Susan E. Wiegers, MD, FASE, FACC

Our professional society is based on maximizing the quality and value of cardiac ultrasound for our patients. One of the reasons many of us first joined ASE was to access the great educational opportunities—live courses and scientific sessions, webinars, DVDs, guideline posters and even the ability to ask questions on the on-line forum. A core value of all of our members—sonographers, nurses, and doctors alike—is the obligation to “keep up” with the advances in echocardiography, making sure we are delivering the very best care to our patients.

Recently though, the ASE had to stand up for its physician members, who were feeling “held up.” Many of you are aware of the recent uproar against the American Board of Internal Medicine’s (ABIM) new Maintenance of Certification (MOC) program. Announced several years ago, it took effect in January of 2014. Initially the MOC program was billed and accepted by many professional organizations as a better way to move toward “life-long learning” and have educational modules that were more practical and practice-based. ASE got involved as it looked like this was where postgraduate education was headed and applied to the ABIM to be able to create and offer MOC modules. However, their new system hit a roadblock when, suddenly in January 2014, many board-certified internists and cardiologists found themselves listed on the ABIM website as “not in compliance with MOC requirements.” The cost of compliance turned out to be several thousand dollars over 10 years. Additionally, there were serious questions raised about the value of the onerous and time-consuming MOC requirements. The passage rate on the recertification exam had been steadily declining (leading a national weekly magazine to ask “Are doctors really becoming stupider?”) so that many had to pay a large fee to retake the recertification exam. Additionally, some of the required modules in patient safety and requirements for inclusion of the “patient voice” contained complicated and burdensome requirements that involved a huge expenditure of physician time which many categorized as busy work. The ABIM initially resisted the criticism, categorizing their critics as professionals who didn’t want to “keep up.” Eventually, the pressure and outcry was too great, and the ABIM held a summit of Medical Sub-Specialty Groups attended by many cardiology groups along with other internal medicine sub-specialty organizations to discuss the situation. ASE was invited to this meeting, and I went as the organization’s representative.

The first meeting was not encouraging. ABIM was on the defensive while speaker after speaker spoke of the anger of their members at the changes in their program. As the ASE representative, I pointed out that the ABIM’s new programs and recertification exams were viewed as onerous by our membership. It also appeared that they were in danger of being seen as financially conflicted since the new requirements also generated large sums of money for the ABIM. I also noted that the National Board of Echocardiography (NBE) had kept their certification exams outside of the ABIM structure. Some sub-specialty groups had originally also done this but had then elected to become part of the ABIM structure (Sleep Medicine, for example) and were now subject to MOC requirements for Internal Medicine, Pulmonary, and Sleep Medicine for many of their practitioners. The NBE stand was controversial at the time, but now seems prescient in avoiding dealing with the larger organization’s troubled system.

The second Summit was held this spring, and again I attended to voice ASE members’ concerns. The ABIM has suspended some of its requirements, is investigating changes in others (such as the secure exam currently required every 10 years), and is attempting to engage the community in planning a new set of requirements for “keeping up.” The financial conflicts appear to remain and continue to be outlined in the press. The situation is far from resolved but the ASE will continue to advocate for transparency and against modules that are unproven in their effects on patient care or that require a large amount of unproductive effort. Even more importantly, we will continue to resist the characterization of those who disagree with the ABIM as slackers with no interest in life-long learning. ASE will also monitor, with concern, the development of systems to replace the ABIM certification process. If a new system were to be developed by other groups, it must be a collaborative effort with input from all the stakeholders. The finances must also be completely transparent to avoid a repetition of history.

It is worth pointing out that the ASE has maintained a separation from the organizations responsible for accreditation and certification in the field of cardiovascular ultrasound in structure, leadership, and finances. These organizations include EACVI, ARDMS, CCI, NBE, ASCI, IAC-Echo, and IAC-Vascular. We have supported and partnered with many of these organizations because the goal of benchmarking and pursuing high quality care in the field is important. While ASE endeavors to help our members keep current and we fully support individual and laboratory certification/accreditation, we are not ourselves in the certification or accreditation business. Our role has been to develop educational products that support our members’ ability to pass the variety of requirements needed for their continued professional designations and employment hurdles (see www.ASEUniversity.org and www.ASEMarketPlace.com ). Our educational products are largely developed by volunteers or individuals who are paid small honoraria for hours of work. As volunteers and as an organization, we are proud of the quality of our educational products and appreciate the enthusiasm they generate both in the US and internationally. We all agree that “keeping up” is every professional’s responsibility, and ASE’s goal is to assist with those efforts. We hope that the ABIM and other certification and accreditation organizations will consider the big picture and work toward easing our members’ burdens and permitting ongoing learning to flourish in a more supportive and a less punitive framework.

Dr. Susan E. Wiegers, FASE, FACC is Senior Associate Dean of Faculty Affairs and a Professor of Medicine at Temple University School of Medicine.