Editorial: Preparing for the Maintenance of Certification (MOC) Examination in Rhinology

In 2000, the American Board of Medical Specialties (ABMS) adopted Maintenance of Certification (MOC), as a change in physician selfregulation.1 Specifically MOC is designed to encourage physician self-assessment, lifelong learning and continuous performance improvement. Multiple factors brought about this change, including an increase in the complexity of health care delivery that parallels improvements in development of new methods of diagnosis and treatment.2 Consumers became more interested in the delivery of appropriate health care in the setting of unsustainable cost increases, and heightened scrutiny over the use of limited funds. Additionally, technological improvements allowed for more careful monitoring of health care delivery, leading to increased accountability. The demand for increased value, quality and accountability is what effectively led to MOC.2 The idea of MOC was met with a fair amount of controversy. While most physicians support the need to demonstrate their ongoing competence through formal MOC programs, more extensive debates have focused on how to develop MOC methods, how to demonstrate competency, and how to pay for these initiatives.2 The cost-effectiveness of the MOC is also a point of debate. Many physicians were not interested in the time and financial burdens associated with the MOC, given the uncertain benefits and questionable importance. However, the risk of government agencies bypassing the ABMS to institute their own regulations exists, particularly if they are not satisfied with the stringency of the current MOC. There is also a conflict between the desire for change and the transparency of cost effectiveness data on various MOC components. Substantial evidence exists for the need of MOC; studies have shown that up to 12% of physicians fail to maintain standards and patients receive approximately 50% of the care that is indicated for their specific conditions.1 The data consistently shows that physician knowledge and skills, evidence based medicine and outcomes decline, while adverse actions by state licensing boards increase as the time from medical training increases. While various specialty boards are approaching the MOC differently, all MOC programs consist of 4 parts:3