Alexander T. Sandhu, MD; R. Adams Dudley, MD, MBA; Dhruv S. Kazi, MD, MSc, MS
Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the U.S. Department of Veterans Affairs.
Acknowledgment: The authors thank Ann F. Bolger, MD; James G. Kahn, MD, MPH; and Rashmee U. Shah, MD, MS, for their thoughtful comments on the draft manuscript and Meghann Williams, Elizabeth Thew, and LaCretia King for their administrative support.
Financial Support: This study was funded in part by the University of California, San Francisco (Dr. Kazi), and the U.S. Department of Veterans Affairs (Dr. Sandhu).
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-1011.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Reproducible Research Statement:Study protocol: Not available. Statistical code: Available from Dr. Kazi (e-mail, firstname.lastname@example.org). Data set: No additional data are available.
Requests for Single Reprints: Dhruv S. Kazi, MD, MSc, MS, Division of Cardiology, San Francisco General Hospital, 1001 Potrero Avenue, Room 5G1, San Francisco, CA 94110; e-mail, email@example.com; Twitter, @kardiologykazi.
Current Author Addresses:Dr. Sandhu: Stanford University Center for Primary Care and Outcomes Research, 117 Encina Commons, Stanford, CA 94305.
Dr. Dudley: Center for Healthcare Value, Philip R. Lee Institute of Health Policy Studies, 3333 California Street, San Francisco, CA 94118.
Dr. Kazi: Division of Cardiology, San Francisco General Hospital, 1001 Potrero Avenue, Room 5G1, San Francisco, CA 94110.
Author Contributions: Conception and design: A.T. Sandhu, R.A. Dudley, D.S. Kazi.
Analysis and interpretation of the data: A.T. Sandhu, R.A. Dudley, D.S. Kazi.
Drafting of the article: A.T. Sandhu, D.S. Kazi.
Critical revision of the article for important intellectual content: A.T. Sandhu, R.A. Dudley, D.S. Kazi.
Final approval of the article: A.T. Sandhu, R.A. Dudley, D.S. Kazi.
Provision of study materials or patients: D.S. Kazi.
Statistical expertise: A.T. Sandhu, D.S. Kazi.
Obtaining of funding: A.T. Sandhu, D.S. Kazi.
Administrative, technical, or logistic support: R.A. Dudley, D.S. Kazi.
Collection and assembly of data: A.T. Sandhu, D.S. Kazi.
Sandhu AT, Dudley RA, Kazi DS. A Cost Analysis of the American Board of Internal Medicine's Maintenance-of-Certification Program. Ann Intern Med. 2015;163:401-408. doi: 10.7326/M15-1011
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Published: Ann Intern Med. 2015;163(6):401-408.
This article has been corrected. The original version (PDF) is appended to this article as a Supplement.
In 2014, the American Board of Internal Medicine (ABIM) substantially increased the requirements and fees for its maintenance-of-certification (MOC) program. Faced with mounting criticism, the ABIM suspended certain content requirements in February 2015 but retained the increased fees and number of modules. An objective appraisal of the cost of MOC would help inform upcoming consultations about MOC reform.
To estimate the total cost of the 2015 version of the MOC program ("2015 MOC") and the incremental cost relative to the 2013 version ("2013 MOC").
Decision analytic model.
All ABIM-certified U.S. physicians.
10 years (2015 to 2024).
Testing costs (ABIM fees) and time costs (monetary value of physician time).
Internists will incur an average of $23 607 (95% CI, $5380 to $66 383) in MOC costs over 10 years, ranging from $16 725 for general internists to $40 495 for hematologists-oncologists. Time costs account for 90% of MOC costs. Cumulatively, 2015 MOC will cost $5.7 billion over 10 years, $1.2 billion more than 2013 MOC. This includes $5.1 billion in time costs (resulting from 32.7 million physician-hours spent on MOC) and $561 million in testing costs.
Costs are sensitive to time spent on MOC and MOC credits obtainable from current continuing education activities.
Precise estimates of time required for MOC are not available.
The ABIM MOC program will generate considerable costs, predominantly due to demands on physician time. A rigorous evaluation of its effect on clinical and economic outcomes is warranted to balance potential gains in health care quality and efficiency against the high costs identified in this study.
University of California, San Francisco, and the U.S. Department of Veterans Affairs.
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