Fear And Loathing Of MOCA Is Spreading

I have mentioned many times about the widespread disgust many anesthesiologists feel toward the Maintenance of Certification in Anesthesiology (MOCA) program instituted by the American Board of Anesthesiology. In particular, people resent the ever changing requirements imposed on different graduating classes and the hypocrisy of allowing older anesthesiologists to keep their certificates without having to go through the process. This despite studies that have shown that these doctors are precisely the ones who need to be retested to check for their medical competency. Now that animosity is becoming more public.

In two recent issues of Anesthesiology News, Dr. Tania Haddad, MD from Phoenix, AZ, provided more substance to this bitterness. In Part 1 of her editorial, she recounted how MOCA came to be. It was patterned after the Maintenance of Certification that was started by the American Board of Internal Medicine in 1990. It too imposed a ten year duration for new board certificates. After MOCA was created, efforts were made to try to improve upon the testing methods in order to assure competency of the test takers. As a result the ABA has required 140 more CME credits than when MOCA first began. It has also added a simulator session that was not imposed until just recently. This begs the question; does all this testing make somebody a better anesthesiologist? Are the anesthesiologists who undergo the simulators better physicians than me who didn't suffer through all that? Are all MOCA candidates better doctors than the exempted anesthesiologists or is the ABA simply blowing smoke up our asses?

In Part 2 of Dr. Haddad's editorial, she highlighted the costs of keeping the board certificate one has already received after investing years of blood, sweat, and sleepless nights. The price of CME credits alone can easily top $1,000. Participating in the mandatory simulation sessions will set back the anesthesiologist $2,000. Taking the written test will cost another $2,100. All these are current rates subject to change, upward, at any time. By comparison, the MOC program as administered by the ABIM costs only $1,675 which includes the CME credits, computer simulation, and the written exam. Is the MOCA better and more effective than the MOC because it's more expensive? If something costs more because it is better, are board certified anesthesiologists three times better doctors than board certified internists? If not, are anesthesiologists being gouged by the ABA in order to keep their certificates?

Besides the expense of maintaining the board certificate, there is the time and emotional stress too. It takes time to complete all the CME credits. These are precious hours that should be spent with family and friends instead of sitting in front of a computer answering multiple choice questions. Weeks are spent studying for the simulation exam and the written exam. Even though greater than 95% of all first time recertification test takers pass the test, that doesn't lessen the apprehension people feel. After all, failure will just cause more anxiety as one will have to prepare for the test over again at a future date with a higher statistical probability of repeating the same result. Nightmares of losing one's practice because of the inability to pass recertification goes through everybody's head at some point.

Then it all comes back to the grandfathered status of the anesthesiologists who have escaped this ordeal due to their God given status of being born earlier than the rest of else. If MOCA is all about ensuring patient safety by checking the competencies of anesthesiologists, why is anybody exempt from taking the exam? Is the ABA afraid that the older generation may decide to file a class action lawsuit if their lifetime certificates are revoked? Would the public agree with these doctors that they don't need to prove their capacity to provide anesthesia safely decades after their training ended? If capabilities don't diminish with time, what is the point of having MOCA in the first place?