Maintenance of Certification (MOC) Questions & Answers

These questions were given to Marshall Land, MD on January 23, 2018 at a MOC Informational Meeting held at the AAP-OC Chapter office to discuss the changes being made to the Maintenance of Certification process. The meeting discussed the following points:

  • The 10-year test will now soon be replaced by an ongoing “take-at-home” exam designed as a learning experience and allowing you to use reference materials
  • Qualifying CME activities are now eligible for Part 2 MOC points, reported automatically in your portfolio
  • Part 4 credit is available for work already being done in your workplace

1. Why not give MOC credit for community improvement (e.g., working with mental health providers and other health providers, school educators, social services)?

Answer:  This is a great idea.  It’s exactly what the ABP would recommend you do:  get credit for something you’re already doing, that’s relevant to you, that’s attempting to improve the care of your patients.  MOC Part 4 (Practice Improvement) is awarded for any activity which attempts to improve the care you are providing for your patients.  There are a lot of possibilities for your question.  For example, a project could be designed to improve the referral process or the feedback process with these organizations. Log in to, look under Maintain Certification, then Improving Professional Practice (Part 4), then click on “Are you creating your own QI project?”.  Call the ABP (919) 929-0461 and ask for MOC if you need help.  Another option would be to do this through AAP’s PediaLink program.  The ABP is already working with CATCH to be able to provide credit for many of the CATCH programs.

2. Regarding MOCA-Peds, the new test format, can I “work ahead” to finish questions for the next quarter early? Can the quarterly deadline be extended for any reason?

Answer:  MOCA-Peds was designed and tweaked with the input of thousands of pediatricians to try to combine an assessment of knowledge with a continual learning process, taking into account that pediatricians are busy and that life circumstances happen.  80 questions per year are divided into quarters, so folks don’t get into a crunch of that many questions in one sitting.  The pilot demonstrated that pediatricians took 38 minutes on average to answer all 20 questions for the quarter; those questions may be answered singly or in batches; the majority of pediatricians did not spend any time studying ahead for the exam; and you may drop the lowest 4 quarters of performance at the end of year four.  Pediatricians participating in the pilot felt these measures helped with the issues you bring up.  So, the answer is no.

3. Why not help AAP chapter and CME events earn MOC credits?

Answer:  That is a goal of the ABP.  And we already do that.  MOC was awarded for NCE this past year, and is already awarded for many AAP Chapter events.  Beginning January 2017, MOC points can be awarded for any CME activity which meets the ACCME criteria for assessment.  That would certainly include activities at AAP Chapter events that meet that criteria.  Organizers for these events must apply through ACCME.  Hopefully, this process will become more streamlined to help those organizations.  We also think that AAP Chapter events are a wonderful opportunity to determine MOC Part 4 (Performance in Practice) projects which are relevant and meaningful on the local level.

4. Where can I find free MOC activities?

Answer:  You could obtain all of your required Part 2 and Part 4 MOC points in your 5 year cycle at no cost through ABP activities which you can find on the ABP website.  They are included as part of your 5 year fee.  There are small additional fees for some ABP projects, and projects from other organizations.  Again, the MOC staff at the ABP would be glad to help you with this.  (919) 929-0461

5. There were several questions/suggestions related to developing a “hub” for learning activities, including updated medical information, standards of care, and other free educational materials.

Answer:  This is also a great idea.  The question is which organization would have the bandwidth to be the “home” for that hub.  Having been part of a team that has tried to put together information in just one area, behavioral/mental health, it is more complicated than it might seem:  permission, keeping updated, and there are costs, etc.  Still, I will bring this up for discussion again at the ABP.  Meantime, the AAP is a wonderful source of educational materials, and they work feverishly to keep that up to date.

6. I think team based learning is important.

Answer:  Team based learning is an important part of the educational process.  One opportunity comes through AAP meetings, at the chapter and national levels.  We also feel that Part 4 (Performance in Practice) projects can offer the stimulus and opportunity for group learning.  All PIMs (Performance Improvement Modules) have a group capability; and the expectation is that most QI projects will be group projects.

7. Has the Board considered creating an app for Question of the Week that can be downloaded to one’s phone?

Answer:  This has been discussed.  It’s in the budget forecast for 2019.  It’s expensive to develop, so it needs further consideration.

8. I did not like the test center atmosphere (and other grumblings about the test center).

Answer:  Comments about the test center from diplomates were one of the reasons the Board looked into alternatives, and developed MOCA-Peds.  As we talked about at the meeting, this new process integrates learning into assessment.  This can be done in the comfort of your home or in your office, using a web or mobile device, at a time that is convenient for you, using resources, and you can answer the questions singly or in batches.  Many positive comments regarding the ease of this new process and its value as a learning tool have come back from those who have participated in the pilot

9. The website needs updating.

Answer:  The ABP has recently revised its website, again with the input from many diplomates.  The new MOC landing page will be available late this month as an alternative with a place for feedback.  This will be finalized and will replace the current landing page in the late spring.  Please send us your comments on the parts of the website which you find least user-friendly.  We will continue to make improvements.

10. Can the fees be lowered?

Answer:  First, I would acknowledge that the current fee of $1304 is not cheap, even every 5 years. You should know that the Board has not changed that fee for several years.  And beginning this year, diplomates may pay the fee on an annual basis, $275 per year.  Not trying to sound defensive, but I’ll try to give you some idea of the basis for that fee.  The ABP is nonprofit, and works very hard to steward the resources we have. MOC is not a “money maker” for the ABP; it actually loses money. The ABP does produce over 50 separate examinations; while continuing to develop as many MOC exams as it currently does, the ABP will also be developing MOCA-Peds for all subspecialties.  It also produces many Part 2 and Part 4 activities that can be used to complete MOC for both generalists and sub-specialists. Unfortunately, most of the sub-specialty examinations cannot cover their expenses given the small numbers involved (just 20 or so rheumatology fellows exit training each year for example, but the costs remain the same). Although most people do tend to equate the cost of certification and maintenance of certification with the perceived costs of exam development and administration (for the ABP, that cost is about $3000 dollars per question, slightly less than the industry standard), the fees for certification and maintenance of certification must support all of the Board’s operations of which development of multiple examinations is only one part. These operations  include, but are not limited to: development of initial and recertifying examinations in general pediatrics and for each of the 15 sub-specialties; the staff who review eligibility requirements, work with residency and fellowship program directors on details related to resident and fellow tracking, and develop and administer in-training examinations; development of instruments to assess the general competencies of trainees in both general pediatrics and its sub-specialties; examination psychometric analysis; participation in national efforts related to competence, quality improvement, and standard setting; participation in all functions of the Residency Review Committee in Pediatrics of the Accreditation Council for Graduate Medical Education; and membership in the American Board of Medical Specialties (ABMS) just to name a few of the less visible activities.  In comparison to other Boards of the American Board of Medical Specialties, the American Board of Pediatrics has the third lowest fee structure (fees for some of the other twenty-three Boards are as high as $3,700). MOC enrollment fees going forward will be inclusive, covering all 4 parts with a single fee.  The fee is based on how many certification areas a person wants to maintain.  There will not be a separate exam fee for each area, although there will be a modest exam site “seat” fee if a diplomate chooses the secure exam.  Almost all ABP-sponsored Part 2 activities and some Part 4 activities also earn CME credit at no additional charge.