title: Who is maintaining certification in internal medicine--and why? A national survey 10 years after initial certification.
abstract: BACKGROUND
  The American Board of Medical Specialties (ABMS) adopted a framework, called Maintenance of Certification (MOC), for all certifying boards to evaluate physicians' competence throughout their careers, with the goal of improving the quality of health care. The MOC participation rates of the American Board of Internal Medicine (ABIM) show that 23% of general internists and 14% of subspecialists choose not to renew their respective certificates.
  
  
  OBJECTIVE
  To study U.S. internists' perceptions about the forces driving them to maintain certification.
  
  
  METHODS
  Mail survey.
  
  
  METHODS
  A nationally representative sample of certified internists in the United States.
  
  
  METHODS
  Physicians originally certified in internal medicine, a subspecialty, or an area of added qualifications in 1990, 1991, or 1992.
  
  
  RESULTS
  The overall rate of response to the survey was 51%. Although 91% of all participants are still working in internal medicine or its subspecialties, this percentage is notably lower among general internists (79%). Of those still working in the field of internal medicine or its subspecialties, approximately half report being required to maintain their specialty certificate by at least 1 employer, but only approximately one third of those who completed or enrolled in MOC report this requirement as a reason for participating. Those who completed or enrolled in MOC do so more for positive professional reasons than for monetary benefits or professional advancement. The most common reasons for not participating are the perceptions that it takes too much time, is too expensive, and is not required for employment.
  
  
  CONCLUSIONS
  Respondents were volunteers from an early cohort of diplomates entering the program, and those with less positive attitudes may have responded at higher rates. Results are based on self-reported data, and misconceptions about program requirements may have led to some inaccurate responses.
  
  
  CONCLUSIONS
  The relatively large percentage of general internists who left internal medicine mostly to work in another medical field explains why rates of MOC participation for general internists seem lower than those for subspecialists (77% vs. 86%). Although positive professional reasons clearly have a compelling internal influence on program participation, it is less clear whether employers' requirements are an equally compelling external influence. Although half of all respondents report that MOC is required by 1 of their employers, only one third of those who participate in the program describe it as a reason for participating.
authors.affiliation: American Board of Internal Medicine and American College of Physicians, Philadelphia, Pennsylvania 19106, USA.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Lipner
authors.forename: Wayne H
authors.initials: WH
authors.lastname: Bylsma
authors.forename: Gerald K
authors.initials: GK
authors.lastname: Arnold
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Fortna
authors.forename: John
authors.initials: J
authors.lastname: Tooker
authors.forename: Christine K
authors.initials: CK
authors.lastname: Cassel
mesh_terms: D001291:Attitude of Health Personnel; D002568:Certification; D006801:Humans; D007388:Internal Medicine / Q000592:standards*; D011361:Professional Competence / Q000592:standards*; D011795:Surveys and Questionnaires; D014481:United States; D000078329:Workforce