ABNS MOC Program
The American Board of Neurological Surgery (ABNS) was founded in 1940 to provide initial certification to practitioners of neurosurgery who meet its training and practice requirements. The broad aim of the Board is to encourage the study, improve the practice, elevate the standards, and advance the science of neurological surgery, thereby serving the cause of public health.
In the late 1990s, the American Board of Medical Specialties (ABMS) created the Task Force on Competence to assure that all certified specialists maintain satisfactory, up-to-date knowledge and skills throughout the span of their careers. All 24 ABMS member Boards, including the ABNS, agreed to develop a Maintenance of Certification (MOC) program or modify their recertification programs in that model. The expectation of MOC is that training and acquisition of medical practice knowledge and skill will begin in medical school, be enhanced in residency, and maintained throughout a specialist's career.
ABNS Directors realized that neurosurgeons would soon be required by regulatory bodies to participate in an MOC process. Recently the public, payors, health care organizations, and governmental agencies have called for periodic recertification of specialists. Consequently, development of the ABNS program was unanimously endorsed. Directors committed to making available to Diplomates a meaningful and practical MOC program, one that would take into account the concerns of Diplomates and the needs of the public. In addition, it must meet Board standards, as well as those established by the ABMS. The program was rolled out in 2006.
CERTIFICATION AND STATE LICENSURE
Requirements for certification and MOC are distinct from those for license. While certification and participation in MOC are voluntary processes, licensure is legislatively mandated and falls under the jurisdiction of each State where the physician practices.
PHILOSOPHY OF THE ABNS MOC PROGRAM
The guiding principle of Maintenance of Certification is to foster excellence in patient care. Through MOC the ABNS intends to encourage, stimulate, and support continuing education in the practice of neurosurgery thereby assisting its Diplomates in their dedication to life-long learning and self-assessment.
The program is designed to permit Diplomates to meet its requirements as they continuously work to keep current with changes in the specialty. It provides an avenue for compliance with State and hospital requirements, which in the near future are expected to include either participation in an MOC program or periodic re-examination by a State Medical Licensing Board. MOC also provides assurance to patients and their families, payors and funding agencies, and the general public that ABNS Diplomates maintain and continually improve their knowledge and practice.
The program reflects the realities of today's neurosurgical practice. Emphasis is placed on core neurosurgical knowledge and practice common to all neurosurgeons; notwithstanding, Directors realize that neurosurgeons often concentrate in various subspecialties areas. Consequently, the process had been designed to permit participants to include the area of their expertise when devoting time to CME activities, selecting a Key Case to log data, completing one of the SANS examinations, and selecting a module for the Cognitive Examination. As the specialty changes, requirements and oversight methods will be altered.
To participate in the MOC program, neurosurgeons must hold an ABNS certificate, a currently valid unrestricted license to practice medicine in the States where they practice, and unrestricted hospital privileges for a neurosurgeon. All Diplomates certified in 1999 and more recently have been awarded ten-year time-limited Certificates. They must enroll in MOC the year after achieving initial certification in order to maintain their certificates. Non-time-limited Certificate holders may voluntarily begin their participation in the program at any time and are highly encouraged to do so.
MOC consists of three successive three-year mini-cycles and a final tenth year. The requirements of each mini-cycle are fulfilled independent. In the tenth year participants have no requirements, other than successfully passing the Cognitive Examination if they did not do so in year eight or nine. New time-limited Certificates are awarded to Diplomates at the end of the tenth year after they successfully complete all MOC requirements, including paying dues each year. The first three-year mini-cycle of the next ten-year MOC timeframe begins January 1 of the next year, and a new on-line application must be filled out to begin.
To begin, participants complete a web-based application found at MyMOC on the Board's website, www.abns.org. From then on, they can track their progress through the requirements at MyMOC.
- Time Limited Certificates In order to maintain ten-year time-limited Certificates, Diplomates must participate in MOC. The ten-year MOC cycle begins the January following certification. Individuals who have not completed all aspects of MOC, including passing the Cognitive Examination at the end of their ten-year cycle, may re-instate their Diplomate status only by earning a valid, new time-limited certificate - in other words, going through all of the requirements of initial certification just as they did after completing residency, including passing both the Primary and Oral Examinations.
- Non-Time-Limited Certificates These were issued to ABNS Diplomates certified prior to 1999. They are valid for the life of the individual and will not expire regardless of participation in MOC. Diplomates in this group are urged to participate in MOC. For them, the January of the year they enroll marks the beginning of their ten-year cycle. Once enrolled, they complete the same requirements as participants with time-limited certificates. However, those who voluntarily participate in MOC will not lose their certificate if they drop out of the MOC process or fail the MOC cognitive examination.
All ABMS MOC programs have four basic components:
- Evidence of Professional Standing
- Evidence of Lifelong Learning and Involvement in a Periodic Self-Assessment Process
- Evidence of Cognitive Knowledge
- Evidence of Evaluation of Performance in Practice.
In order to assess these, the ABNS program has integrated the following requirements:
- Chief of Staff Questionnaire
- Unrestricted License to Practice Medicine
- Unrestricted Hospital Privileges
- 150 Continuing Medical Education (CME) Credits
- 60 AMA PRA Category 1 Credits ™ in neurosurgery related activities
- 90 credits that may be more of the same, or non-verified, self-reported activities the participant enters at MyMOC
- SANS (Self-Assessment in Neurological Surgery) original, pediatric or spine examination
- Key Case Module
- Patient Safety Module
- Cognitive Examination
The process is still evolving. Additional educational material to help improve patient care is being developed and will be added over time. A Patient Satisfaction Survey will be added soon.
CATEGORIES OF CERTIFICATION
Individual neurosurgeons are classified by the ABNS into four distinct categories:
- Currently Certified – Participating in Maintenance of Certification
- Currently Certified – Not participating in Maintenance of Certification
- Certified – Retired from Operative Practice
- Not Certified
- Currently Certified – Participating in Maintenance of Certification
These are Diplomates who have paid their annual fees and are in the process of completing MOC requirements in a timely fashion for each three-year mini-cycle within the ten-year cycle.
- Currently Certified – Not Participating in Maintenance of Certification
This classification consists of Diplomates who are not participating in MOC and have either non-time-limited Certificates or time-limited Certificates that have not yet expired. MOC participants who fail to meet the requirements of a three-year mini-cycle in a timely fashion shall be subject to the following with respect to participation classification:
- A Diplomate who has participated in a three-year mini-cycle but is delinquent in some of its components will be notified of his or her delinquencies. The Diplomate may enter a six month grace period to fulfill all the requirements of that mini-cycle while also working on the requirements of the new mini-cycle. The grace period fee must be paid as specified by the Board. This may be done twice during the ten-year MOC time-frame
- A Diplomate who has not participated during the previous three-year mini-cycle will be notified of his or her non-participation. In order to be reinstated, the individual must pay a re-entry fee and fulfill such other requirements as the Board may establish to prove evidence of professional standing, lifelong learning, and satisfactory performance in practice. Failure to participate in a mini-cycle may occur only once in the ten-year MOC time frame.
- A Diplomate who falls into either of the above categories, either reinstated or partially delinquent, will be classified as “Certified – Participating in MOC” during the entire three-year mini-cycle. Over the following twelve months, he or she will be classified as “Certified - Not Participating in MOC” if the requirements for re-instatement or the grace period have not been met. New three-year mini-cycles and the entire MOC cycle will begin and end on the same schedules as if the Diplomate had no deficiency.
- A Diplomate who never begins MOC will be classified as “Certified – Not Participating in MOC”. If the Diplomate holds a time-limited Certificate, he or she will be so classified until the Certificate expires. At that time, he or she will no longer be an ABNS Diplomate.
- Certified – Retired
This category refers to Diplomates who have retired from the practice of neurosurgery but were certified and in good standing at the time of retirement. In order to remain certified, they must:
- Inform the ABNS in writing of their intention to retire,
- Execute the ABNS standard retiree form thereby warranting that they will forever cease the practice of neurosurgery.
- Exchange their Certificates for a Certificate stating “Retired in Good Standing”,
Individuals who elect this status and comply with these requirements will not be required to participate in MOC and will be listed as “Certified – Retired” on the ABNS website. If they later resume the practice of neurosurgery, they will have their Certificates permanently revoked unless they:
- Petition the ABNS for re-instatement of their original Certificates prior to resuming practice,
- Re-instatement is approved by the ABNS,
- Comply fully with any conditions imposed by the ABNS in connection with such re-instatement.
- Not Certified
This category includes:
- Diplomates whose Certificates have been suspended or revoked.
- Diplomates whose time-limited Certificates have expired, and they have not been awarded new time-limited Certificates due to their failure to complete the MOC process successfully.
- Neurosurgeons who have never been ABNS certified. Individuals in this category include those who have never sought certification, as well as those who never completed the certification process. Such individuals will not appear on any database or listing maintained by the ABNS.