Richard Baron, MD, CEO of the American Board of Internal Medicine (ABIM) and staunch supporter of the controversial maintenance of certification (MOC) program, announced that he will retire in September 2024.
“I can say with confidence that I will definitely miss working here,” said Baron, 70, in an ABIM blog post. “But I will never figure out what else I might do with my life besides working if my wife Jane and I don’t retire. So, after a career spanning nearly 50 years, including 30 years in community practice, that is our plan.”
Baron’s planned retirement after a decade on the job comes amid a flood of pushback against the much-maligned MOC program. That program requires internists wishing to acquire or maintain their internal medicine board certification to either take a lower-stakes, 30-question, open-book exam every quarter or a high-stakes test every 10 years.
Pushback: A Petition and Proposed Secession
The latest wave of pushback was set in motion by a petition started in July by Aaron Goodman, MD, of the University of California San Diego, calling for an end to the MOC program. It now has more than 20,500 signatures.
Goodman shared the petition with his 128,000 followers on X (formerly Twitter), starting a sustained uproar on social media, particularly on #medtwitter, which continues to this day.
The petition provided “a central thing people could rally against. Even big leaders in our field, we’ve all banded together on this … and it sparked podcasts and media [coverage],” Goodman told MedPage Today. “There’s been rare uniform support on #medtwitter across party lines. … Everyone agrees, and no one is coming up on social media to support [MOC].”
That petition seeks the same thing as a letter sent to Baron last week from the American Society of Hematology, Baron said in a phone interview Friday at which a public relations person was present. “They want to go back to lifetime certification. They believe that doctors are really already under a lot of pressure, they already do a lot of work, and they say that you shouldn’t ever have a program that puts their certificate at risk.”
However, Baron said, although ABIM switched to this type of “time-limited” certification in 1990 — 13 years before Baron took the CEO position — “the American Board of Family Medicine, which was created in either ’67 or ’69, never had lifetime certification, because by then it was clear that lifetime certification really wasn’t appropriate.”
“For fields that change as much as clinical medicine, with stakes as high as patient care, dealing with a credential that somebody got 10, 20, or 30 years ago doesn’t say anything very meaningful about what they’re able to do today,” he added. “So family medicine was created that way, and emergency medicine never had lifetime certification. Basically every board created since 1970 never had lifetime certification.”
Following Goodman’s petition, several major medical societies have spoken out against MOC, and even against ABIM.
Four cardiology societies announced earlier this month that they’re planning to create a new board for cardiovascular medicine that’s separate from ABIM. The societies are the American College of Cardiology, Heart Failure Society of America, Heart Rhythm Society, and the Society for Cardiovascular Angiography & Interventions.
The groups said in a press release that they are “working together to submit a new Board application, with potential for additional consortium members to join.” The statement noted that formal support from the American Heart Association is pending, based on consideration at its next board of directors meeting.
The release specifically mentions that the new independent cardiovascular board would “pursue a new competency-based approach to continuous certification,” replacing MOC with a “pathway to continuous certification and competency.” The groups plan to “de-emphasize timed, high-stakes performance exams in the continuous certification process and instead will focus on learning assessments to identify gaps in current knowledge or skills, with recommendations offered on CME learning resources and activities to help close the gaps.”
The American Society of Clinical Oncology also launched a member survey to better understand participants’ feelings about MOC.
Goodman said “in an ideal world,” new leadership at ABIM will “get rid of MOC and focus on the initial certification and make it a more friendly process.”
“I think that many doctors, including myself, value that initial certification as a capstone, cementing all of the knowledge we’ve gotten through our training,” Goodman said.
Paul Teirstein, MD, is president of the National Board of Physicians and Surgeons, which he formed in 2015 as an alternative to MOC. He said that “regardless of who is in charge at ABIM,” his group believes MOC “is part of a broken system that is hurting physicians, their patients, and the practice of medicine.”
“Hopefully, a change in leadership … will help catalyze momentum in the right direction,” Teirstein said in an email to MedPage Today. “No entity should be allowed to wield an expensive and arduous process that burdens physicians, reduces patient access to care, and increases the cost of healthcare.”
Westby Fisher, MD, a cardiologist at NorthShore Medical Group in Glenview, Illinois, and a longtime critic of Baron and the MOC program, said in a phone interview that he doubts these efforts will make any difference.
“The problem is that the American Board of Medical Specialties [the medical specialty accreditation body] is a member board of the Accreditation Council on Graduate Medical Education [ACGME], alongside the American Medical Association, American Hospital Association, Association of American Medical Colleges, and the National Board of Medical Examiners,” he said. And the ACGME, which accredits education programs at teaching hospitals, “requires that ACGME program directors be ABMS-board-certified. If you want to have a teaching hospital, you have to have ABMS certification. So I cannot get re-certified through my hospital through anyone else except ABIM. It’s regulatory capture.”
Fisher added that, although he wishes Baron good luck in his retirement, “No one’s going to cry a tear over Rich Baron leaving. He’s going to walk out with a golden parachute we all paid for.”
Earlier reporting by MedPage Today showed that MOC requirements can cost physicians hundreds of dollars per year, are burdensome, and serve as a significant stream of revenue for boards with high-earning executives. If they don’t participate, however, doctors risk not being employed by hospitals or paid by insurers. In addition, many pointed out that there are scant data to show that MOC requirements make doctors safer.
Not All Negative
Baron disputed that idea. “There’s lots of evidence” that the program is effective, he said. “What [the critics] did was to cause people to doubt the evidence that was out there and deflected attention from the body of evidence there is.”
On the other hand, he added, “there is plenty of evidence that continuing medical education (CME) and self-assessment doesn’t work in ensuring doctors are current. But the critics aren’t talking about that.”
Not everyone is dissatisfied with Baron’s performance. David Coleman, MD, chair of the ABIM Foundation Board of Trustees, praised Baron in a phone interview for guiding the board through a big change in its makeup, transitioning it from being “30-35 members with representatives of each subspecialty board to its current state, which is to have [a smaller board that includes] lay members and people from a much more diverse pool of the healthcare professions — nurses, healthcare executives, and practicing physicians. In short, the governance structure really became much more democratized.”
Rajeev Jain, MD, chair of ABIM’s board of directors, agreed, noting in a phone interview that the changes to the board makeup “made it much more reflective of who the diplomates are and what they deal with on a day-to-day basis.” In addition, during Baron’s 10 years on the job dealing with the changes to the MOC program, “he has listened to what’s out there and, within reason, took the constructive criticism and responded to it,” Jain said.
Jain also applauded Baron for continuing to practice medicine a half-day each week even while he was serving as ABIM’s CEO: “People think he’s ‘ivory tower,’ but he is out there doing that.”
Noting that the board has already set up a search committee, headed by ABIM board chair-elect Robert Roswell, MD, to pick Baron’s placement, Jain added, “I hope we hit the jackpot again like we did 10 years ago when we hired Rich Baron.”