title: Family physician participation in maintenance of certification.
abstract: OBJECTIVE
  The American Board of Family Medicine has completed the 7-year transition of all of its diplomates into Maintenance of Certification (MOC). Participation in this voluntary process must be broad-based and balanced for MOC to have any practical national impact on health care. This study explores family physicians' geographic, demographic, and practice characteristics associated with the variations in MOC participation to examine whether MOC has potential as a viable mechanism for dissemination of information or for altering practice.
  
  
  METHODS
  To investigate characteristics associated with differential participation in MOC by family physicians, we performed a cross-sectional comparison of all active family physicians using descriptive and multinomial logistic regression analyses.
  
  
  RESULTS
  Eighty-five percent of active family physicians in this study (n = 70,323) have current board certification. Ninety-one percent of all active board-certified family physicians eligible for MOC are participating in MOC. Physicians who work in poorer neighborhoods (odds ratio [OR] = 1.105; 95% confidence interval [CI], 1.038-1.176), who are US-born or foreign-born international medical graduates (OR = 1.221; 95% CI, 1.124-1.326; OR = 1.444; 95% CI, 1.238-1.684, respectively), or who are solo practitioners (OR = 1.460; 95% CI, 1.345-1.585) are more likely to have missed initial MOC requirements than those from a large, undifferentiated reference group of certified family physicians. When age is held constant, female physicians are less likely to miss initial MOC requirements (OR = 0.849; 95% CI, 0.794-0.908). Physicians practicing in rural areas were found to be performing similarly in meeting initial MOC requirements to those in urban areas (OR = 0.966; 95% CI, 0.919-1.015, not significant).
  
  
  CONCLUSIONS
  Large numbers of family physicians are participating in MOC. The significant association between practicing in underserved areas and lapsed board certification, however, warrants more research examining causes of differential participation. The penetrance of MOC engagement shows that MOC has the potential to convey substantial practice-relevant medical information to physicians. Thus, it offers a potential channel through which to improve health care knowledge and medical practice.
authors.affiliation: The Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC, USA.
authors.forename: Imam M
authors.initials: IM
authors.lastname: Xierali
authors.forename: Jason C B
authors.initials: JC
authors.lastname: Rinaldo
authors.forename: Larry A
authors.initials: LA
authors.lastname: Green
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Petterson
authors.forename: Robert L
authors.initials: RL
authors.lastname: Phillips
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Bazemore
authors.forename: Warren P
authors.initials: WP
authors.lastname: Newton
authors.forename: James C
authors.initials: JC
authors.lastname: Puffer
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002568:Certification / Q000592:standards*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D004502:Education, Medical, Continuing / Q000592:standards*; D005260:Female; D005550:Foreign Medical Graduates; D006291:Health Policy; D006302:Health Services Research; D054624:Health Status Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010821:Physicians, Family / Q000523:psychology* / Q000592:standards; D011787:Quality of Health Care; D014481:United States