ABIM MOC Fee Credit Component of MOC for Fellows-in- Training

Issue Brief:

ABIM diplomats who received initial board certification in Internal Medicine (IM) in 2013 or later are required to participate in MOC to remain board certified. IM board certified diplomats enrolled in ACGME accredited subspecialty training programs earn 20 MOC points (10 points medical knowledge and 10 points practice assessment) during each year of fellowship training. To apply this MOC credit toward maintenance of their IM board certification during subspecialty training they must enroll in ABIM MOC. 

If fellows entered their fellowship immediately after completing their 3 years of IM residency training, they do not need to pay a MOC fee.  However, fellows with a gap between residency and fellowship (due to a Chief Medical Residency Year, Hospitalist Year, non-ACGME fellowship year for research, etc.), are required to adhere to the ABIM Fellowship fee credit cycle and make an MOC payment during their first year of fellowship. The fellow will receive a “fee credit” from ABIM at the end of the year when the program director completes the fellow’s ABIM FasTrack evaluation. The ABIM allows the fellow to use this credit toward their first ABIM MOC payment at the end of fellowship training, several years later.  

If fellows with this gap in training do not pay the MOC fee credit, they are no longer board certified in IM. Of note, fellows do not need to do anything for MOC when they are in fellowship other than enroll, which requires a payment, if they have a gap. 

This has been discussed with the APCCMPD membership at the APCCMPD 2015 Spring Conference and again at the APCCMPD 2015 Spring Business Meeting. APCCMPD members have asked the APCCMPD to advocate for the removal of the MOC fee for fellows involved in fellowship training. APCCMPD members feel it is unfair to collect the MOC fee from fellows while they are in training and retain the money for the duration of their subspecialty training. The APCCMPD suggested two possible options: 1) allow a two year fee waiver, which will capture most of the fellows with a gap in training, or 2) ask the ABIM to refund the fee once FasTrack is completed.

The APCCMPD is aware that this is a complicated issue and that the APCCMPD opinion represents those of Program Directors for Pulmonary, Pulmonary and Critical Care Medicine, and Critical Care Medicine Fellowship training programs.  However, the APCCMPD believes this issue is larger than just Pulmonary and Critical Care Medicine fellowship training and is relevant to all subspecialty fellowship training.  As such, the APCCMPD advocated the Association of Subspecialty Professors in June 2015 and APCCMPD members Kevin Chan, MD and Peter Sporn, MD advocated on behalf of the APCCMPD directly to the ABIM.  

ABIM Response
In 2014, when ABIM updated its MOC changes were made to simplify the fee structure by adding an annual payment option. An unintended consequence of these changes was that physicians who did not enroll in and pay for the program in years in which they did not have to complete any requirements became “Not Certified.” This policy had a particularly adverse effect on those who just completed training or were engaged in fellowship.

After listening to members of the community—especially program directors and society leadership, the ABIM Board of Directors unanimously agreed that ABIM needed to change this policy. Effective immediately, diplomates who are meeting all other programmatic requirements will not lose certification simply for failure to enroll in MOC. 

For more information on this policy change please visit: http://transforming.abim.org/acting-on-diplomate-feedback-moc-enrollment-and-certification-status/?utm_source=NT&utm_medium=email&utm_campaign=MBM-PD-AODF

What Does this Mean for Fellows?

In the past, if fellows entered their fellowship immediately after completing their 3 years of IM residency training, they did not need to pay a fee to enroll in MOC. However, fellows who had a non-ACGME year (Chief Medical Resident, non-ACGME research year or Hospitalist position) between residency and fellowship were required to pay the MOC fee to enroll in MOC. These fellows were then provided a “fee credit” that would delay their first payment to ABIM upon completing fellowship. 

This policy change, allows fellows who have a non-ACGME year between residency and fellowship to remain certified without paying the MOC fee.

Fellows who earned initial certification since 2013 or renewed certification since 2014 and have paid the MOC fee may request a refund from the ABIM. Note: that if ABIM provides a refund, MOC enrollment will be canceled, the fellow’s status will be reported on abim.org, and to the American Board of Medical Specialties (ABMS) as “Certified, Not Participating in MOC”. The fellow will no longer have access to ABIM activities or their MOC Status Report, which gives them their specific requirements and deadlines.

Earning MOC Points While “Certified, Not Participating in MOC”

Fellows, regardless of MOC Status, who are enrolled in ACGME accredited fellowships will still accrue 20 MOC points during each year of fellowship (10 points for medical knowledge and 10 points for practice assessment). These points will not appear on the fellow’s ABIM MOC status report until the fellow enrolls in MOC and pays the MOC fee. Once enrolled, all MOC points accrued during fellowship will be activated, be visible on their ABIM MOC Status Report, and counted toward the 5 and 10-year MOC requirements to maintain their certification.  

Fellows who wish to be reported as “Certified, Participating in MOC” must be enrolled in the MOC program, be current with their MOC payments and continue to meet ongoing program requirements. Fellows listed as “Certified, Participating in MOC” will have their MOC points visible on their ABIM MOC Status Report.

Fellows, regardless of MOC Status, must still meet 5 and 10-year MOC program milestones to maintain their certification.

APCCMPD will continue to meet with national stakeholders to offer guidance and provide the perspective of APCCMPD members on national GME issues such as this.