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Does certification have your head spinning? There are many factors to consider and understand. We've compiled a number of FAQs to help you navigate this complex issue.
What is the ACR’s role in this discussion?
The ACR does not have oversight over rheumatology certification and the ACR will not be the ones deciding whether rheumatology certification moves from ABIM to ABAI. The ACR has entered this discussion based on feedback received from the membership regarding their concerns about MOC. ACR leadership took steps to examine MOC options which lead to identification of the ABAI program based on a shared interest in immunologically mediated disease and their continuous assessment program (CAP). The ACR is now in the process of gathering input and collecting feedback from the membership and key stakeholders to better inform the discussion. Should a decision be made to pursue moving rheumatology certification from ABIM to ABAI, an application would be prepared and submitted to the ABMS. The ultimate approval to move certification from ABIM to ABAI can only come from ABMS.
Is the ACR planning to advocate for continuous certification (maintenance of certification) to be eliminated?
Based on our members’ feedback, the ACR supports the ABMS foundational assumptions that view professional self-regulation as both a privilege and a responsibility and the role of continuing board certification (MOC) as part of the professional self-regulatory system. ACR will continue to advocate for ensuring that future changes to continuous certification (MOC) are evidence-based and include a reduction of redundancies between medical boards and state licensing requirements.
I heard ACC, ASCO and ACP are developing alternative assessment programs that may be approved by ABIM. Is ACR planning to develop a program for rheumatologists with ABIM?
The American College of Cardiology (ACC), the American College of Physicians (ACP), and the American Society of Clinical Oncology (ASCO) have agreed with ABIM to develop alternate MOC pathways. It is our understanding that details of these pathways are in various stages. The ACR had previously discussed with ABIM leadership the feasibility of piloting a program similar to ABAI’s CAP within the ABIM structure. The ABIM indicated that a journal based assessment does not align with ABIM’s MOC principles. Based on ABIM’s feedback, the ACR does not believe it is feasible for the ACR to develop a CAP or a similar unique innovative program that will meet the needs of rheumatologists within the ABIM structure.
Can the ACR certify rheumatologists?
No. The ACR is not an ABMS certifying Member Board. The ACR does not and will not have the ability to provide rheumatology certification. ABIM and ABAI are both ABMS certifying Member Boards.
Who is ABMS?
In 1933, the ABMS was established with the goal of building a national system of standards for recognizing specialists and providing information to the public. Today, the ABMS in partnership with its 24 certifying Member Boards provides the professional and educational standards for medical specialty practice and certification of physician diplomates.
What is difference between licensure and certification?
All physicians in the United States must be licensed in order to practice medicine, but they are not required to be board certified. A license is issued by the physician’s state medical board. In contrast, board certification is issued by an ABMS certifying Member Board where the requirements go above and beyond licensing requirements. Board certification is a voluntary process and is not mandated by law. However, physicians have reported certification has been used as a requirement by payers, employers, and hospitals.
What is the value of certification?
It has been a long-held view that earning and maintaining certification through an ABMS Member Board, demonstrates a physician’s commitment to achieve expertise in a particular medical specialty or subspecialty, and to then continually update his or her knowledge throughout the course of their career. The guiding principles of ABMS, ABIM, and ABAI all uphold that the achievement of certification indicates that the physician has demonstrated that they have the clinical judgment, skills and attitudes essential for the delivery of excellent patient care and public service. The ACR believes rheumatologists and the public continue to support and value specialty and subspecialty board certification in rheumatology and is committed to ensuring the credential is meaningful and relevant.
How do the ABMS MOC Standards impact this discussion?
The ABMS Program for MOC was established to serve patients, families, and communities of the United States (the Public) and to improve patient care by establishing high standards for ongoing learning, practice improvement, and assessment activities of diplomates who have achieved initial certification from one or more of the 24 ABMS Member Boards. Both ABIM and ABAI are ABMS Member Boards and therefore their MOC programs must meet the ABMS Standards in a manner consistent with the letter and spirit of the standards and consistent with the specifics of the relevant specialty. The standards for ABMS Programs for MOC are common across the ABMS Member Boards while permitting relevant distinctions in programs among the specialties.
The ABMS Program for MOC incorporates the six ABMS/ACGME Core Competencies of Practice-based Learning & Improvement; Patient Care & Procedural Skills; Systems-based Practice; Medical Knowledge; Interpersonal & Communication Skills; and Professionalism. It has an integrated four-part framework that addresses; (1) Professional Standing and Professionalism; (2) Lifelong Learning and Self-Assessment; (3) Assessment of Knowledge, Skills, and Judgment; and (4) Improvement in Medical Practice.
See MOC FAQs Part 2 and 4 below or the comparison chart to better understand how ABIM and ABAI has responded to the standards.
What is the ABMS commission and will it impact rheumatology certification?
The goal of the ABMS Continuing Board Certification: Vision for the Future Commission is to provide a set of recommendations regarding the future of continuing board certification for consideration by ABMS. ACR President, David I. Daikh, MD, PhD, provided testimony to the Commission in March 2018 and requested appropriate standardization across the ABMS certifying Member Boards, assurance that ongoing certification is relevant to the practices of physicians without undue burden, and that necessary changes will be implemented in a timely manner. Read testimony.
At this stage, it is not known what changes will be recommended or adopted. The Commission is expected to release a draft report for public comment in November 2018, and a final report will be sent to ABMS in February 2019.
Who is ABAI?
ABAI is an ABMS certifying Member Board. The ABAI was founded in 1971 and is a conjoint board with the ABIM and American Board of Pediatrics (ABP). ABIM and ABP as the parent boards, continue to have the responsibility of approving by-laws and elections for ABAI. The ABAI currently has 5,440 diplomates who are board-certified in Allergy and Immunology. If rheumatology certification were to be moved to ABAI, rheumatology diplomates would represent at least 50% of a new combined board of Allergy, Immunology, and Rheumatology.
Why did ACR contact ABAI?
In an effort to address member concerns about MOC, ACR examined options and contacted ABAI based on our shared interest in immunologically mediated diseases and an interest in learning more about ABAI’s new continuous assessment program (CAP), which primarily tests knowledge of recent medical literature. ACR and ABAI have discussed the possibility of moving rheumatology to ABAI and forming a new combined board of Allergy, Immunology and Rheumatology. As initial certification and MOC cannot be offered by separate ABMS Member Boards, the conversation has expanded beyond MOC to include initial rheumatology certification.
Over time, these discussions evolved and the ACR is gathering input and collecting feedback from the membership and key stakeholders about moving rheumatology certification from ABIM to ABAI.
What is the ABAI Continuous Assessment Program (CAP)
ABAI CAP is an online assessment program for maintenance of certification. CAP emphasizes continuous literature-based learning, allowing diplomates to determine when and where they would like to answer questions. Instead of a single exam day that may require months of preparation, physicians may test as they go. ABAI designed CAP as an alternative to their 10-year secure exam.
What is the process of moving rheumatology certification to the ABAI?
The ultimate decision to move rheumatology from ABIM to ABAI requires ABMS approval. If an application is submitted to the ABMS, the review process is expected to take 6-12 months from the application submission date. If the application is approved, it is expected that it will take 12-18 months for the rheumatology committee to prepare a new rheumatology initial certification exam and CAP program for rheumatology.
What are the implications of moving rheumatology certification and MOC to ABAI?
ABAI’s Continuous Assessment Program (CAP) is based on 40 questions; 30 questions come from 10 recently published medical articles that the physician chooses from a pool of 12-15 articles and 10 are general knowledge questions. This model appears to address many of the learning goals directly expressed by ACR members, while also providing a meaningful pathway for rheumatologists to demonstrate continuous professional development. However, there are other factors to consider including how moving certification (which includes both initial certification and MOC) to a new Board may impact the field of rheumatology and the patients we serve. There are also several unknowns at this stage, including future program changes and cost. See Other Certification Considerations.
Is it feasible to move rheumatology certification to ABAI to form a new Board of Allergy, Immunology and Rheumatology?
Both ACR and ABAI believe it is feasible. However, at this stage it is important we hear from all stakeholders to better inform the discussion.
ABAI is “conjoint board”- what does this mean?
A Conjoint Board resembles a Primary Board in that it is separately incorporated and has similar responsibility for determination of requirements for certification, accepting candidates for certification, administering examinations, and issuing certificates. A Conjoint Board differs from a Primary Board in that it is established and functions under the joint sponsorship of not less than two (2) Primary Boards. The purpose of a Conjoint Board is to set training standards and evaluate the qualifications of individual candidates in an area of specialty practice common to the sponsoring groups. Applicants for certification by a Conjoint Board must complete satisfactorily a preliminary training program acceptable to at least one (1) of the sponsoring boards and to the Conjoint Board in order to be considered for examination by the Conjoint Board." The ABAI is sponsored by the American Board of Internal Medicine (ABIM) and the American Board of Pediatrics (ABP). If ABAI expands their existing board to include rheumatology, ABAI would pursue a conjoint board within the ABMS framework. ABIM would continue to manage initial certification and MOC for internal medicine. For qualified applicants (those who received ABIM internal medicine certification), initial certification and MOC for rheumatology would move to ABAI.
I maintain both internal medicine and rheumatology certifications. How will a move to ABAI impact me?
The ABIM would continue to provide initial certification and MOC for internal medicine. Currently, ABIM works closely with other certifying ABMS Boards to streamline the MOC process for physicians who are board-certified by multiple Boards by offering reciprocal credit. It may be possible for your internal medicine ABIM MOC point requirements to be waived if your certification is current and you are meeting the ABAI Continuous Assessment Program (CAP) requirements. The process for rheumatologists who choose to maintain their internal medicine certification through ABIM would be determined in the event of moving rheumatology certification to ABAI. Review ABIM reciprocal credit policy.
I recertified with ABIM 2018 and don’t need to take another exam until 2028. If rheumatology moves to ABAI will I have to do a CAP assessment immediately or can I wait until 2028?
ACR envisions that a limited transitional period between ABIM and ABAI will be offered. However, ABAI does not offer an optional 10-year MOC exam, so most rheumatologists would begin to participate in the CAP immediately. The transitional plan needs to be included in the application to ABMS. Therefore, if the discussion moves forward, the ACR will update this information.
I understand the ABAI CAP program launched in 2018 and is a pilot program. Does this mean the program may change?
Any changes made to an MOC program by an ABMS Member Board must be instituted as a pilot per the ABMS prior to full approval. ACR anticipates that all programs will continue to evolve as the practice of medicine changes; however, the details of such evolution or the timeline for any changes cannot be determined.
When was the ABAI CAP launched and what has been the experience so far?
The ABAI CAP pilot was instituted in January 2018 and replaces the 10-year MOC examination. ABAI has reported that diplomates are actively engaged in the program and providing positive feedback.
If rheumatology certification moves to ABAI, does that mean allergy/immunology questions will be included on the assessments?
No. Questions for the initial certification examination and the MOC assessments will be written by rheumatologists and will consist solely of questions that are applicable to the practice of rheumatology.
If rheumatology certification moves to ABAI, will I now be considered an allergist?
No. Diplomates who are certified in the subspecialty of rheumatology are rheumatologists, regardless of whether they are certified by ABAI or ABIM.
Will a move to ABAI impact rheumatology training programs?
During this exploration phase, the ACR will seek to better understand if a change in the rheumatology certifying board could positively or negatively impact rheumatology training including the recruitment of medical students and residents into the field. ACR will provide an update once we have analyzed the survey data and gathered additional information from rheumatology program directors and division directors.
If rheumatology moves to ABAI, who will develop the initial rheumatology certification exam?
If rheumatology moves to ABAI a new pathway for initial rheumatology certification would need to be established within ABAI. Rheumatology certification would still be in the subspecialty of rheumatology (not allergy and immunology). The initial certification exam for rheumatology would be prepared by a test writing committee consisting of rheumatologists and ABAI experts in psychometrics (methods of testing validity). Certification in internal medicine by ABIM and passing the ABAI initial rheumatology certification exam would be required to become certified in the subspecialty of rheumatology. Allergy and immunology would remain completely separate with initial certification and MOC continuing to be prepared by experts in allergy and immunology.
Would having rheumatology certification/MOC placed within ABAI impact the standing of rheumatologists in either academic or practice settings?
During this exploration phase, the ACR will seek to better understand if changes in rheumatology certification could positively or negatively professional standings. Considerations include on one hand whether staying with ABIM would be beneficial for rheumatology by remaining within the core of internal medicine; and on the other hand whether moving to ABAI may establish greater positioning for rheumatologists as the foremost experts in the care of immunologic disease and musculoskeletal medicine and open venues for additional scientific collaborations. ACR will provide an update once we have analyzed the survey data and gathered additional information from all stakeholders. See Other Certification Considerations.
Will a move to ABAI impact rheumatology rotations for medical students and residents?
During this exploration phase, the ACR will seek to better understand if changes in rheumatology certification could positively or negatively rotations in rheumatology. ACR will provide an update once we have analyzed the survey data and gathered additional information from all stakeholders. As we are currently just exploring this option there are several unknowns. See Other Certification Considerations.
Who is ABIM?
ABIM is an ABMS certifying Member Board. ABIM governs internal medicine and its 20 subspecialties. The ABIM was founded in 1936, with certification in the subspecialty of rheumatology first offered in 1971. The ABIM is a non-profit, independent evaluation organization. ABIM is accountable to both the medical profession and to the public. ABIM is not a membership society. Rheumatology diplomates represent 3% of ABIM’s total diplomates.
What changes has the ABIM recently made to its MOC program?
ABIM has made several changes to its MOC program since this was initiated in 1990. The most significant recent change is that beginning in 2019 rheumatologists can choose to take a shorter assessment (90 multiple choice questions) every two years rather than the 10-year exam (240 multiple choice questions). The two-year “knowledge check-in” option can be completed at home or office but will be video proctored. The two-year knowledge check-in will only be offered on certain days. The assessment is timed, allowing approximately 2 minutes per questions and all questions must be completed in one sitting. Pass/fail results will be available immediately afterward. A report grouped by disease areas will be issued at a later date regarding answer errors, but this report will not provide feedback on specific missed questions. The 10-year exam will remain an option. Partial access to UpToDate will be available as a resource during the two-year knowledge check-in and the 10-year exam and is currently the only permitted resource. You can read more about the other changes and ABIM’s MOC FAQs.
Is ABIM considering additional changes to its MOC program?
ABIM is exploring offering additional resources beyond UpToDate for both the two-year knowledge check-in and the 10-year exam. ABIM has also indicated they are exploring the development of assessments that focus on a subset of knowledge relevant to clinical practice. Rather than covering the entire breadth of the discipline in every assessment, an assessment would provide questions on only certain disease areas that over the 10-year cycle would continue to cover the entire discipline under the ABIM blueprint. If ABIM introduces these options we do not know if they will be available for rheumatology. Learn more about ABIMs changes.
If rheumatology moves to ABAI, can I continued to be certified in rheumatology by ABIM?
The ABMS requires that only one Member Board offer certification for each specialty/subspecialty and does not allow initial certification and recertification to be separated. Therefore, it is the ACR’s understanding that this will not be possible.
I have already prepaid for 10-years with ABIM. If rheumatology moves to ABAI will I be reimbursed or receive a credit?
ACR is tracking this as an important issue that would need to be resolved. As soon as we have accurate information, we will provide an update. Learn more about ABIM’s fee structure.
My ABIM certification is due to expire soon. Should I wait until a decision is made to enroll in ABIM’s MOC program?
At the current time, rheumatology certification remains with ABIM and the ACR encourages rheumatology diplomates to enroll in MOC before your certification expires. The ultimate decision to move rheumatology from ABIM to ABAI requires ABMS approval. If an application is submitted to the ABMS the review process is expected to take 6-12 months from application submission date. If the application is approved it is expected the ABAI testing writing committee will take 12-18 months to develop an initial certification exam and a Continuous Assessment Program (CAP) program for rheumatology. At this stage, the ACR is only exploring the option of moving rheumatology from ABIM to ABAI – an application has not been prepared.
How do the ABIM and ABAI board certification programs differ?
Both ABIM and ABAI are ABMS certifying Member Boards. To review the differences please refer to the ABIM and ABAI comparison chart.
Are the diplomate fees the same?
Cost has been a significant point of discussion for ACR members and has been identified as a high priority issue to address. The ABAI fees for rheumatology would not be known until final calculations are prepared. The goal would be to keep the costs comparable to ABIM fees.
The initial subspecialty certification fees payable to ABIM are $2,255 and the fees payable to ABAI for allergy/immunology are $2,350. The annual MOC fees payable to ABIM are $275 (based on payment received in the year due) and the fees payable to ABAI for allergy/immunology are $400.
What is the timeline for a decision?
The ultimate decision to move rheumatology from ABIM to ABAI requires ABMS approval. If an application is submitted to the ABMS the review process is expected to take 6-12 months from application submission date. If the application is approved it is expected the will take 12-18 months for the rheumatology committee to prepare a new rheumatology initial certification exam and CAP program for rheumatology. At this stage, the ACR is only exploring the option of moving rheumatology from ABIM to ABAI – an application has not been prepared.
What are Part 2 and Part 4 MOC requirements?
The Part 1-4 program elements of maintenance of certification (MOC) are based on the ABMS Standards.
How will Part 2 MOC requirements be impacted if rheumatology certification moves to ABAI?
ABIM currently requires that 100 MOC points be obtained every 5 years with some points being completed every two years. The ACR has offered Part 2 ABIM MOC credit through the annual CARE modules and the annual meeting MOC activities. ABIM has instituted a program whereby an increasing number of CME programs are also eligible for MOC. ABAI requires 25 points of CME each year to meet Part 2 requirements.
How will Part 4 MOC requirements be impacted if rheumatology certification moves to ABAI?
In Feb 2015 ABIM temporarily suspended its Part 4 requirements along with the previously planned Patient safety and Patient survey modules. The future of Part 4 within ABIM remains unclear but Part 4 remains a current ABMS Standard. ABAI requires that one Part 4 activity be completed every 5 years, with a wide range of eligible programs based on options that the physician is already engaged in. Should rheumatology certification be moved to ABAI it would remain to be determined what activities would be eligible for Part 4 credit, but this could include the RISE registry.
I hold a time unlimited (lifetime) rheumatology certificate from ABIM (“grandfathered”). If rheumatology moves to ABAI will I have to enroll in ABAI’s Continuous Assessment Program?
Your lifetime certification from the ABIM will not be revoked. MOC is a voluntary process for time-unlimited certificate holders. ABAI will not "revoke" a time unlimited certificate for failure to participate in MOC, however, the diplomate will be reported in ABMS and ABAI databases as "Not Meeting MOC Requirements" which is similar to ABIM.
Will Pediatric Rheumatology move to ABAI?
The ACR’s discussions with ABAI have been limited to certification of adult rheumatology. If a decision to submit an application to ABMS is made, it will be limited to adult rheumatology. The American Board of Pediatrics (ABP) will continue to certify pediatric rheumatology.
If rheumatology moves to ABAI, would this change impact ABIM’s dual certification in rheumatology and allergy and immunology?
The ACR does not believe ABIM would have any need to change this process. ABIM’s current dual certification in rheumatology and allergy and immunology requires a minimum of three years of training which must include: (1) at least 12 months of clinical rheumatology training supervised by the director of an accredited rheumatology training program; (2) 18 consecutive months of rheumatology continuity clinic; and (3) at least 18 months of allergy and immunology training supervised by the training program director of an accredited program in allergy and immunology. Learn more about dual certification.
How can I make my voice be heard about rheumatology certification and the ABIM or ABAI options ?
Please complete the membership survey! This was developed because the ACR wants and values your feedback about this critical process that impacts you and your patients. We encourage you to share your thoughts and concerns directly with the ACR. You can submit questions and comments directly to the ACR at firstname.lastname@example.org at any time throughout the process.
Updated June 6, 2018