A Letter from MSMA President

William Grantham, MD

Many members of the Mississippi State Medical Association are frustrated and burned out on the onerous maintenance of certification (MOC) requirements imposed by their respective national specialty boards. These requirements have distorted board certification into the bane of the modern physician, rather than a voluntary mark of distinction achieved with gratification. This problem is exacerbated by insurance panels and hospital medical staffs that force physicians to participate in MOC to remain on in network and/or on staff.

Despite MSMA policy opposing mandatory MOC and use of board certification as a credentialing criteria, the problems persist and continue to vex Mississippi physicians. To help physicians combat burdensome MOC requirements MSMA staff initiated a plan which began with a review of efforts already in place across the country.

Physicians in other states have attempted to alleviate the MOC problem through legislation that prohibits private hospitals, private insurance companies and medical licensure boards from requiring participation in MOC as a condition of staff privileges, panel inclusion or licensure, respectively. While some states have passed legislation with this goal in mind, these laws have not been put to the test nor enforced against the intended parties. MSMA staff spoke at length with the AMA, national specialty societies and other state medical associations about these laws and their effect.

MSMA staff shares the legal opinion with other policy experts that these laws are not sufficient and will not provide the protection physicians want. More importantly, a legislative fix isn’t realistic. Legislatures are often reticent to dictate how private businesses such as insurers and hospitals contract with other entities and operate day-to-day. Legislation is further discouraged as MOC restrictions are pitting physician against physician when medical specialty organizations disagree on solving the MOC problem through legislation. This was evident in Texas and Tennessee where groups such as the American Board of Medical Specialties (ABMS) and the American Board of Surgeons recently lobbied heavily against MOC legislation opposing government intrusion into the right of the profession to set its own standards and self-regulate. Specialty boards for anesthesia, surgery, dermatology, pathology and others have already modified MOC processes to emphasize meaningful lifelong learning rather than onerous testing platforms construed as financially unappealing as well as unrelated to improved practice.

Given that legislation will not change the underlying problem (the ability of a private medical specialty organization to regulate its members) we must go to the heart of the matter to make meaningful changes. Rather than focusing on state legislatures, medical policy experts believe a better way to reduce the burdens of MOC is to broker change by arming physicians with tools that empower them to lobby their national specialty boards and local hospitals.

The playbook that follows provides communication templates that you can use to rally your state / national specialty societies and petition your national specialty board to change its MOC requirements. A collective voice will leverage influence to change the root of the problem. The playbook also contains model medical staff bylaws and other bylaw changes you can use to ensure your hospital medical staff bylaws protect physicians from the growing concern with MOC. Lastly, included are new developments in specialty board testing requirements and CME program accreditation. Some boards have responded to their members’ requests; make sure yours is one of them.


William Grantham, MD
Mississippi State Medical Association President 2017-2018