By Avery Hurt

Abdul Moiz Hafiz, MD, was flabbergasted when he received a phone call from his institution's credentialing office telling him that he was not certified for interventional cardiology ― even though he had passed that exam in 2016.

Hafiz, who directs the Advanced Structural Heart Disease Program at Southern Illinois University School of Medicine, phoned the American Board of Internal Medicine (ABIM), where he learned that to restore his credentials, he would need to pay $1225 in maintenance of certification (MOC) fees.

Like Hafiz, many physicians have been dismayed to learn that the ABIM is now listing as "not certified" physicians who have passed board exams but have not paid annual MOC fees of $220 per year for the first certificate and $120 for each additional certificate.

Even doctors who are participating in mandatory continuing education outside the ABIM's auspices are finding themselves listed as "not certified." Some physicians learned of the policy change only after applying for hospital privileges or for jobs that require ABIM certification.

Now that increasing numbers of physicians are employed by hospitals and healthcare organizations that require ABIM certification, many doctors have no option but to pony up the fees if they want to continue to practice medicine.

"We have no say in the matter," says Hafiz, "and there's no appeal process."

The change affects nearly 330,000 physicians. Responses to the policy on Twitter included accusations of extortion and denunciations of the ABIM's "money grab policies."

Sunil Rao, MD, is director of interventional cardiology at New York University's Langone Health System and is this year's president of the Society for Cardiovascular Angiography and Interventions (SCAI).

Rao has heard from many SCAI members who had experiences similar to Hafiz's. While Rao describes some of the Twitter outrage as "emotional," he does acknowledge that the ABIM's moves appear to be financially motivated.

"The issue here was that as soon as they paid the fee, all of a sudden, ABIM flipped the switch and said they were certified," he says. "It certainly sounds like a purely financial kind of structure."

Richard Baron, MD, president and CEO of the ABIM, says doctors are misunderstanding the policy change.

"No doctor loses certification solely for failure to pay fees," said Baron. "What caused them to be reported as not certified was that we didn't have evidence that they had met program requirements. They could say, 'But I did meet program requirements, you just didn't know it.' To which our answer would be, for us to know it, we have to process them. And our policy is that we don't process them unless you are current on your fees."

This is not the first time ABIM policies have alienated physicians.

Last year, the ABIM raised its MOC fees from $165 to $220. That also prompted a wave of outrage. Other grievances go further back. At one time, being board certified was a lifetime credential. However, in 1990 the ABIM made periodic recertification mandatory.

The process, which came to be known as "maintenance of certification," had to be completed every 10 years, and fees were charged for each certification. At that point, says Baron, the relationship between the ABIM and physicians changed from a one-time interaction to a career-long relationship. He advises doctors to check in periodically on their portal page at the ABIM or download the app so they will always know their status.

Many physicians would prefer not to be bound to a lifetime relationship with the ABIM. There is an alternative licensing board, the National Board of Physicians and Surgeons (NBPAS), but it is accepted by only a limited number of hospitals.

"Until the NBPAS gains wide recognition," says Hafiz, "the ABIM is going to continue to have basically a monopoly over the market."

The value of MOC itself has been called into question. "There are no direct data supporting the value of the MOC process in either improving care, making patient care safer, or making patient care higher quality," says Rao. This feeds frustration in a clinical community already dealing with onerous training requirements and expensive board certification exams and adds to the perception that it is a purely financial transaction, he said. (Studies examining whether the MOC system improves patient care have shown mixed results.)

The true value of the ABIM to physicians, Baron contends, is that the organization is an independent third party that differentiates those doctors from people who don't have their skills, training, and expertise. "In these days, where anyone can be an 'expert' on the internet, that's more valuable than ever before," he says.