Friday, April 24, 2015

MOCA 2.0. Pay Now Rather Than Pay Later

The world of maintenance of certification as imposed by the American Board of Medical Specialties is facing a backlash as never before. Following the spectacular expose published in Newsweek about the greed and impropriety at the American Board of Internal Medicine, in which millions of dollars were paid out in executive salaries, real estate, and first class air travel, hundreds of doctors rose up in protest. In a surprising turnaround, the ABIM apologized for the excessive burden that the MOC has become and promised to reform the process.

Every physician wondered which medical board would follow the ABIM's changes. Now the American Board of Anesthesiology has decided that its MOCA program also needs to be changed. In an email to anesthesiologists yesterday, the ABA calls its new program MOCA 2.0.

MOCA 2.0 has several major modifications from 1.0. One of the biggest is the removal of the much despised simulation exam. This portion is hugely disruptive to most anesthesiologists, requiring them to spend thousands of dollars for the exam, travel to a simulation center, and time spent studying for and taking the test. It was one of the most divisive tests ever devised by the ABA and the ABMS, no matter how popular the organizations claim the simulations are. I count myself as one of the lucky ones who was first board recertified before the simulation was enacted and now it is being abolished before my next recertification. Hallelujah. There will be no tears shed for the end of this monstrosity.

Next, the recertification exam itself is gone. Can you believe it? No more exams again, EVER! Instead, the ABA has instituted an online program called MOCA Minute. Once a week, the ABA will post a question on its website that had the highest failure rates during certification exams. The user will have one minute to answer the question. If they answer the question incorrectly, there will be a brief explanation of the answer but it doesn't count against anything. No punishment. No repeating another question. The diplomate will have to answer 30 questions per calendar quarter or 120 per year. They can be bunched up together so one doesn't have to log in every week. But the ABA will only count 30 per quarter even if you answer more. This prevents people from doing all their requirements at the end of the year. The MOCA Minute does not replace the CME requirements that are already a part of MOCA or for your state medical licensure.

MOCA Part 4, or the Improvement in Medical Practice, is still evolving. This portion has always been nebulous in its requirements and implementation. They are withholding details of the new system for now.

Has the ABA also changed the cost of participating in MOCA? Yes and no. Thousands of dollars have now been saved by eliminating the simulation exam. But the ABA still expects one to pay $2,100 to be recertified. Instead of paying it all at once to take the exam, now they want to extract $210 every year for ten years. Credit cards accepted.

What hasn't changed? The need to be board certified by the ABA in the first place. Many lifetime certified physicians are still incensed that their certificates now read certified but not participating in MOC on the ABA's website, an asterisk in a perfectly legitimate career. Even these new changes will not appease doctors who feel any extra work to maintain their certificates is overly burdensome. These are the people who are flocking to the alternative certification program NBPAS. But for now, the removal of the recertification exam and the simulation is a huge step forward. Hopefully the ABA will continue to be responsive to the outcry of its members for simplification of a process that has huge implications for their livelihoods.


  1. Thank you for your blog! This was the first time that I heard about this major change for our speciality

  2. Today, I received this email from the ABA regarding MOCA changes. It concludes by asking diplomats to complete a survey. I don't even know where to begin as far as making recommendations to part 4. The email they sent does not even define part 4 of MOCA.

    "The American Board of Anesthesiology (ABA) announced on April 23 that it will launch a redesigned Maintenance of Certification in Anesthesiology Program (MOCA), or MOCA 2.0, in January 2016. All diplomates who have certificates that expire in 2016 or later and who are participating in MOCA will be enrolled. As part of the program, the ABA is developing a variety of MOCA Part 4: Improvement in Medical Practice options that will give diplomates greater flexibility to complete activities relevant to their practice. The Board will award points to diplomates completing MOCA Part 4 activities based on the time and effort required to complete them. A minimum number of Part 4 points will be required for all diplomates participating in MOCA 2.0.

    The Board is seeking diplomate input on what activities should be considered for MOCA Part 4 credit. Based on adult learning theory concepts and diplomate input, the ABA will finalize a list of Part 4 activities and their associated points in the coming months. "

  3. I personally involved in this evolvement of MOCA requirement. I certified in 2000 (miss the ship by one year ,could be home free for rest of my courier). I recertified on 2010 and after that the whole thing changed, they add different requirement including MOCA part 4. I send email to ASA simulation committee regarding deficiencies of this part and expense associated with it, no respond what so ever. when I look at the name of simulation committee member it turn out that most of them are directors of the simulation centers (no wonder! tell me about conflict of interest ! ),
    Then ABA came up with new version of part 4 called it MOCA 2.0 . For those who do not know about MOCA part 4 , it is simulation test that you go to specific center and there is instructor who goes through different but limited scenario in anesthesia and it is limited to one day ( I wonder how much you can learn.), then ABA give you 25 point and you need to take one of this simulation each 5 year, now ABA with MOCA 2.0 give options like do a research (probably will take a month to finish ) and then give 20 point (not EVEN 25 point) so even after finishing your research you still owe them 5 point, in other word they want to push you to simulation center so they can pocket money (it will cost you 1700 $ for one day registration fee, plus air fair , plus hotel cost for at least two nights and food and etc).

    I even suggest them to arrange for internet simulation like the one which is offer by American Heart Association (ACLS, BLS) . it is comprehensive, repeatable, convenient and they can have zillion scenario , again no respond from ASA and ABA..

    When I went to ABA board of directors and see who are this people ,it seems they don't need to take the exam like us, it seems they are all board certified way before 2000 and simply they don't care.

    My solution
    1- create coalition against MOCA part 4 the way it is now, the more people the better.
    2- voice our concern and flood them with E-mail and may be request internet version of simulation
    3-Change ABA board of directors and at least 3-4 member has to be people who were certified after 2000 with same interest as us
    4-Drastic measure not to pay membership first to ASA which it seem are partner with ABA in this is not hurting your job application, second not to pay membership to ABA .

    5-for your knowledge president of ABA is Dr. Cynthia Ann Len and her E-mail is