The American Board of Internal Medicine (ABIM) captured attention in late 2024 when it revealed the removal of its controversial two-year Maintenance of Certification (MOC) point requirement. On the surface, this seemed like an advancement, a step towards simplicity after prolonged criticism from doctors who believed they were ensnared in a costly, time-consuming process that contributed little to their actual work. However, beneath this change lies a more challenging inquiry: Has anything genuinely shifted, or did the ABIM merely peel away one layer from a dysfunctional system that has persisted for decades?
The contemporary certification labyrinth
Let’s envision several physicians navigating today’s certification labyrinth, circumstances that reflect what many of us face annually. Dr. Patel is a mid-career gastroenterologist who completed her training in the early 2000s. Every five years, she finds herself back in the cycle: tracking points, paying fees, and logging into ABIM’s Longitudinal Knowledge Assessment (LKA). It’s a continuous hum of administrative upkeep, answering queries that may or may not capture the daily intricacies of her practice.
Meanwhile, Dr. Reynolds, who certified before 1990, never has to do any of this. He’s “boarded for life.” Identical credential, identical privileges, identical hospital staff title. One physician invests hundreds of hours substantiating ongoing competence; the other never lifts a finger. If lifelong learning truly holds significance, and it does, this disparity undermines the rationale of the system. Either the knowledge decay we fear is authentic or it isn’t. Both cannot coexist.
The CME puzzle
Next is the state licensing layer, a distinct yet equally convoluted web that nearly no one outside the medical field grasps. Each state medical board establishes its own continuing education mandates, ranging from 20 to 100 hours per renewal cycle. The content varies dramatically: opioid prescribing in one area, human trafficking awareness in another, implicit bias or domestic violence training elsewhere. Most topics are certainly valid, with few challenging that. Yet for specialists, much of this feels disconnected from the realities of subspecialty care.
Take Dr. Harris, a blend of numerous mid-career physicians working locums across various states. She maintains active licenses in Illinois, Florida, and Arizona. Each state ticks its own clock regarding CME obligations, accompanied by different reporting portals, formats, and deadlines. She estimates spending nearly 80 hours annually fulfilling mandatory CME, and not a single one of those hours automatically counts toward her ABIM MOC credit unless she pays a conversion fee or participates in a dual-certified course. It isn’t the learning that poses an issue. It’s the redundancy. The system confounds activity with competence.
When every gatekeeper demands proof
For physicians engaged in locums or telemedicine, or who retain multi-state licenses for seasonal or consulting pursuits, the cumulative load becomes overwhelming. Different states stipulate varying CME topics. Hospitals impose their own credentialing modules. Insurers add annual compliance training. Then ABIM sends its LKA reminders. Each organization seeks a checked box, an uploaded certificate, a paid fee. None communicate with one another.
A physician working across 5 states may need to monitor 5 CME renewal deadlines, 5 documentation sets, and create separate log-ins for every system. The irony is hard to overlook: We practice medicine in an age of electronic health records, telehealth, and AI-enhanced diagnostics, yet our professional maintenance continues to feel like maneuvering through a bureaucratic spreadsheet from 1995.
ABIM’s 2024 “streamlining”
When ABIM eliminated the two-year MOC point checkpoint, it characterized the move as a reduction of unnecessary bureaucratic hurdles. “The requirement didn’t offer added value,” the board stated, a commendable acknowledgment but also a telling one. That encapsulates the crux of the matter. The requirement lacked substantiating evidence from the very beginning. Moreover, there remains no published data indicating that the current model, which entails 100 points every five years and continuous participation in LKA, genuinely enhances patient care.
The LKA was intended to substitute the high-stakes, decade-long examination with something less intimidating and more ongoing. On paper, it appears more approachable: brief online question sets that can be addressed from home. However, for many, it feels like endless testing under a different guise: One more inbox reminder, one more password, one more task to complete before dinner. No randomized or longitudinal studies have confirmed that physicians enrolled in LKA achieve better outcomes or provide safer care compared to those certified through older pathways. The assumption that perpetual quizzing translates to improved practice remains unverified.