transition to EMR with ever expanding meaningful use mandates/ documentation requirements PLUS q 10 year recertification exams (for CV disease, for Echo, for Nuc, etc...), plus competitive business environment, decreasing reimbursements, increasing audits and precertification, economic mandates to form networks, committees to restructure practices and document efficacy/ patient satisfaction, etc... AND ON TOP OF IT ALL, I NOW HAVE TO JUMP THROUGH q2 YEAR MOC HOOPS TO SATISFY ABIM DEMANDS? (pt survey/chart review/etc a total WASTE OF TIME, EFFORT, MONEY)!!!!!! Is there any time left for patient interaction/care (let alone addressing business issues)? PLEASE HELP US !!!!!(AND ADVOCATE FOR COMMON SENSE SIMPLE SOLUTIONS) At some point, (multiple) well meaning actions lead to disaster....the enemy of good is perfect, etc.... Q. And lastly, please provide any final comments that you would like ACC leadership to know concerning the 2014 ABIM revised requirements concerning Maintenance of Certification.

17. From the Mouths of Members … • Current Medicine and Cardiology practice requires knowledge integrated and interfaced with EMR. Access to information is immediate and online. Exams and modules are obsolete because are not keeping with current changes • current status is confusing • Currently retired from active practice. Though I maintain my own quota of CME credits, I have no intention of pursuing MOC requirements. My certification has been grandfathered and I will be reported as "Certified, Not Meeting MOC Requirements." As a retiree this has no impact. I regret that the younger people still active in practice have to deal with this onerous process. What impact is this requirement having on the quality of patient care, teaching and research? Also, the mandates from the RRC on training programs is equally out of control. • Do we really deserve to be treated like adolescents? We have had to put up with a lot of interference recently. I find that the cardiologists that I work with are professionals in the true sense of the word. This implies keeping up to date, practicing responsibly and ethically. I sometimes wonder where all this external interference comes from. I'm sure there are a very small number of cardiologists who are not practicing according to these high standards but there must be other ways to deal with this. • drop the whole thing • Either MOC or the exam but not both. • Fight against these ridiculous requirements demanded from professionals- we are practicing cardiologists not kids at kindergarten • For those in practice a long time, this is a terrible burden. If there is insistence on something along these lines, there should be some period of grandfathering so that doctors in practice 25 years do not need to do this. • GET RID OF ANOTHER ROAD BLOCK AND UNNESESSARY BURDEN ON ALREADY STRAINED FINANCIAL SITUATATION OF PHYSICIANS . LOOK WHAT HAS HAPPENED TO US AKLRADY WITH aco AND OBEMA CARE • Good luck to ABIM. I am opting out. • H.L. Mencken.. "Simplify. simplify, simplify". • How many bureaucratic things we need . I will not practice find cardiologists for patient, disgusting . • I am a pediatric cardiologist • I am a pediatric cardiologist and dealing with the same issue with ABP. My wife is an internist and she has started loosing motivation t practice medicine because of the time she spends in non patient care (EMR, various courses to keep hospital privileges, dealing with insurance and now MOC. I appreciate this advocacy with ABIM. I also wish ACC to provide advocacy for the pediatric cardiologist members too. I see very little effort in this regard from ACC and we pediatric cardiologist feel like step children. I am considering not renewing my membership with ACC and rather join a more dedicated organization • I am a pediatric cardiologist- So none of this is applicable Q. And lastly, please provide any final comments that you would like ACC leadership to know concerning the 2014 ABIM revised requirements concerning Maintenance of Certification.

18. From the Mouths of Members … • I am in favor of continuing education and I help plan CMEs. The MOC is draining any interest from CME activity and participation, since clinicians must spend more on MOC. • I am not sure what the impetus for this kind of program was. • I am refusing to pay the ABIM any more money. They already charge way too much for their certification examinations. It is nothing but extortion. • I believe it is not unreasonable to provide some evidence that a professional is keeping up with new knowledge in his/her field. However, the costs and time requirements of the MOC, as it is now structured, are prohibitive in an economic environment that is hostile to practicing physicians. • I believe that the moc requirements are not needed. no professional has such requirements to practice. this does not make us better doctors, it is a waist of precious time. it takes doctor away from their patients and families. will not support the acc if nothing is done • I believe that these changes to MOC were capricious and not well thought out. The motivation is unclear. If board certification and recertification does not sufficiently demonstrate that a physician has the knowledge base to practice as a cardiologist on its own merits than why is is necessary. The MOC requirement added to the board certification seems overbearing. • I believe that we need to take a stand against the unilateral ability of the ABIM to redefine maintenance of certification for physicians who have established their certification under pre-existing rules. It is one thing to change the process for physicians who are becoming newly certified, but this process is establishing something retroactively for people who certified in good faith under previous rules. • I did not feel the ACCF board review course covered topics adequately for my interventional boards. This needs to be improved. • I find it extremely onerous financially and it is clearly a money-making scheme • I have been in practice for greater than thirty years, F.A.C.P., F.A.C.C., F.A.C.P, provide about 100 c.m.e. credits per year including ten in vascular and echocardiography. I work from 8 to 5 or 6 pm. daily and come in on Sunday to do paper work to catch up from the week. The hospitals mandate that I come in and do 12 hours to comply with their electronic records. ICAEL now wants me to take the test for echos and stress echos that only someone that just came out of their fellowship could pass, even though I submit all my studies and have passed their standards, even before it became mandatory. I don't mind taking courses and I have attended the A.C.C. at the Hilton in NY every year for greater than thirty years. However, you say I'm grandfathered and then change it all. I disagree. Q. And lastly, please provide any final comments that you would like ACC leadership to know concerning the 2014 ABIM revised requirements concerning Maintenance of Certification.

19. From the Mouths of Members … • I have no problem with physicians having to stay up to date or mandating CME's. The MOC is OK as far as continuing ed is concerned. The practice improvement modules are a waste of time. The charges (for the MOC and all the other things we have to do are exorbitant ) and the time required burdensome. It is unclear to me whether at this stage in my career I will retake the boards within 10 years (especially when I have Echo and Nuclear boards to take as well) • I have not received the MOC requirements yet • I have tried to do a phase IV PIM and found it to be a hopelessly complex and time consuming process. • I hope ACC advocates for solutions where problems exist, not where education theorists speculate they may exist. MOC revision is not a response to an actual problem but to a theoretical problem. I hope ACC listens to its membership, aligns itself with us and advocates for our interests. • I prefer low cost online materials to maintain certification that I can access whenever I have free time so I don't have to take time away from my private practice • I should be able to do whatever CME I'd like, not have to pay the ABIM for theirs. This is a self serving ABIM arrangement. Practicing cardiologist are upset about this!! • I strongly believe that 50 CME credits a year should be adequate • I strongly oppose MOC. We live in an incredibly regulated world and the previous system was adequate to ensure ongoing learning and staying up to date. This is just more busy work and expense in a world of vanishing physician reimbursement. I feel as though the ABIM is doing this to milk more money out of their co-physicians who have no recourse. • I think it's unnecessary requirement for sub specialties . Doctors with sub specialty should take their specialty certifications • I think that ACC should develop its own "MOC" exam for certification in cardiology to achieve a status of Fellowship. Also I believe that I, having been denied Certification by ABIM, the MOC exam to maintain certification is meaningless to me. Herein lies the importance of ACC Grand fathering those practicing Cardiology physicians using their knowledge and experience treating patients and caring in their prevention of CV disease, maybe considered for Grand Father clause. • I think that the MOC requirements is purely another way to make money from physicians in practice. Prior to MOC (when I took my boards) physicians electively did CME courses which I have done for the last 29 years. I think the advantage was that physicians could focus on training and learning relevant to their practice as opposed to taking a standardized exam and answering irrelevant course booklets. No other profession (law, accounting, etc) have such stringent requirements with regard to taking recurring exams. We should be channeling our energy and learning practices to helping patients and not finding new ways to get money from physicians. • I trust the ACC leadership to do what is best to improve C V care. Q. And lastly, please provide any final comments that you would like ACC leadership to know concerning the 2014 ABIM revised requirements concerning Maintenance of Certification.

20. From the Mouths of Members … • I understand fully that the changes to MOC process have been promulgated by ABIM and not ACC. However, that this could occur with strenuous objections and threats of serious action by ACC is extraordinarily disappointing. It is another example of ACC's lack of leadership and effective advocacy. No one cares how many guidelines ACC authors. What cardiologists care about is their day to day responsibilities and their work environment. The new ABIM MOC regulations worsen those tremendously, even ignoring the high cost. This is a test case for ACC: Either these requirements are rolled back, or ACC will have been proved to be essentially irrelevant. The organization will follow the path blazed by the AMA, which went from having near universal membership in the 1960's to representing less than one in five physicians today. WAKE UP! • I was grandfathered in, but elected to re-take the exam even before the new requirements. The most onerous by far is the practice based requirements which are horrible and seem like kindergarten busy work • I will not decertify when my current credentials expire • I would cancel my membership from ACC, if they do not listen to us. • I would like a quarterly update of what I have to do by when... • I'm glad that I'm retired! • In my opinion, ABIM's oversight of the certifying exams results was not adequate. Some manipulation of results occurred so that resident program directors made sure that their candidates did well on the exam • In this changing environment in medicine generally with new electronic medical records requirements, and all of the other pressures placed on physicians to see more patients and do more with less, it is absurd that the American Board of internal medicine place this kind of pressure on physicians who were promised that they would not be placed in this position previously. • It is monopoly by ABIM because they are the only one in the business of certification . They are doing whatever they want and we are to oblige with the requirement . There is no evidence that it improves quality of care in anyway. It's a sham to fill their pocket and pay the hefty salaries of the CEO . And they want show they are doing something to justify the salaries . • It is unacceptable ABIM claiming monopoly on content approval for MOC. Why can't we use some CME credits for MOC ? • It seems that it is a money grab, with no evidence that it helps patient care • It would be more helpful to set up MOC as questions to answer after a topic review. • MOC is a money making scheme of ABIM and serves no useful purpose • MOC not needed! • Money making scheme for abim and acc Q. And lastly, please provide any final comments that you would like ACC leadership to know concerning the 2014 ABIM revised requirements concerning Maintenance of Certification.

21. From the Mouths of Members … • Most cardiologists are very conscientious about keeping current. I feel that the MOC requirements onerous, and somewhat parental. • Much too onerous and expensive esp. for those who have been in practice for many years. After taking recert 2 times and passing, maybe that should be it, and you should only have to do CME to maintain certification. Do we really need 65 yr olds taking exam?? • New MOC issues involving those "grandfathered"" for 30 or more years is a new exercise to raise more money and does not speak well of those asking for it. Hope good and mature sense would still prevail to undo those shenanigans. • Not happy. • Onerous, too costly and more over regulation. • Onerous, not in touch with the realities of current practice, way too time consuming and expensive. What credit do we get for multiple board certifications. Simply put, outrageous. • oppose vigorously • Our lives are very busy trying to keep up will the new advances and regulations that have become part of cardiovascular medicine. We don't need more bureaucracy. Where is the ACC? Why are you trying to undo this when it should have been opposed from the beginning. • Personally, I would want to have better information as to what the new requirements are. Also, I would like the requirements not to lose an additional financial burden on the members • Physician in general are very dissatisfied with entire recertification process devised by ABIM, Its popularity and acceptance is low, may be time is ripe to start a rival to ABIM, It seems ABIM does not realize that physician age also they get married, they have their children and then grand children, we also face ups and down in our life, for physicians to continue a long and drawn out process is unintelligent see this entire process is another tool in hand of malpractice lawyers to demoralize the practicing physicians not full time salaried physicians sitting in medical institutions who rarely see patients or involved in direct patients care. I would like to know how many professors or full salaried have gone through this process I believe ACC and ACP etc should get a good survey of physicians before dissatisfaction is extreme. • physicians are concerned about the costs of these MOC young faculty view it is a financial burden medical divisions or departments do not assume the cost older physicians who have been away from the classroom and test taking may pose a challenge for proper evaluation. cme and its validation, maintenance and documentation may be part of the solution • PIMs are a huge waste of time and are not useful in any way to assess or improve knowledge • Please don't make our life more complex which is already overwhelmed with too many responsibility, long duty hours and too many board exams. Q. And lastly, please provide any final comments that you would like ACC leadership to know concerning the 2014 ABIM revised requirements concerning Maintenance of Certification.

22. From the Mouths of Members … • Please include our other CME approved activities in MOC. NY State requires 50 hrs/ yr, and this should be counted in MOC. • please join with other professional organizations so that we can exercise a stronger voice to have these new requirements changed. Increased regulation is humiliating. • Please support the major opposition from medical fraternity regarding NEW MOC requirements from ABIM • Putting aside the issue of whether or not MOC achieves the desired objective, I spent 3% of my gross annual income as a cardiology fellow to certify in internal medicine. For someone at my stage in life, it's a considerable investment. At the time, the product offered was certification for 10 years. They didn't say there would be a caveat or an asterisk attached to my certification. You can tell me what the cost of a product is ahead of the sale. As an informed consumer, I can judge its relative value. But what legal right does ABIM have threatening to taint that certification after the fact with a public statement that I am not meeting requirements if I don't pay newly assessed fees? That's not what I paid for. It's called blackmail. • Question 5: Do you favor or oppose the new ABIM MOC requirements? ..is really two questions. Cannot answer as above. ACC should work to succeed the "requirements" to a version of MOC specific for cardiologists and our collective voices. thanks • Resent the cardiology establishment milking the members for more money at every turn. All on line courses are too expensive, they should be made free, this is what universities should d be all about, and proving participation in those activities should suffice. • Shame on you ACC • should be discontinued or take the place of the exam. both should not be in place. • Someone has got to be the focal point of reigning ABIM in- they create cost and excess time demands that are burdensome and unfair. Continued education and some form of MOC are fine, but they are out of control and are clearly very self serving. The exam in particular is a waste if you do regular knowledge and pIM work, they are double dipping. • STAND UP TO ABIM and support your members! We are facing enormous pressures from government, insurers, hospitals and the legal system. Why are we adding self inflicted wounds? If ACC cannot do more to help defend the private practitioner I don't see the value of membership. I have signed the petition to stop MOC; so far there are 13,000 signatures. This represents significant discontent-I hope ACC is listening. • Stating the obvious. Enough is enough for a million reasons.... • suggest that a unilateral decision that appears to largely be a money grab should be resisted. • Tell them that those of us who are already Board Certified should be Grandfathered. • The ABIM is acting in the capacity of an organized crime syndicate. They should be brought up on racketeering charges Q. And lastly, please provide any final comments that you would like ACC leadership to know concerning the 2014 ABIM revised requirements concerning Maintenance of Certification.

23. From the Mouths of Members … • The ABIM should not be permitted to enjoy the monopoly it currently has on certifying and recertifying physicians, making us jump through hoops so that they can continue to enrich themselves at our expense - both in dollars and hours - with no proven benefit to anyone but themselves - especially the CEO who reportedly rakes in $800k per annum. As cardiologists, we're encouraged to practice evidence-based medicine; how about a little evidence demonstrating there is any virtue to this onerous certification process. I did one of these ludicrous PIMs the last time I recertified and it was an utter waste of time. • The ACC should advocate for us. MOC should be abolished. Keep CME requirements (any reasonable level is OK) • The ACC should formally oppose the ABIM's over reaching and expensive intrusions into the practice of medicine in general and cardiology in particular. • The concept of CME is good and needed . However, I feel that the "industry" that has grown around this recertification process appears to be more interested about making money rather making good doctors. Avoid these stress producing tests and assume doctors who remain active in practice and keep themselves intellectually up to date with conferences, teaching, reading journals, etc. are really what this country needs. K • The cost associated with MOC is unacceptable and borderline scam. • The cost in time and money must be reduced • The field of cardiology is ever evolving - new innovations, new techniques, new insights are made everyday. The certification/recertification exams themselves are dated (usually lag 1-2 years behind current data). The MOC will absolutely not change my practice strategies, and will not enhance my knowledge base but in fact force me to 'know' dated material. • The manner in which the ABIM has addressed this issue is unethical. Their primary intent is self gain. The threat to designate nonparticipating physicians as failing to meet MOC requirements unless they pay a fee (in the thousands of dollars) to sign up is extortion, which is a felony. • The MOC is 100% unreasonable and not indicated. The MOC is a financially beneficial endeavor for the ABIM. The ABIM claims that the MOC will resolve a self-declared problem when NO problem actually exists. The ABIM president's response statement regarding the MOC is a disgrace and an insult to the intelligence of the members. The statement could have been written by any politician or attorney. • THE MOC IS TOTALLY COUNTER-PRODUCTIVE AND NOT NECESSARY • The MOC process in general has become a money making scam. I am an interventional cardiologist in private practice (20 years) and a huge part of my interventional boards had to do with PCI of renals/carotids/peripheral, as well as mitral valvuloplasty and TAVR. What happened to coronary angioplasty as the mainstay of the CORONARY INTERVENTIONALIST????? I have become very disillusioned with the MOC system. Q. And lastly, please provide any final comments that you would like ACC leadership to know concerning the 2014 ABIM revised requirements concerning Maintenance of Certification.

24. From the Mouths of Members … • The MOC process is a joke. The exam is not a true test of competency. Overly expensive and an incredible waste of time • The new ABIM MOC rules are a burden to practicing physicians, especially those with umpteen years of experience and continue CME activities. AMA PRA is more than sufficient to maintain current CME. This new MOC will also wind up replacing the current CME activities and cause physicians to do modules instead of attending live conferences. • The new MOC requirements are intrusive, costly and do not serve to improve the practice of medicine/cardiology. I am sick of the costs of practicing medicine & being over-regulated. • The newly revised requirements are extremely burdensome on an actively practicing cardiologist. They need to be streamlined and made less expensive. Recertifying for multiple boards will become a full time job and not allow physicians to practice medicine. • The PIMs are bullshit and a waste is time. I passed the test as I am not grandfathered in. I have not finished the PIMs and likely won't have time. They are ridiculous and not pertinent and disrespectful to our time and it is all a money generating scheme • The process is burdensome, inappropriate (patient survey portions) and excessively expensive • The program is cumbersome The process confusing ACC should work with the AIBM to develop the trues objectives for this program and a reasonable program for practicing cardiologists Right now this looks like a scheme for the ABIM to raise revenue • The RCPSC in Canada requires its members to do CME activities every year. You log on their site and record your activities. There is a dashboard where you keep your MOC needle in the green zone for the year and for the 10-year MOC cycle. No need for repeat exam. A lot less stressful. • The secure exam is superfluous. The important thing is whether people are keeping up to date with knowledge. That is tested with the modules. The way the test is administered is degrading with our being fingerprinted, photographed, and videotaped. It lacks professionalism and treats physicians like criminals. It would be good to add a Journal Club component where we read key papers and have to answer questions. That would help with knowledge too. • These new requirements are awful, expensive, time-consuming and do not add value to life-long learning. This is where we need the ACC to stand up and represent us and cardiology • They are expensive and extremely time consuming and of dubious value. I work over ten hours a day, not including night call and weekend call. • They are overly burdensome, expensive and time consuming. • This is a betrayal after I was grandfathered. It seems that it may be an attempt to generate revenue. Q. And lastly, please provide any final comments that you would like ACC leadership to know concerning the 2014 ABIM revised requirements concerning Maintenance of Certification.

25. From the Mouths of Members … • This is ALL about making money!!!! • This is in my opinion a ridiculous, bureaucratic scam that is meant to enrich the AIBM at the expense of physicians. It should be resisted at every level. • This is part of a sad and relentless march towards socialism without anyone saying so in so many words and with collusion from so called thought leaders and experts. • This is simply a money making new program for ABIM ABIM has become a monopoly and abusing its power without any input from the people supporting it financially. It is undemocratic and abusive. • This MOC garbage is an additional burden to what is already becoming an overwhelming one-- given changes in medicine occurring with the ACA, ICD 10, PQRS, etc. A board exam q ten years is more than enough. Our own medical overweight institutions need to stop nickeling and diming practitioners (CME and MOC being perfect examples)and focusing on helping us. • this whole idea is a sham and acc should have nothing to do with this money making scheme have personally accumulated hundreds of cme credit hours. Does this amount to nothing • Too busy to go through MOC Need to scrap it and ACC should take the lead in this • Too many requirements bi hold 3 certificates and IBHRE status for ppm and icd's and then there are separate hospital and state requirements with in servicing. Its too much and not necessary • Too many requirements for practicing medicine that actually take out time from clinical medicine and ultimately bad for patient. • too much for a practicing physician board cert test takes 3 months to get results and they fail 25-33% of doctors who have already passed it-->ridiculous • Undue burden on practicing physicians and adds no value whatsoever in improving patient care. • Used SCAI-ACC Board Review for recent 10 year recert in IC, and found that the actual test was way off the mark from the review in terms of the weight given various aspects. • Very expensive - Feels like doctor tax. Large time commitment with little data showing association with competency. • We already have too many hoops to jump through. The format of MOC is excessively time consuming, expensive and has no relationship to day to day practice. I will not participate in this charade • We are too busy to fulfill so many different requirements especially with multiple certificates. Too costly as well. Finally we have to factor this nuisance in with other requirements states and hospitals require. There isn't time left for anything less. Develop modules that are open book and eliminate the exams. Allow the modules to count toward more than 1 certificate • We need help on how to actually go about doing what we need to do to comply with MOC Q. And lastly, please provide any final comments that you would like ACC leadership to know concerning the 2014 ABIM revised requirements concerning Maintenance of Certification.

26. From the Mouths of Members … • WE NEED TO BE LEFT THE HELL ALONE THE ACC NEEDS TO LOSE THE ABIM WE SHOULD COMPLETE CMES AND BE DONE NO MORE TESTS • We should all refuse to comply with there onerous time wasting and costly requirements. • What exactly is the rationale for these changes. Sorry for my cynicism but it seems to me that part of the motivation is financial. The fees will keep the coffers of ABIM brimming. Otherwise what exactly was broken that needed fixing? What motivated these unilateral changes. Was the quality of care worsening? Cardiologists are not grade scholars and should be trusted to know to continue the habit of life-long learning without the compulsion imposed from above. Most hospitals require a certain minimum number of CME credits to maintain privileges. That should be enough. Lastly, when people are grandfathered, this status should not be changed on a whim as is being done here by ABIM. What evidence is there that people who were grandfathered provide lower quality care? • While I like to be as academic as possible I believe both the ACC and ABIM are using this as a money making opportunity. The charge for MOC should be zero dollars • While I understand the rationale for the MOC requirements and certainly could not argue with the need for physicians to be well-informed and current, the cost in time and money is just another burden for those of us in active practice. Another 5-20 hours per year does not seem like much to the ABIM, but its going to be hard to find when you're on the front line all day. The repetitious litany on the FAQs of the ABIM website is also offensive. We know you don't care much, ABIM, but don't make it so obvious. • With the new almost mandatory installment of EHRs I know cardiologists that have been practicing for >15 years and have seen their productivity or lifestyle drop tremendously. The almost simultaneous addition of these requirements seems so untimely that it almost appears to be an attempt to 'kick a guy while he's down'. I can ultimately understand the more frequent question modules but the practice improvement parts are unproven and likely unnecessary. The latter seem like the typical 'solutions' we see administrators trying to prove their abilities and relevance throw at the people actually out in the field. Imagine asking a soldier to go back into the field every 6 months and collect data about number of shots fired, accuracy and temperature of the atmosphere at the time of the shot. Would it add data that would allow you to spit out a report? Yes. Does it sound ridiculous? No more than your measures sound to those of us who are actually stretched out thin enough as it is, sirs. • You can tell them that not only do I have no intention of taking the MOC but about 15 other cardiologists I spoke to recently feel the same way. We already spend enough on CME and other related requirements of the state and hospitals we work for. I wonder if the ABIM is just losing dues paying members and trying to use MOC as a way to recoup some money • Your website has been poor for many years. There are no teaching videos. You overcharge for all subscriptions such as ACCEL You should get in the business of fostering education in a low-cost way free of charge for all paying members such as by posting maintenance of certification lectures on your website and making your website functional like the ESC website Q. And lastly, please provide any final comments that you would like ACC leadership to know concerning the 2014 ABIM revised requirements concerning Maintenance of Certification.

27. Questions: Chapter ExecNancy Weiner, MPH (nweiner@nycms.org) (212)686-0228Amy Dearborn (adearborn@acc.org) 202.375.6257Greg Brouse (gbrouse@acc.org) 202.375.6531