Board Opposes Use of MOC Status to Penalize Physicians
A work group on physician wellness and burnout is working to develop resources that will help physicians deal with professional stress and to connect with other members in order to diminish professional isolation.
Decisions regarding physician licensure, hospital privileges, credentialing, or participation in insurance panels shall not in any way be contingent on completion of or participation in Maintenance of Certification (MOC).
David Hathcox
That’s the policy approved by APA’s Board of Trustees at its meeting in Washington, D.C., last month. During the meeting, the Board also addressed physician burnout and wellness and updating of DSM-5, and approved policy opposing restrictions on international medical graduates (IMGs) entering U.S. graduate medical training and legislative attempts to permit pharmacists to alter prescriptions, among other issues.
The position statement on MOC was approved in response to an action paper by the Assembly in May and to widespread concern about MOC, especially the Part IV Performance in Practice component (also known as Improvement in Medical Practice). “Performance in Practice” refers to a requirement that physicians build into their routine practice the capacity to assess their performance continually against guidelines for best practices and make improvements to meet those guidelines.
“APA is strongly supportive of life-long learning for all physicians,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “However, many members have expressed their frustration with the current structure of MOC, many of whose requirements are unnecessarily burdensome and often irrelevant to clinical practice. We are committed to working with the American Board of Psychiatry and Neurology to improve MOC. In the meantime, however, we strongly oppose any attempt to penalize physicians for licensure or credentialing purposes for failure to participate in or complete MOC.”
APA President Anita Everett, M.D., said Maintenance of Certification is an issue affecting professional satisfaction, contributing to physician burnout.
APA President Anita Everett, M.D., echoed those comments. “This is an issue of professional satisfaction and physician well-being,” she said. “Physicians are alre ady burdened with administrative and other requirements unrelated to taking care of patients. Maintenance of Certification is a major concern for physicians of all disciplines, contributing significantly to professional dissatisfaction and burnout. It is unacceptable for licensing or other bodies to use MOC as a criterion for licensing, hospital privileges, or insurance empanelment.”
Everett has made addressing physician burnout and wellness a major priority of her presidential year. Connected to that initiative, the Board heard a report from Richard Summers, M.D., who is chair of the Work Group on Psychiatrist Well-Being and Burnout appointed by Everett. (See related story.)
Summers said the work group planned to do the following in five areas:
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Data: Recommend a process to assess members’ wellness, professional satisfaction, and experience with burnout based on available data.
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Resource Document: Work with APA administration to create a resource document that will include a review and summary of relevant research and tools on psychiatrist well-being and burnout. Update the APA position statements on well-being and burnout.
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Education: Recommend specific educational activities about physician wellness, including work-life balance, desirable practice parameters, and self-care for APA members, residents, medical students, and other physicians.
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Resources: Recommend resources other than education to support members’ mental health, wellness, and satisfaction. This will include resources for vulnerable psychiatrists and opportunities to provide support to other medical membership organizations regarding physician well-being and burnout.
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Communications: Work with staff in the Divisions of Communication and Publishing to develop recommendations for a communications strategy that will promote these products and opportunities.
“So much of this problem has to do with professional isolation,” Summers said.
Trustees agreed that burnout is a problem affecting all medical specialties at every career stage and that psychiatry’s response to the crisis can benefit the entire medical community.
Future of DSM Discussed
The Board heard a report from past APA President Paul Appelbaum, M.D., chair of the DSM-5 Steering Committee. Since a web portal on the APA website was opened in January for the submission of proposals to revise or update the diagnostic manual, the committee has received just two relatively minor proposals: a correction to the criteria for acute stress disorder and the addition of ICD-10-CM codes for substance use disorder in remission.
Appelbaum said DSM-5 was envisioned as a “living document,” drawing on digital technology to update the manual incrementally, in place of the expensive and time-consuming effort to rewrite the DSM wholesale that has characterized revisions in the past. In 2013, then APA President Jeffrey Lieberman, M.D., appointed the Work Group on the Future of DSM, with Appelbaum as chair. The work group developed a report, approved by the Board in 2014, that outlined a process for iterative, online updating of the manual.
Rustin Carter, M.D., the APA/American Psychiatric Foundation/SAMHSA Diversity Fellow, reminded trustees that physician burnout encompasses a spectrum that at the far end includes major depression and suicide. To his left is Chandan Khandai, M.D., M.S., the APA/APAF Leadership Fellow, and James Batterson, M.D., speaker-elect of the Assembly.
David Hathcox
At last month’s meeting, Appelbaum said the updating process was guided by two overarching, competing principles: the need for stability so that changes are not made too rapidly and the need for revisions that keep up with evolving knowledge and research.
Due to the small number of proposed changes so far, Appelbaum said that in the coming months, the steering committee will be revisiting the process to determine whether the threshold for making changes should be lowered and/or whether an effort to better publicize the web portal is necessary.
“For much of the year, the phone has been silent,” Appelbaum said. “Is it because people are unaware of the process or are the criteria for making changes too rigorous?”
For more information about the update process, see an upcoming edition of Psychiatric News.
Other Actions
Trustees also approved several new policies including, among others, resolutions in the following areas:
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APA elections: The Board approved four recommendations of the Ad Hoc Work Group on Election Violation Issues for mediating and resolving allegations of election rule violations (See related story).
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Referenda: Trustees approved a policy stating that if a majority of members approve an issue in a referendum, but the minimum requirement of 40 percent of the voting eligible membership does not participate, the issue will be brought before the Board as an action item for a vote.
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IMGs: Trustees approved the retention of a 1994 position statement opposing restrictions on the number of IMGs entering graduate medical training with a minor revision. The revised statement reads: “The American Psychiatric Association firmly opposes any arbitrary ceiling restriction on the number of International Medical Graduates entering graduate medical training.”
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Pharmacists altering of prescriptions: The Board approved a position stating the following: “APA opposes legislative attempts at any level of government that would permit pharmacists, when presented with a prescription for a pharmaceutical product, to dispense a medication containing a different pharmaceutical moiety but which is of the same therapeutic and/or pharmacological class (therapeutic substitution). Physicians’ prescriptions should not be overruled or substituted without prior physician approval and should recognize patient preference.”
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Mental health care for displaced people: Trustees approved policy stating the following: “American psychiatrists have broad skill sets for relieving suffering inflicted upon immigrants and refugees by displacement from and within their home countries and can provide direct psychotherapeutic and psychosocial interventions, as well as programmatic leadership, for the care of persons suffering posttraumatic symptoms and other migration-related syndromes of distress. ■
Summaries of Board actions are archived here.
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Published online: 10 August 2017
Published in print: August 5, 2017 – August 18, 2017
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