Every significant policy in healthcare is meant to be grounded in evidence. We monitor results for new medications, instruments, and interventions. We evaluate hospital mortality, infection statistics, and compliance with protocols. However, one of the most resource-intensive and costly physician initiatives, Maintenance of Certification (MOC), has not been subjected to that same level of scrutiny.

For many years, the American Board of Internal Medicine (ABIM) and other specialty organizations have maintained that recertification benefits patients by ensuring physicians stay informed. It’s a persuasive narrative. Yet after extensive research, the reality is much murkier: There’s limited reliable evidence that involvement in MOC, including testing or point acquisition, enhances our practice or improves patient outcomes.

A statement without verification

When the MOC framework was established, its rationale seemed obvious. Medicine evolves swiftly; physicians need to continue learning; thus, regular testing and structured education should enhance our clinical abilities.

The flaw lies not in that reasoning but in the absence of verification.

The majority of studies referenced by ABIM and the American Board of Medical Specialties (ABMS) are either observational or correlational. They indicate that physicians who are board certified (as opposed to those never certified) occasionally achieve better scores on guideline adherence metrics. But this does not constitute proof that MOC itself, with its ongoing recertification periods, fees, and quizzes, improves patient care. It’s akin to asserting that gym memberships enhance fitness without evaluating who genuinely exercises.

No significant randomized, longitudinal, or outcomes-focused studies have demonstrated that physicians actively participating in MOC achieve statistically significant better patient outcomes compared to their non-participating counterparts.

A few studies, modest signs

Proponents frequently reference a small number of studies indicating potential benefits. One 2008 analysis published in Annals of Internal Medicine discovered that internists who scored better on MOC exams tended to provide somewhat improved diabetes and hypertension care for Medicare patients. Another, more recent study highlighted minor variances in preventive care indicators among physicians who had recently recertified.

While those findings are noteworthy, they do not provide a conclusive argument. Both studies were conducted prior to the current longitudinal MOC frameworks and depend on proxy outcomes (such as lab testing frequencies) rather than concrete clinical endpoints like mortality, complication rates, or readmission rates.

Conversely, more extensive reviews have revealed no consistent differences in patient results between physicians who maintain their certification and those who do not, particularly among those with significant clinical experience. To date, the connection between MOC and improved patient care seems to be at best flimsy.

Meanwhile, the burden increases

Let’s envision a few physicians stuck between ideals and practical execution.

Dr. Malik, an internist in his 40s, diligently completes his LKA questions each quarter. He finds some intellectually stimulating; a well-crafted question can inspire a brief review of guidelines. More often, however, he encounters material unrelated to his daily practice. “It’s not that I don’t want to continue learning,” he states. “I just want to invest time into something relevant, not a pop quiz on inpatient nephrology while I’m an outpatient gastroenterologist.”

Then there is Dr. Rivera, a hospitalist busy in a metropolitan center. She is enrolled in two separate longitudinal MOC programs, one for internal medicine and another for her subspecialty. Between clinical responsibilities, hospital-required CME, and MOC requirements, she estimates dedicating about 150 hours annually to compliance efforts. That equates to nearly a month of full-time work, none of which has been proven to enhance outcomes or decrease medical errors.

These are common narratives in 2025. The original aim of MOC, which is lifelong learning, has been overwhelmed by a culture of constant testing and administrative tasks.

The issue with surrogate metrics

The healthcare field values metrics, but MOC relies on inappropriate ones.

Completing an online quiz or gathering CME points does not equate to establishing competence. Genuine competence is reflected in clinical reasoning, diagnostic precision, and patient communication—factors that cannot be assessed through multiple-choice questions.

If we were to create a genuinely outcomes-based maintenance system, we would examine indicators that truly matter: rates of missed cancer diagnoses, preventable readmissions, incidents of patient safety concerns, and adherence to contemporary treatment standards. Instead, we depend on documentation, logins, and fees. It’s as though the system confuses measuring education with gauging impact.

What the data could show, if we took the effort to gather it

The irony is that we possess the tools necessary to evaluate if MOC is effective. With interconnected electronic health records, outcome registries, and performance data at the physician level, we could finally investigate whether maintaining certification influences measurable outcomes.

Imagine if every physician’s certification status could be anonymously connected to actual patient metrics: screening rates, safety data for procedures, chronic disease management. Over a decade, we could empirically determine whether physicians involved in structured maintenance provide superior care.

However, the boards have not conducted that research. Nor have they made their data available for independent examination. Without transparency, we are left with speculation, not substantiated evidence.