I could not agree more. The ABIM and others seem determined to see how much of our free time and money they can suck out of our lives.  Don't remember who wrote it, but someone suggested the cost for a cardiologist who does everything, as many of us do, is over 100K every 10 years. Boards in IM, cardiology, echo, nuclear, intervention.  Now they want to add CHF and maybe one does pacemakers too? Add two more.

$1-2000 per exam + a 3-4 day review course of some type + time away from practice + travel and not counting the incalcuable cost of loss of family time.

I do not know a cardiologist that is not up on the current literature, reading JACC, AJC, Circ and others every month.  We get no points, no bennies, no kisses; we do it because we want to be up to date in our field.  Most attend at least one meeting of significance each year, again more reward from the local hospital and state medical boards than ABIM.

I don't understand why "we" keep doing this to ourselves.  In the era of evidence based care and guidelines by the ream, where is the evidence this methodology improves outpatient or inpatient care?  Probably in the same place having residents only work 12 hours at most?

I took the echo boards this year and that is my last board exam.  I'm done and refuse to do any more. 

Giovanni,

Your English is impeccable. I speak about three lines of German, about 50 lines of French and about 30 lines of English. No Italian. You should make no apologies!! Thanks for posting and I can certainly identify!

Ralph,

I feel your pain. It's been a tough week. Office was an absolute mad house and a death in our family. I'm afraid Dr. Rao's ACS chapter has gone lacking and I'll promise to start Monday!!

Melissa

I meant 30 lines of Spanish!! Though it could be argued!LOL

Melissa

Dear Melissa,

 I am currently trying to finish off my last 20 MOC points to be recertified. I'm doing the "communication with referring physicians" module. (And by the way expect to be getting a questionnaire from me shortly.) Like so many of the PIM modules the improvement plan depends on things I have no control over like my office staff. We are an employed practice. My staff actually works for the hospita. They aren't even my employees. We do not yet have an EMR so PIM's requiring chart reviews are painful and practically impossible. These extra hoops to jump through are just more in a seemingly endless series of meaningless tasks that take my time away from patient care and reading the journals to stay up to date. I'll sign off now before this rant becomes inappropriate. Thanks for the opportunity to vent.

Mike Springer MD

Dear Melissa-

 I am just traveling home after spending the last three days at the ACC board of trustees meeting.  Your blog posting on the pain and challenges associated with board recertification/MOC, etc was read, discussed and agreed with by many of us attending the meeting!  But after 3 days of discussion and reflection on the ACC digital future, I also have some reason to be optimistic for the future.  

As way of disclosure, I have been involved with many of the educational activities of ACC over the years.  All of us involved in education share your pain and frustration with a system that seems to be designed to generate activities but not to create a true system of lifelong learning.  ACC leadership has heard this from many, many of the members and is in the midst of rolling out a much more learner-focused series of educational activities and equally important, a web-based method (the life long learning portfolio) for tracking each individual's activities and linking that to MOC and MOL.  The big vision is to creat an interactive system that will deliver point of care education using high quality materials based on guidelines and other evidence.  Wouldn't it be fantastic if in addition to logging your activities and linking these to MOC, all of our practice data (for example in NCDR) could be used to both provide QI MOC and make suggestions to us as learners for information to address our learning gaps!  Evidence-based education to complement evidence-based practice!  Now that's a future!

Thanks as always for being an honest, critical and involved member of the community.  Keep it up!

Bob 

 A note from the ACC:

Our primary mission is to provide means and opportunities for cardiovascular care providers to continually refine their clinical performance and keep abreast of the latest developments in the field.  Aware that CardioSource needs to change to meet tomorrow’s needs; we dedicated the majority of our board of trustees meeting (happening while your blog was published) to roll out a comprehensive digital strategy which will be a multi-phased, multi-year deployment.

Our first phase, targeted to address many of the things you note in your blog is actually scheduled for a soft release on August 31^st and hard release (meaning more features and functionality) in March 2013. 

At the end of this month we will launch of our lifelong learning portfolio (LLP) and our proprietary technology delivering point of care solutions.  Each ACC member will have his or her own lifelong learning portfolio that will store their personal data and enable them to design, access, and fulfill their own personalized curriculum.  The LLP will enable members to understand the changing certification requirements and track their CME, CE and Maintenance of Certification (MOC) progress via “My Transcript/My MOC Tool.” Any credits earned through the ACC will be automatically transmitted into your portfolio.   Any credits earned outside the ACC can be manually entered and scanned to maintain a complete transcript. 

The LLP also enables individuals to design their own curriculum based on their own interest areas, preferred learning formats, and practice gap areas. There will be150 activities that individuals can incorporate into their activities list to access for future reference and curriculum development.

The LLP site will be a dynamic site that customizes an individual’s experience as he or she uses it. For instance, if a user engages in one of the many self-assessment quizzes, the responses to the quiz will be used to recommend appropriate learning interventions and quality tools to help close any gaps in care.  Our recommendation engine is powered through an individual’s self-assessment scores, CardioSource profile, learning format preferences, and scores from other online activities.  Through this algorithm, ACCF recommended activities will be placed into the personalized LLP for your consideration.

Perhaps the most exciting aspect of the LLP will be the release of proprietary technology behind our new point of care (POC) tool; a semantic tool that will help users navigate guidelines, appropriate use criteria (AUC) and other clinical documents.  By simply entering an open-ended question into the POC, individuals will be pointed to the specific portion of the guideline, AUC or clinical document that addresses their needs.

While we can’t hold off electrical storms and resulting power surges….we hope in the very near future ACC will ease your burden of recertification.  In the long term we hope to help you meet most of your certification requirements in line with practice. 

Mike,

I feel your pain! certainly glad to help with that physician communication/questionare/ letter, but you better expect a favor back!! HA! Good luck!

Bob,

I appreciate your post. It was a grand coincidence that your team was meeting while I was engaging in my therapeutic whine. Sounds like we are all getting a solid prescription for our cert/recert ills.  See you in Munich? Looking forward to it.

Mary Ellen,

thanks for your communication. I think it's important to understand that many practices still do not have EMR (mine is one of them and so is Mike's above) and the reasons vary: Some just can't make up their minds what's the best system- Some can't afford it, others have partners who are not computer savvy but still work full time but are dedicated to patient care. Those practices still exist.  

  Your post lets us all know that cardiosource is aware and working on improving the process. I appreciate your post as well.

Now, if you could just work on the Kentucky weather too!! :) I'll take sunny, 76 degrees and no humidity-a little rain every night, while we're all sleeping!!! 

Melissa

Melissa,

 You are a treasure. Thank you for your gracious whine. I'm an old school guy who is now an Emeritus Professor, semi-retired, and I cannot count the recerts I have taken in so many areas. I genuinely feel your pain. Keep the faith.

Thanks Bill! I appreciate your reading and congrats on all those recerts! You give me hope that I can keep going!

Melissa

Dear Melissa,

how did your recertification go?

Giovanni

Giovanni,

Thanks for asking. I have just over a year until I take the exam. Between my mom's knee surgery, my dad's TAVR and the local hospital politics, I have done nothing toward my studies, other than THO reading of course, for a few weeks.  I could write a book-so my progress was ground to a halt. when I started back, I ran into the same situation with gliches.   I called again to the Cardiosource folks a few days ago trying to figure out how to upload my MOC points. I did it ONCE successfully and could never get it to go through again. So.....my plan is to just keep reading (finally finishing module 6 hopefully today), then try and stay on course until I get through all twenty.  I plan to hire a computer geek/tech or ask a friend for a favor who might be able to navigate the site for me. 

The reading is great. Really excellent material, but the process of getting these "points" has been a time wasting stressful distraction from private practice and life. Trying to be a sport, but after a conversation with another cardiologist yesterday who practices in a large metropolitan area, he had the same experience and he was having to call yesterday to ABIM to see if he was even finished yet with the process.  He said, "I'd try to help you, but I don't even know how I've gotten this far myself".  

I will tell you that my recert 10 years ago was a million times easier. I took the Int Med and Cardiology in the same setting. Both were fair exams. No hassle except the time it took out of my practice to take the exam. I actually enjoyed taking the exams that day. 

So.....wish me luck. Say a prayer. Going to need both just to get through the MOC stuff.

Melissa