February 5, 2015

How can we streamline board certification for family physicians?

Michael Parchman, MD, MPH

A study by Dr. Michael Parchman and the American Board of Family Medicine could help give doctors more time for patient care

Most doctors’ walls have diplomas showing completion of medical school, residency, and licensing. Many physicians also become board certified: They meet the standards of a professional medical specialty organization. Board certification indicates a commitment to keeping up with medical knowledge and best practices. To maintain certification, doctors take continuing medical education (CME) courses, regularly pass exams, and participate in clinical quality improvement activities. But controversy over the maintenance-of-certification (MOC) program has led tens of thousands of physicians to sign anti-MOC petitions.

“The MOC process is burdensome and time-consuming for physicians—it pulls them away from patients,” says Michael Parchman, MD, MPH, Group Health Research Institute senior investigator and director of its MacColl Center for Health Care Innovation, which has expertise in primary care practice improvement. Many doctors also feel that MOC activities, particularly the quality-improvement requirements, are “busywork,” with little value to their patients.

Now Dr. Parchman is working to solve the problem. He’s part of a national study to make MOC activities more efficient and more closely tied to clinical quality. Funding comes from the Agency for Healthcare Quality and Research (AHRQ) and the American Board of Family Medicine (ABFM).

Roots of current discontent

In 2000, the American Board of Medical Specialties (ABMS), the overarching organization for the U.S. medical boards, adopted a new MOC program. Motivated in part by a changing health care environment, the program focuses on six core physician competencies, from clinical knowledge to communication skills. In 2015, the ABMS adopted new standards for MOC activities. The standards, organized by the six core competencies, emphasize professionalism and patient safety.

Most physicians agree that lifelong learning is essential to their profession, says Dr. Parchman. They support CME and the core competencies. But many don’t like spending so much time on MOC activities—such as data collection in the quality-improvement phase—and don’t feel that those activities are strongly connected to improved patient care.

The new study that could help resolve the controversy is called TRADEMaRQ (TRial of Aggregate Data Exchange for Maintenance of certification and Raising Quality). It is now recruiting family physicians across the country, including more than 100 at Group Health, to test new ways to meet some MOC requirements. TRADEMaRQ is a research partnership of Group Health, Kaiser Permanente Colorado, the Oregon Community Health Information Network, and Southeast Texas Medical Associates.

In January 2015, Dr. Parchman visited ABFM headquarters in Lexington, KY, to meet his collaborators and launch the project. Back in Seattle, Dr. Parchman says, “ABFM is doing this study because they want MOC to be less of a burden for their board-certified physicians and they want the MOC activities to be clinically meaningful.”

How TRADEMaRQ could improve the MOC

The study will test a way to automatically collect data for the quality improvement portion of MOC—not just for a handful of patients, but for all patients in a physician’s panel. This relieves doctors of the time-consuming task of collecting and submitting the information by hand. TRADEMaRQ will also give physicians feedback about their performance. This feedback could connect MOC activities to better patient care, because providers will see where they can make the greatest improvements, for example by increasing rates of recommended vaccinations or cancer screenings, or ensuring consistent medication use by patients with chronic conditions. The TRADEMaRQ research team will study whether performance feedback affects the topics physicians choose for their MOC activities and improves the quality of their practice.

TRADEMaRQ is win-win-win proposition, Dr. Parchman says. Physicians could gain a streamlined way to fulfill MOC requirements. The ABFM and researchers will learn what might help providers quickly and effectively improve their practice. Patients will benefit from physicians who have both up-to-date medical knowledge and more time to spend on their care.

“Group Health has a unique opportunity with TRADEMaRQ,” he says. “This study is at the forefront of a new approach to encourage family physicians in quality improvement efforts that should ultimately result in better patient care.”


by Chris Tachibana

TRADEMaRQ collaborators

Left to right: James Holly, Southeast Texas Medical Associates (SETMA); John Owen, SETMA; John Schmidtbauer, OCHIN; John Johannides, ABFM; Bhavaya Sachdeva, OSHU/OCHIN; Robert Phillips, ABFM; Michael Parchman; Lars Peterson, ABFM; Scott Fields, OCHIN;  David Price, KPCO. 

Please note: Participation in the TRADEMaRQ study is limited to physicians practicing at Group Health, OCHIN, Kaiser Colorado and South East TexasMedical Associates.