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American Academy of Emergency Medicine

MOC Member Survey Results

In February 2015, AAEM sent the following message to our members with a survey regarding the Maintenance of Certification process. The letter and results are listed below.


Letter to Members

Dear Fellow AAEM Member,

As you may be aware the American Board of Internal Medicine (ABIM) has decided to revise its Maintenance of Certification process. In order to guide our interactions with the American Board of Emergency Medicine (ABEM) we need up to date information on how our members feel about the ABEM Maintenance of Certification requirements. The Academy plans to share our members' concerns with ABEM. In order to do so, we need the opinions from as many members as possible.

Will you please take a moment to click on the following link to answer a very brief survey regarding this topic? Members' answers to questions will be tabulated and survey results will be anonymous.

On behalf of the American Academy of Emergency Medicine, I would like to thank you in advance for your help.

Mark Reiter, MD FAAEM
President, AAEM


Survey Results

9. Please feel free to add further thoughts on the MOC process. Open-Ended Response

  1. An additional factor, is the cost, especially to take the ConCert exam. Couldn't the Board sent its members to continental USA cities to submit and go over the questions, as oppose to Hawaii, Banff etc. The cost involved in this every year must be enormous. Too bad it is on the backs of the ED grunts on the front line, doing weekends and nights. I know many ED MDs who are going to let their certification lapse, because of cost, and at some point they will not need it any more.
     
  2. I agree with ABIM -- the recert/maintenance of certification process is burdensome and onerous -- If my hospital didn't require board certification I would never recert with ABEM.
     
  3. inconsistent with providing best possible patient care.
     
  4. I am due to retake the Concert exam in 2016. As I am 57 years old I do not think it likely that I will take it again when I am 68 years old.  I think that one think lacking in the certification process is a requirement for a certain base of regular clinical experience. I don't think anyone who rarely if ever does any direct patient care in emergency medicine should be certified to do it at all. I think patient satisfaction is a particularly bad way of evaluating physician performance. If it is done at all there should be hard stops on certain patients like those that have pain contracts and want us to break the contract and give them medications that their primary doctors don't want them to have. The problem with patient satisfaction, however goes far beyond that small description. There is actually no practical criteria that would reliably exclude patients who will not be unhappy if we practice medicine ethically.
     
  5. Simplify and use cme tracking in lieu of poorly selected articles
     
  6. The exam had no bearing on real practice. The effort of a large review was good for my practice but the exam itself was a joke. I believe that it was designed with little effort to make it current or representative. Mostly easy questions to allow for the 93% pass rate to keep us from complaining. Then a few poorly designed questions that make you wonder what exactly is this asking. Highly unsatisfactory experience taking the test. I felt ripped off, was ready for a real exam but got to pay alot for an exam that had little substance. This is a money making scam. Make a real exam or stop charging for it and wasting my time.
     
  7. ABEM is the industry leader in MOC.
     
  8. I HAVE NO PROBLEM DOING LLSSA EXAMS. MY CONCERN IS THAT IT IS DIFFICULT AND EXPENSIVE TO GET MY HANDS ON THE RELEVANT MATERIAL IN ORDER TO STUDY. IF IT IS SO IMPORTANT TO BE UP-TO-DATE ON THESE TOPICS, WHY DOESN'T ABEM PROVIDE US THE MATERIAL FOR A NOMINAL ADMIN FEE. A SINGLE LLSSA EXAM COSTS 100 TO TAKE AND MUCH MORE TO STUDY FOR.  SO WHILE I AGREE WE NEED TO STAY CURRENT AND ABEM CAN ASSIST US WITH THAT, I DO NOT FEEL THAT ANY MIDDLE MEN SHOULD BE MAKING LARGE PROFITS OFF OF IT. IT FEELS LIKE EXTORTION.
     
  9. LLSA can be accomplished but the other requirements are difficult and time consuming, don't provide much benefit. People are just looking for an easy thing to throw together to meet minimum requirement
     
  10. Waste of Time. No proven benefit to patients.
     
  11. I think the idea of continuous certification has merit. However, continuous certification is intellectually incompatible with the ConCert exam. If ABEM believes in continuous certification, it needs to get rid of the ConCert exam
     
  12. I was in the first or second group to have to perform the Quality and Patient satisfaction activities. In short, neither was beneficial and the QI requirement was hugely frustrating and time consuming. Not working at an academic center, I basically had to have our group's billing liaison (? For lack of knowledge of her exact job title) to pull all the charts for me because I didn't have access to any way to sort and search for a diagnosis-based set of charts. In addition, the charting relied on non-academic nurses and tech's documentation and was inconsistent. In short, this activity was almost not possible because I'm not in a research facility with all those resources and mindset. It basically created work for the billing liaison (and I had to keep going back to her because charts didn't actually meet my criteria.). I found no clinical benefit to this exercise, but was frustrated by it. As far as the QI portion, it feels like ABEM, on behalf of board certified EM physicians, is supporting the poorly written surveys that most of us do not feel are appropriate for our specialty. Let's not give support for a set of bad tools.
     
  13. This process is very burdensome and does not improve quality. Most hospitals now have QA/QI in place, as well as, patient satisfaction surveys. These activities are really just a way to extort money from hard working physicians.
     
  14. I think it's beneficial for the public for us to periodically be tested on our knowledge base, as incentive for us to keep up to date. I like the LLSA concept as an educational tool (i.e. ABEM chooses the most important developments in the field and presents the list for us to review), but feel that LLSA exams PLUS Concert is too onerous. If doing Concert every ten years isn't frequent enough to force people to update their knowledge base, then I would propose that they do it every five years, and base the test on the LLSA literature/ articles, but drop the LLSA exam requirement. The Practice requirements are a ridiculous added administrative hassle, as our medical director just "rubber stamps" everyone, wasting valuable time--his, ours, and ABEM administrative staff. Frankly, all of this feels like a $$ grab for their financial benefit.
     
  15. The issue becomes in the waning years of one's career when I might want to stay board certified but not actively practicing in a hospital ED ... the additional QA and patient satisfaction components become onerous not just of questionable value.
     
  16. Please pay attention to what is happening in the Internal Medicine community... recently, ABIM admitted: "We got it wrong." This process might have been a good idea at its inception, but it has morphed into a costly boondoggle. Endless requirements and mandates to pacify third party "stakeholders."  It seems like this is run by non-practicing physicians or those in limited and/or academic practice. They seem to have little experience or forgot what it is like it be a "pit doc" in the real world. Look at the tax returns (AAEM included) on the links I have provided. Clinicians who earned their certification do not need to be coerced into a lifetime of learning by a board of bureaucrats... I do far more CME than is required because I want to competent and successful.  This process is incredibly costly; with no accountability on the part of the certifying boards... they took no responsibility for the horrendous choice of "Pearson-Vue" to administer the CONCERT exam. The customer service, website & testing centers were third-rate, and certainly not worth a fraction of the cost I paid ABEM. It was likely dealing with a government agency.  And what about potential conflicts of interest between the boards and other organizations? There is now a push afoot to tie medical licensing to re-certification. We physicians continue to allow our leaders to sell out to third party interests like the government and the pharmaceutical companies. Look at the example of ACEP's joke of a tPA "clinical policy" written by drug company flunkies... Thanks for asking the tough questions of the AAEM membership; I just hope an open mind is kept because one may not like the answers. http://nomoc.org/  http://www.changeboardrecert.com/index.php
     
  17. The basic idea is good, but the process has become overreaching with an excessive burden and little benefit to patients. at my site there are no individual satisfaction scores -- just departmental -- I think this info is quite limited to what is real and applicable.
     
  18. The new QI and Pat Sat requirements are confusing, of dubious value, and somewhat ambiguous.
     
  19. ABEM has become out of control with the requirements. When do we have to stop jumping through hoops and paying fees for being doctors? We all finished medical school and residency. Give us a break.
     
  20. The patient satisfaction scores are a ridiculous and unscientific measure of how we treat and manage patients through their course in the ED. It clearly needs to be dumped. Also let's get rid of the PI aspect also. It is enough that we do a test every 10 years, and to even take that test read articles that by the time the 10 years is upon us, are out of date on the whole. There has to be a better way. We are smart enough to find it.
     
  21. Waste of time. Way too much work for zero benefit. Cost/ PITA factor is high. Needs to go away.
     
  22. Getting out of control. LLSA, Concert Exam seemed reasonable----the other 2 parts are excessive.
     
  23. MOC process was fine until the addition of APP, patient satisfaction, quality improvement requirements were added. Keep the LLSA and ConCert. Get rid of everything else.
     
  24. I believe the MOC process is a complete scam without any justification except to make money by ABEM and CME providers who are pumped up with their own sense of self importance
     
  25. I believe the PI and Patient Satisfaction components are unnecessary. They are ubitquitous in any viable practice anyway.
     
  26. Ten year Re-certification is good and necessary. Everything else is cumbersome and unnecessary. Yearly LLSA Articles should be a recommendation, not a requirement, by the board.
     
  27. The testing does not measure my ability to perform in the ED's where I work. I do not feel the tests have done much to measure my knowledge or abilities as an EM physician.
     
  28. Let be serious, the MOC does not force anyone to stay current. This comes from individual pride of profession and dedication. At best it makes the ABEM money, and wastes a lot of time. How about just having us do an oral exam with a panel of our peers once every 5 years and discuss these things. It will be clear when there is BS and when there is real knowledge and insight into practice problems. I am a full time Locums in 3 countries and can tell you after 30+ years of EM practice I can tell when someone is on game or not after about 1 or 2 case discussions. But hey that would be too easy and much less expensive.
     
  29. Currently our hospital requires all physicians on active staff to be board certified, but there is a definite movement afoot to eliminate any recertification requirements. That is, initial certification would be required, and then yearly CME requirements per the Medical Board, but no further recertification would be required. In the Department of Emergency Medicine, we feel that board certification provides some degree of clout with patients and colleagues.
     
  30. I actually thought that the ConCert was a major fund raiser. Little did I suspect that the naked double the fund raising LLSA was on the way.
     
  31. The assessment of practice performance is very aggravating and just puts more impediment in the way of maintaining one's boards. The LLSA and Concert exams provide sufficient means to keep us up on current emergency medicine. Instead of the APP maybe you could include some type of statement about one's practice - i.e. patient volume, CME activity, and how one keeps his or her practice up to date. This could be reviewed by the board and further information could be obtained if they felt there was a concern with a particular candidate.
     
  32. I believe in maintaining certification and continuing CME;however, the CME is rigid and does not allow for me to spend time and get credit to learn things that I think I want/need to learn. Time is limited and if I have to spend it doing all the required CME, that time is lost for CME I find useful to my personal practice of medicine. Additionally, I feel the new additions to the MOC are challenging to quantify and take significant personal effort in the community. I understand the theory behind those requirements, but feel they are quite impractical. My job evaluates me on performance and quality measures already. Now it is my responsibility to quantify these processes and have someone sign-off on stuff I am already doing. It adds time and stress to my job, that I feel in no way actually changes any of my practice, but like many things in medicine, just adds frustrating busy work.
     
  33. I strongly feel that the MOC process is money making operation for ABEM. ALL of my colleagues are of the same opinion. The LLSA exams are based off of a few articles. The articles are generally interesting however have no greater value than the CME activities I am already required to do as part of my hospital credentialing and my license renewal. It is a dictatorial approach to how physicians "learn." I am basically being told what to read, when to read it and then prove that I retained the information. This is an infringement on my personal time. I no longer have the time to read the articles that I find of interest.Physicians are held at gunpoint by the very organization that we fought hard to be recognized.
     
  34. expensive, redundant
     
  35. I am an Academic Emergency Physician, and thus boarding is a requirement. If I was in the private sector, I would let it lapse as it gives no benefit given the onerous procedure.
     
  36. Too many additional requirements that are unnecessary and does not enhance/benefit clinical skills. Physicians practicing full time in EM should be given options for educational requirements. On line courses..webinars..conferences that are "Board recognized/approved" should be enough. Passing one's board certification should not put additional undue stress!. The practice environment in Emergency Medicine is becoming more difficult each day. EM is taking a worst turn since my graduation from medical school in 1996. Pass Board 1st time 2002 and renewed 2012 1st attempt. Press Ganey is a travesty to EM although my score is 99th percentile the last two years. Someday, all qualified providers will not choose this specialty for all the unreasonable requirements thrust upon the frontline EM physician without much support from ABEM and ACEP.
     
  37. I feel that our personal PI and Patient Satisfaction is already being monitored through other sources such as our own practices/hospital, and to be forced to do more paperwork for yet another governing body seems trivial, annoying and to duplicate our work. We have enough our plates as it is, and I don't think these 2 portions enhance our training or education.
     
  38. The effort can be overwhelming with the concert since the pressure to pass is very high. The LLSA is reasonable.
     
  39. No way around it; of all the required certifications and hoops we have to jump through, those of our own speciality are the most useful. LLSA topics are often relevant.
     
  40. In Emergency Medicine, you cannot practice without being evaluated constantly - wait times, patient satisfaction scores, number of tests ordered, RVU's etc. What the MOC requires we are already doing as a part of our everyday practice. There is no need to go through the trouble of documenting it for some agency that should know that these things are inherent in our specialty. It is unnecessary and provides NO benefit to us. Concert exams and maybe even the LLSA are necessary requirements to ensure that we are all staying current and the study time involved encourages us to take a review course or pick up a book (if we weren't already doing that anyway. I think a recertification exam is absolutely necessary for any specialty board. The LLSA has been improving and the articles have been useful to my practice so I am changing my feelings about this activity - it is probably a good thing for us to do once a year at least - and adding the CME component was a BIG plus. Besides these exams, I feel that all of the rest of the MOC requirements are useless to us.
     
  41. This process is a collective waste of time, just like the oral board exam, and is just another way for ABEM to rake in additional money. Give me the ConCert exam every ten years and let me choose how I prepare for it. All of these other requirements are just unnecessary and time consuming.
     
  42. Good doctors will stay abreast of current knowledge because they care. Bad doctors will game the system and pass anyway they can, and this process won't change that.
     
  43. The ABEM has morphed from a source of guidance in the skills - retention and advancement of emergency medicine into a social overseer with ever increasing demands (and fees! Nice new certificate! Will that be redesigned every 1 or 2 years at significant expense?). While board certification is now required by most hospital bylaws, the addition of feel-good requirements has diluted its standing with at least one diplomate after 30+ years.
     
  44. I think the initial idea behind it wasn't bad but the requirements are becoming more and more onerous.
     
  45. The LLSA articles are excellent, and it makes sense the BC EM docs have all read the same critical literature.  The Concert exam serves no purpose. I learned nothing studying for the test, but due to the possibility of not passing it, I spent many hours studying and going to an expensive conference. There was no increase in my knowledge whatsoever.  In the modern practice of medicine, I am constantly reading, attending lectures, and learning. There is tremendous oversight and review at my hospital and there is no additional benefit of the attestations.  My time is overburdened with requirements to comply with the state medical board, hospital requirements, and board requirements. My costs continue to increase and my income and time continue to decrease! Please remove some of these onerous requirements; especially the ConCert exam. If we are taking tests annually, why a cumulative test? I have prove my knowledge thousands of times per year caring for patients. This is not High School.
     
  46. If there were coordinated, national, multicenter studies perhaps guided by ACEP, ABEM or AAEM that could produce real, meaningful data about process, they could be useful. But to have thousands of small, meaningless projects to check a box and make it look like all the Board Certified EPs are participating in meaningful research is dishonest to the public and an incredible waste of time for ABEM and the thousands of EPs who participate.
     
  47. Too much nonsense!
     
  48. I feel the entire MOC endeavor is a money making enterprise for all of the ABMS speciality boards and the businesses that have aligned with them. I am not opposed to a "recertification" process, but the amount of money which amounts to a "tax" to continue to be a "Board Certified" Emergency Physician is excessive.
     
  49. The process is time consuming, expensive, and provides no real educational benefit. Maintaining current CME requirments is sufficient. ABEM created LLSA as just another money making scheme. The ABEM website is confusing and the patient improvement initiatives are meaningless and too cumbersome.
     
  50. We are not children. Almost every hospital already does satisfaction scores, why report it here. Same thing with quality measures. They all have to do so quit this. the LLSA is marginally beneficial---many groups take it together, splitting the articles to read fully. The long and short of it if someone wants to keep their education up they will, if they don't they won't. No amount of testing will change that. If they don't want to take the tests/take their board, they will work in facilities that don't require board certification. If they don't want to keep up their education, they will be sued, and drop out of the work force eventually. The key is you CAN'T MAKE someone want to stay educated, they have to want it themselves.
     
  51. If ABEM did not charge so much money for these tests, I'd believe them more that it was not a money making sceme. It's outrageous how much each test costs.
     
  52. As a hospital employee my group basically makes sure my patient satisfaction and qi stuff gets done. It would be a real burden if I had to do it personally. LLSA is silly. I scan the articles to do the questions, and I'm sure everybody else does, too.
     
  53. Having a recert exam every 10 years is not unreasonable, although the questions could definitely be improved to reflect everyday bread and butter E.M. medicine practiced in the community as opposed to esoteric ultrasound images, questions about radiation exposure,... The LLSA articles are no where near the most important articles in E.M. each year. The other crap ("pt/process improvement"/satisfaction,...,...) is a huge waste of time.  It's as if whomever is making this up and adding it onto the back of the pit doc. is just trying to justify their job/seat on a committee,...
     
  54. Almost every year since I first became Board Certified, ABEM has added more hoops that I must jump through to maintain certification. I don't really trust the organization as much as a result, and I feel like they are doing this to generate more income, rather than improve care that ED patients receive. I already participate in CME activities, Press-Ganey surveys, hospital committees, and the education of residents/students/EMTs and paramedics. Why should I need to pay ABEM multiple extra fees to "attest" to this?
     
  55. The EM MOC seems to me to serve ABEM (via fees and expanding their role in our world) far more than it does us or our patients. Most people I know feel disgruntled about this process and misrepresented by ABEM.  I will pursue my 20 year recertification (out of necessity) but do not plan to do the 30 year (age 60) because of the hassle factor and I anticipate not needing it by then. If it were a more reasonable process I would likely continue in the profession longer.
     
  56. Waste of time. Clearly done just to generate revenue for the board. Stupid.
     
  57. It's a money maker nothing more the usual political rape of docs
     
  58. It very much seems like the LLSA and other inter-concert exams are a money grab by ABEM, and have minimal, if any, influence on practice.
     
  59. Please do away with it!!!
     
  60. ABEM is adding to the useless paper trail with most of their demands
     
  61. Too expensive to take llsa
     
  62. Expensive source of headaches
     
  63. I feel the yearly LLSA cost is excessive.
     
  64. The MOC process is costly in time, money, effort and good will toward the board. Instead of finding articles that are free to all they select ones that require a fee which suggests kick-backs or profiteering by insiders. The effort expended yields very little gain and the persons who likely would need to review the readings most are probably also the ones finding the answers without doing the studying. Most physicians are going to read materials on their own that they feel they need to review the most. I don't need the board telling me what to read. I already completed my residency. The performance improvement is waste of the practicing physicians time. If the board wants people join and stay in the profession they need to eliminate these onerous requirements.
     
  65. In addition to what ABEM requires most of us also have to do BLS, ACLS, PALS, and ATLS. At my institution I also have to do 20 hours a year of trauma continuing education and 20 hours a year of stroke continuing education. This has gotten completely out of control. After I do my next con cert exam, unless ABEM lightens up, I will no longer do LLSA's nor will I plan to sit for another con cert. ABIM got it right. Maintenance of certification has turned into a cottage industry that primarily benefits those running the process and does almost nothing to benefit the public.
     
  66. It is perceived by myself and most of my colleagues as a money making venture by those who run it with poor demonstrable scientific evidence to justify its current structure, especially a > $1,000 exam every ten years with the accompanying affiliated cottage industry of guaranteed pass rate preparation courses. Many other professional specialty organizations while having an LLSA like structure to ensure currency with the literature, have eliminated the concept of a one day exam every decade with mutiple subjects of academic minutiae to test on with little real world clinical relavancy. Having taken the Concert exam last winter I did note an improvemnt in clinical emphasis from the one taken ten years prior. However the expense and utility is of very questionable benefit and is only adding to the disillusionment amongst many in the rank and file to a profession already drowning in a stressful environment with varied useless EMRs and the inherent pressures of the career.
     
  67. I have no problem taking the ConCert exam every 10 years. I think forcing the LLSA tests on us is excessive. (I'd be OK with them having yearly suggested LLSA articles to read, but no testing). The QI and patient satisfaction components are excessive and frankly not worth the time or effort. I need to stay certified for my job requirements. I have ConCert coming up later this year, I'm guessing it will probably be the last time I take it. Anything AAEM can do to help change the MOC requirements would be awesome!!
     
  68. I would prefer to see more active yearly management of certification (LLSA, quality improvement, etc.) than ConCert examination. The static testing every 10 years has limited value to me, and I believe yearly meaningful requirements would unify the quality of our diplomats.
     
  69. the combination of recurrent board examination, LLSA testing, performance review, and ongoing self-assessment demands are redundant with what we are required by Hospital, Government and personal employment groups. The amount of educational benefit from the above massive amount of ongoing education is minimal.
     
  70. Concert exam seems excessive as well as the Quality improvement sections of the MOC.  I feel that the LLSA articles/test are the most (and only) beneficial aspects of the MOC.
     
  71. Needs to be changed to a more reality based test of emergency medicine not enforce d continuing education. Abem is not a Qa agency
     
  72. Seems to have created a cottage industry for those seeking to escape clinical practice, either through administering ABEM or the rent-seekers who provide prep materials or elements of the QI requirements.  The requirements actually interfere with my pursuit of CME that I personally find beneficial. This interference is both time and financially-based.
     
  73. For an Emergency physician with 38 years of full time emergency practice not in a fly by night ER but on a level 1 trauma and stroke center Urban major hospital in Detroit and having been involved in the training of over 400 Emergency Residents since 1976 that had graduated and are now practicing all over the US including Hawai,, the MOC process is nothing but a slap on the face denying immediate recognition to those efforts, and obviously a well fabricated underhanded way to further make a significant amount of revenue for the group involved in this scheme. The saddest part of this situation is the universal acceptance by our colleagues to this stupidity.
     
  74. CME requirements, LLSA worthwhile  All else not worth it and excessive
     
  75. What a waste of time and money. Seems the "fathers" of Emergency Medicine have moved on from gaining income off our backs to the latest venture ... MOC and all the money making avenues to support it.
     
  76. I think the cost is about 50% excessive, otherwise I am fine with the process
     
  77. It has to be made easier and one step, more practice and care oriented, than multiple steps and expiration dates with same.
     
  78. Useless
     
  79. Clearly, some MOC process must exist in order to ensure specialist currency and high-quality care for patients. However, the financial underpinnings of the current process are quite obvious: we not only pay to re-certify, we also pay every year to be allowed to pay to recertify every 10 years. and the LLSA articles/exams are not necessarily relevant to daily practice.  Money appears to the bottom line here.
     
  80. This additional burden is difficult to maintain along with all the other duties we are expected to perform for our group and the hospitals we serve. Stretching some of these requirements to a bi-yearly might help ease the burden. I am a medical director, and feel the time I spend performing those duties should be put toward my MOC, as should those who participate in teaching or research.
     
  81. Looking forward to its demise.
     
  82. I'm not a big fan of the LLSA process. I would rather read literature on areas that I feel that I, personally, need improvement on.  Thank you for asking for my input.
     
  83. This process is extremely costly. In an era of rising costs and where these expenses are not reimbursed by employers, this adds expense without value and duplicates functions that are routinely performed as part of facility oversight and credentialing.
     
  84. Process has done little if anything in making me a better EM practitioner. It does seem to generate a lot of money for lots of folks though, with these expenses coming out of every ED doc's pockets. High cost and low return makes a bad system in my mind. The merit badges in this system are akin to ACLS, ATLS etc. They make administrators feel good in some sense, but they do little in making docs better at their jobs.
     
  85. I took the Concert Exam recently. Although I passed, it required an unrealistic amount of time to prepare and I do not feel it accurately assesses current practice in EM. There were many questions which were irrelevant to EM.  The Concert exam should not be about obscure facts and minutiae. It should be about the 'bread and butter' of EM. Just my opinion.  The LLSAs are much more relevant in the maintenance of knowledge for the practice of EM.
     
  86. It is a costly waste of time that doesn't have any documented benefit to my knowledge. That being said, we are held hostage to it, so I am unlikely to let it lapse any time soon. If there were a viable alternative, though, I would pursue it.
     
  87. I do not feel that the added work benefits anyone.
     
  88. Just another hoop to jump through. Recurrent costs and minimal return for expense and effort makes the process undesirable.  Maintaining certification through the MOC process has had little to no impact on my practice of emergency medicine.
     
  89. MOC requirements really just feels like busy work check boxes. Doable, but doesn't serve a purpose. (Already have multiple CME requirements, hospital based patient satisfaction evaluations, QI processes, etc.) Cost seems excessive for a required online exam as well.  On the other hand, reexamination with ConCert exam every 10 years (change to 15?) I do support.
     
  90. Too expensive and time consuming. You get the feeling that more steps are being added to make more money for the organization and justify its existence rather than educate those actually at the front lines of patient care.
     
  91. Seems to be more about political correctness than actual medical knowledge. Doing CME and re-certifying every 10 years is fine, but the issues in between don't strike me as valuable. I can pass the tests without reading the articles, though I do read the articles that seem germane and interesting. The patient surveys are worthless: somehow I hand out 10 or so every year and I get all wonderful results yet my press gainey numbers aren't so good. There are so many biases built in to the whole process -- I hand the patient the card to evaluate me at the time of service vs. an anonymous survey sent sometime after service, after they get the bill -- that while we generate a lot of data, I'm not sure any of it is good data. It just all seems like a response to outside pressures. All this hullaballoo is tiring and adds to burnout, bu every day I go into work, forget about all of it and take of the people that come in to the department and I get away from all the nonsense. I'm residency trained and about 20 years in an urban, level 1 trauma center. I counsel my younger partners to not really worry about anything that comes from admin. Just show up and be the best you can be.
     
  92. Concert exam is sufficient to demonstrate maintainance of competence. The rest is to control Docs by administrative , bureaucratic structures and make money for them.
     
  93. Concert exam and LLSA reasonable. All others are riduculous
     
  94. It seems like more unnecessary merit badge requirements. Adding an extra layer of requirements is not going to make me be a better physician and just puts an extra burden on my practice and licensing.
     
  95. Nothing else to add at this time.
     
  96. This onerous system is not designed to produce better physicians, merely to give hard working physicians headaches, paperwork and busy work. It has no value in policing ranks for bad physicians nor was it ever designed to do so. When I leave emergency medicine it will be because of draconian requirements like this
     
  97. I now have a process to get this done expeditiously but it took a few years to get the hang of it. It dominates my CME.  The concert exam was challenging. In fact,it was probably the most difficult exam in EM that I have ever taken in EM. There should be more guidance for more focused study.
     
  98. LLSA articles were too excessive and often unavailable to me. This has improved by reducing the number and increasing availability.
     
  99. While I think proving some continuing education and competency is important, I believe the PI and Patient satisfaction issues are ridiculous. This should be up to your employer, not ABEM, to worry about. ABEM should only be assessing competency.  Also, the Concert exam should be straightforward Emergency Medicine. We all know that the initial board cert exam has a lot of relatively obscure questions on it, and how you do on that exam has very little to do with how well you will practice EM (and for the record I did well on the test). The Concert exam should be core Emergency Medicine designed to test competency in everyday emergency medicine.  LLSA is actually very good, although the test questions do not always test the pertinent points from the articles
     
  100. It is tiresome to have our own certification entity continually come up with new ways to tax it's membership.
     
  101. There needs to be a good way of assessing the quality of emergency physicians. With todays technologies there are much better ways of conferring new knowledge to providers than the LLSA and MOC processes. The board certifying bodies are living in the 1950s.  No one likes patient satisfaction scores. There needs to be a good way to assess this. The best is by giving patient's choices, encouraging competition based on accurate patient outcome measures. But nobody wants to let that really happen -- too hard and many doctors are afraid of the truth.
     
  102. Although I think that the MOC process is reasonable, it should be studied to determine if various paramaters are met because of the process. Do you need to be a humane ED physician in order to provide good quality care? I think so and the satisfaction surveys do measure this somewhat. Do you need to be a good clinician and diagnostician and patient communicator? Yes, and the practice and quality improvement activities should help to create a culture in EM where this is important.
     
  103. I think the ConCert material could be divided and added to the LLSA material. Spread the testing material over 10 -12 years. That is, for example, put trauma in with the LLSA one year, next year have cardiovascular with the LLSA, etc.
     
  104. I believe that the MOC process was made more onerous in order to supplement the salaries of those with ABEM, those in academic positions who wish to augment their income in this way ( creating the tests, review courses etc). The requirements are actually a distraction from my keeping up to date & most of the questions have no relevance to the site where I practice. I actually was boarded in Internal medicine but let my boards lapse because my group wanted all boarded in EM; I completed a second residency in order to be boarded in EM so I have no tolerance for people who want to practice EM without doing a residency. We just got an ultrasound device at our site but my residency never taught us that & I would LOVE to do a week long u/s course for EM & work on getting proficient but I have to study for my CONCERT exam this year. Also I have already met my CME for CONCERT so I don't want to spend more this year on CME. Finally I do not have time at my site to work on honing my ultrasound skills when I work because I am required to work as fast as possible & "move the meat", avoiding ANY LWBS & having all TAT's less than 120 minutes!
     
  105. These are an added burden with no clear benefit leading many of my peers to plan on letting their ABEM lapse.
     
  106. I would suggest recertification exam every 15 years at most. This is adequate combined with the CME requirements of most members state boards to be up to date with current diagnosis and treatments. This also allow one exam mid 30 year career which is enough. We, ABEM members, are overwhelmed with requirements including LLSA, ConCert, PQRS, etc. If this is going to continue to be the requirements then those efforts should be enough to satisfy state license boards requirements for CME. When state CME requirements are added in, it is untenable. If you live on a state border and practice in two or more states, the requirements are even more. I am licensed in KY and IN. I have CME requirements for both states including specific courses of study already included in my training such as -pediatric head trauma, -HIV, -patient safety, -opiate prescribing. Also we are now being forced by our hospitals to acquire CME for areas of special interest for our hospital such as -stroke and TPA, -cardiac care and STEMI treatment, -traumatic injuries. These are also covered in our current education and unnecessarily repetitive.  The multitude of requirements are overwhelming and lead to increase burnout and early retirement and leave no room for exploring personal areas of interest in medicine. Being able to explore or research areas of emergency medicine which are of specific interest to you decreases the likelihood of burnout.  I will do the things required to maintain my ABEM certification only because I am forced to do so. I have been given no voice in these overburdensome requirements (until now, assuming this is heard). I have been told that the public was calling for these requirements to make sure MDs are up to date but I suggest that meeting these requirements has not been proven to improve care. I would hope ABEM listens to its members and abandons this senseless piling on of requirement after requirement. Instead of echoing the typical approach of our current tax code by adding more and more requirements until what's left is so convoluted and complex it's unmanagable, let's instead wipe the slate clean and reapproach certification anew. Let's act like real scientists and researchers and base recertification on a process that acutally improves care and outcomes instead of bureaucracy. I would dare say initial certification and yearly CME is adequate with no need for any additional recertification.
     
  107. LLSA only component that add value to maintain expertise in EM. Rest of MOC requirements seem to be academic exercise only.
     
  108. I feel all of the ABEM requirements are not helpful in my practice. It is just a way for the organization to acquire more money. It is a waste of my time.
     
  109. This seems like it's a money grab by ABEM and has little to no use in actual clinical practice.
     
  110. Having to undergo cumbersome and excessive additional requirements feels as though we are financially supporting ABEM administrator salaries and dinners rather than supporting our field in a meaningful way.  There ought to be ways to opt out of yearly LLSA concert exams such as attending a yearly national conference (AAEM/ACEP) and fulfilling my yearly MI requirement of 50 hours of CME,  attending academic institutional lectures and working at an academic institution. How about an open book , home-based 10 year concert exam that tests my knowledge and the ability to access knowledge rather than my test taking skills under a highly supervised enviroment meant to deter cheating which is just silly at our level of professionalism (Am I a teenager taking the SAT or a highly skilled professional?) ... not to mention paying the exorbitant testing and license fees!  How about after 20 yrs of fulfilling requirements and completing yearly cme state requirements, ABEM grants me tenure in licensure....Wouldnt that be great? I would like to feel that my board certification organization is working to help to advance my field with meaningful educational requirements, not charging me excessively for pushing paper to sustain themselves. Attending the highly regarded ED lecture series at my academic institution, interacting with my peers on a daily basis, and engaging in my own reading (which far exceeds CME requirements btw), does more for me and the patients, medical students and residents I serve then the current ABEM requirements do, quite frankly. They should count for more towards my standing. -Thank you AAEM !
     
  111. MOC is achieving JCAHO-like status -- I'm not sure of how patient satisfaction and commentary is related to "scientific" clinical competency in EM versus having such matter rest within the perview of the my hospital's privileging and QA process. I'm happy to take examinations (written, oral or practical) on my EM skills; when, however ABEM starts venturing into patient interactions, and satisfaction surveys the Board has overstepped the bounds between it and my hospital and my state's licensure process. Why would ABEM assume some oversight/monitoring of my day to day practice style when that responsibility rests with each EM provider's hospital and state Board? I don't like the current mode of the MOC. Frankly it stinks.
     
  112. MOC is a positive process for practicing physicians
     
  113. I can live with the LLSA articles and exam -- although many of the articles are of dubious quality, draw conclusions that are simply wrong (the conclusions sometimes having been disproven by evidence that has more recently come to light), or are irrelevant to the actual practice of Emergency Medicine. But it never hurts to read....  On the other hand, the Practice Improvement and Patient Communication activities are an utter, complete, and total waste of time. These need to be discarded. Promptly.
     
  114. Selection of articles and questions which are inappropriate.  For example, the last article of the patient safety packet in which the author of the article actually contradicts himself 3 times between text and his charts and tables.  Several questions testing statistics knowledge rather basic knowledge such as in the patient safety articles. . i.e., What is the MOC question/examiner actually testing. eg: "to what degree type questions . . . " ---? the chart table provided in the article. . . is the examiner requesting to test in general--or from a time period preceding. . . Never made clear in an examiner's question on the patient safety exam. Find it objectionable to have to spend a lot of time figure out what the question is actually asking when I have already spent hours reading and listening to the audio lecture tape  To date I have never minded MOC exams and ready--until the patient safety packet
     
  115. The APP do not add anything to one's skill as a physician. They are merely hoops to jump through to satisfy public opinion. In addition, they have a cost associated with them, both monetarily and one's time. They should be removed. The LLSA along with recertification exam are more than adequate.
     
  116. Bureaucratic overkill, we already have enough metrics to follow and maintain, adding endless MOC will be the end of ABEM as docs begin to vote with their feet and ultimately form another certification process if this nonsense continues
     
  117. ABEM has created a very complex and expensive and time-consuming mandatory certification process, and we are doing this to ourselves. We all have to have CME credits yearly, and we learn alot from CME as well as from colleagues, cases, and articles. Isn't that enough already?! I don't see the lawyers creating this self-inflicted certification process. The bar has been set way too high. Stop this nonsense.
     
  118. 10 year recertification is a good idea. however the LLSA requirement is not needed.  requiring a certain amount of CME/year is reasonable but should be able to be self directed CME with requirements for certain areas if desired. the LLSA could be one of the annual CME options, but other self chosen CME that are ER specific (if meet guidelines) should be satisfactory to fulfill annual CME.
     
  119. LLSA should be every 2 years, not yearly.
     
  120. Don't really want to think more about it than necessary as I'm busy seeing patients and running an ED. Thank you to AAEM for taking the initiative to change this process. The MOC process has now turned into financial security for a few people and a big way to generate wasted dollars.
     
  121. Like all continuing education endeavors, it is onerous. But each time that I do it (or some merit badge like ACLS/ATLS/PALS etc), I am glad I was forced to review things forgotten, or update the knowledge that has been refined over time. In the art and science of medicine, I know that science is self-correcting, maybe the art as well. I really enjoy AAEM's Journal for Clinicians approach. As a long-time FACEP and FAAEM, I was heartened to read recently in ACEP's Annals of EM the article about the gaps and limitations and difficulties in relying on evidence-based guidelines for all medical practice. The message was that sometimes the EDP must go with clinical experience as his/her guide, and that it is OK. I think a combination of study and practical experience is the best way to help those we serve. Many of my partners grouse about LLSA/MOC, stating that ABEM is just greedily trying to get more of our hard-earned money. I withhold judgement on that, ABEM certification is one piece of what makes it possible to do what we do in a professional and respectable fashion.
     
  122. The 10 year recertification exam is reasonable but the LLSA, patient satisfaction and QI requirements of the MOC process are not beneficial and are redundant since I already have to complete these items to maintain good standing in my academic job. There should be an option to opt out for those that already perform these activities and can demonstrate them.
     
  123. The APP activities are needless busywork (requiring substantial time )that do not contribute in any way to assessing whether a physician is competent to practice. Since every hospital I have worked in has processes for QC, assessing the need for remediation/education for physicians, and patient satisfaction--the APP creates additional hoops without benefit to anyone. The LLSA has created a cottage industry for people to go take courses to pass in one day. Reading and answering detailed questions too time consuming.  Additionally, the expense assosciated with the MOC is out of control. Where is the data which shows that MOC leads to better practicing physicians?
     
  124. What does ABEM do with the money?
     
  125. PATIENT SATISFACTION MEASURED IN SENSE THAT IF NEGATIVE COMMENTS NOTED AS TREND, IT WOULD APPEAR IN OPPE, AND COULD AFFECT DEFERRED COMPENSATION. NOT BASED ON %-age SCORE IN THE ACCEPTABLE RANGE AT THIS TIME.
     
  126. I have always felt that ABEM for whatever reason wanted to be "AHEAD of the curve" regarding recertification. I am frustrated that we have been the first to have such stringent requirements for recertification. the LLSA articles are sometimes useful but often esoteric. The Concert exam has questions on transplant patient care and other unusual cases that emergency physicians in a community hospital setting never see. We are making the recert process so onerous that many of us older physicians will not want to keep it up after retirement despite wanting to practice medicine in a more limited capacity.
     
  127. The process does not really accomplish the presumed goals of maintaining and improving knowledge/skills. Those of us who want to learn/improve do it everyday, the rest (including many in my practice) easily find ways to jump through these hoops (except the ConCERT) with little to no effort.
     
  128. I FEEL THE LLSA AND CONCERT EXAM IS SUFFICIENT FOR ONGOING CERTIFICATION. THE PI AND CP ARE EXCESSIVE IN THIS REQUIREMENT
     
  129. I actually don't mind the LLSA articles. They are informative and add to my keeping current. The ConCert exam is a waste. I simply study facts that I would otherwise look up, only to forget them. Finally, the Clinical attestation/Practice Improvement projects are a complete waste.
     
  130. Get rid of the extra stuff, waste of time IMO. Just keep llsa and concert exam.
     
  131. MOC process is way more complicated and expensive than it needs to be. Busy work that just burdens us down and costs money and provides virtually no benefit. The only part I like is the recert written every 10 years as a time to review the things we don't normally see. The LLSA and other crap is just a waste of my valuable time. Highway robbery.
     
  132. I would welcome elimination of MOC
     
  133. There is no need for LLSA exams anymore. They are no longer used in questions for the recertification exam as previously. maybe instead attendance of ABEM or AAEM sponsored CME programs for requirements to stay certified.
     
  134. There needs to be an alternate board that we can certify under.
     
  135. not monitored and reviewed effectively to ensure success. poor marker of a clinical provider
     
  136. Metrics such as quality and pt satisfaction are constantly being monitored at my current job.  Fulfilling the MOC requirments is easy because they are alreading being done but the process itself is very confusing, frustrating, and unnecessary.
     
  137. I feel the board recertification & LLAA articles are reasonable expectations. I feel the newly added requirements are unnecessary hoops to jump through. I doubt there are many practices out there not inundated to an extreme with patient satisfaction & practice improvement strategies
     
  138. Please make the questions on the Patient Safety LLSA easier. I have stalled in my attempt to complete it.
     
  139. I do not feel that having patients evaluate you and your communication with them is helpful. I am not doing it now and will not do it in the future. My board certification will expire before I ever consider doing that. The LLSA is helpful but I should not have to pay money for CME for the exam, it should be included.
     
  140. For those involved in locums EM practice the MOC requirements are unreasonable for the quality and pt satisfaction requirements
     
  141. I feel that the patient satisfaction information and the PI part are fine but most hospitals track these topic in their credentials process. The concert exam if full of minutia that can easily be memorized every 10 years and the LLSA articles are not extensive enough to significantly contribute to my fund of knowledge. I have found that programs such as EM RAP and audiodigest are the best way to consistently keep up with the ever changing field of emergency medicine. It is interesting, relevant , and breaks down my CME's to specific requirements such as trauma. I complete the series every month and feel that in addition to my full time work in a busy ED with partners and consultants that I am able to keep my knowledge current and my skills sharp. I suggest that ABEM develop something like this in place of the LLSA and Concert exam.
     
  142. The extra paperwork and cost is unnecessary. Many practices already incorporate practice improvement projects. Inclusion of these projects in to MOC also has created increased burden on physicians in that CMS will likely incur penalties for not completing the paperwork in the future and there has yet to be shown a clear benefit to the patients for the completion of this busywork. Also the requirement for LLSA, while well intentioned, does not allow for ready access to the articles easily. Article reading requires either access to multiple journals, a couple hour long hunt for articles with many times requiring to pay for the article, or paying a review service hundreds of dollars to obtain the articles, let alone paying more money to take a test to get credit for reading the articles. Also, the questions for reading the articles don't seem to assess accurately the knowledge from the articles that was supposedly obtained.
     
  143. ABEM process is: 1. Too complicated 2. over-priced 3. Generates a lot of CME activity
     
  144. Patient satisfaction is linked to higher mortality and morbidity. Why is ABEM focusing on patient satisfaction as a good thing?
     
  145. I have gotten into the habit of reading commercially-available summaries of the annual LLSA articles, rather than the articles themselves. I do look at the article reprints as needed-- mainly for graphics or charts, etc. I'm not sure that this is any easier than just reading the articles, but it is what I have been doing. I think that the LLSA exams and the ConCert exam are appropriate uses of my time. Our group has used TSG courses for more than ten years, apart from any APP requirement of ABEM. We have our own internal risk audit program, too, and so there is no additional work to meet the requirements of ABEM. The same could be said of our exposure to the Press-Gainey surveys. I'm not sure why ABEM needs to get involved in this APP area.
     
  146. I believe the concert exam every 10 years and the LLSA exams are more than enough for those of us in active practice. Busy work that does nothing for my patients and being charged more money to maintain certification drives me crazy. The trend in medicine to document for medicallegal/insurance/and now ABEM is overwhelming and the paperwork is too much. My patient care does not benefit from these extra requirements; which make appealing sound bites to those drawing a good salary in the 9-5 world.
     
  147. I believe that the ABEM process is nothing more than a money making scheme. Most of the LLSA's are poorly written tests, and most physicians collaborate(read:cheat) on the exams. The questions are nit picky, and it is a huge burden to have to complete.Therefore, the worth of the exams is nil.  The other parts of the evaluation are ridiculous. All of the answers are made up, or the projects are bogus. What is the point of that part anyway?  In the end, I took my boards early, and after I finish my last few LLSA's I will let my board certification lapse.
     
  148. Yearly test is a joke. Research projects every 5 yrs a joke! I'm not in academics. I should be the one to pick my own CME. Patient survey is a joke as well. Want a good survey, give some pain meds!
     
  149. The continual addition of additional requirements serves no productive purpose.
     
  150. It could be refined. Most jobs require ABEM certification and letting it lapse would limit my job options too much.
     
  151. would ask that practice improvement be more weighed than patient satisfaction. llsa reads are generally a good thing and improve knowledge- not so much of a burden especially if you get the cme credit
     
  152. The MOC process pre-supposes that it is the only certification process for ED Physicians must undertake. Many of us are also required to completed different training for each state in which we work (say if we reside near state boundaries), each hospital we work and in also in the rare case of each company for which we work. We must also do this on our own personal time, of which these different processes eat into. It also forces me to retrain on information with which hasn't changed significantly or for which I am comfortable, rather than retrain on my choice of topics, for which I pick based on what I perceive as personal weaknesses. It doesn't escape me either, that all this extra training, adds additional costs and bureaucracy to an already burdensome system
     
  153. I dont understand how it is ethical for ABEM to create new mandates without any evidence suggesting that they make one a better physician. I also find it appalling that the money that goes into mandatory testing of colleagues is used to fund travel for ABEM board members to resorts and fancy settings. I think they should meet in an airport hotel, get the work done and not be getting expenses covered to go to luxury locations and eat high end meals. What is more appalling is that I have heard members of the ABEM Board brag about what a great time she was having at these events. Shame on ABEM. This is largest COI possible - create new hurdles for members while being wined and dined on diplomates payments.
     
  154. I HAVE BEEN ABEM CERTIFIED SINCE LEAVING MY EMERGENCY MED RESIDENCY (BC 1995) GIVEN MY EXPERIENCE, CME'S, PRACTICE, POSITIONS AS CHIEF OF THE MEDICAL STAFF, DIRECTOR OF THE ED, I FEEL THAT I COULD TAKE THE WRITTEN AND ORAL BOARDS AND PASS TOMORROW WITHOUT STUDY. EM IS WHAT I DO, HOW I THINK, AND MY PASSION. THE LLSA SOUNDS GOOD ON PAPER, BUT I NOW ALSO OWN AN URGENT CARE CLINIC, AND IF ABEM EXPIRES, I MAY OR MAY NOT TRY TO RENEW. DEPENDS ON THE BURDENS PLACED ON ME. EXPERIENCED BC ED PHYSICIANS IN GENERAL ARE BETTER VERSED AND HAVE LEARNED HOW TO PRACTICE WITH EXPERIENCE. AFTER 20 YEARS, I CAN STILL GET WORK IN ED'S THAT DON'T REQUIRE BC. I FEEL THAT TAKING THE WRITTEN TEST EVERY 5-10 YEARS IS ENOUGH TO SHOW ABILITY TO MAINTAIN CREDENTIALS
     
  155. Patient Satisfaction surveys are important and should be done by every department, but do not belong in Recertification process. "Practice Improvement" activities shared by all department members is important for all departments, but have no place in Board Recertification. Monitoring these small activities by MOC staff simply increases cost without benefit, except to employ more MOC administrative staff. LLSA is reasonable in concept, but requiring all ER docs to find the papers individually is expensive and burdensome. If the point is continuing education, then perhaps the Board could publish a peer reviewed critique of the papers each year, with the essential practice points it considers important. At the very least, there should be a large volume discount negotiated for all cited papers to all enrolling in each LLSA. Where was the data that found the old Board Recertification in need of change, or the new system better?
     
  156. Emergency Medicine should have board certification requirements at least as demanding as internal medicine or general surgery. Our specialty is still in its youth and will bear up better under outside scrutiny if we maintain a rigorous certification and recertification process.
     
  157. The entire process is far to expensive and of minimal benefit. Recertification by proof of CME should be adequate just as it is to maintain license. The Board is exploiting its members financially and has self -served its existence and bureaucratic management of the recertification process. The board should disclose its financial holdings and fis