American Society of Plastic Surgeons
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Lawsuit challenges MOC as ABMS opens public comment period for future of continuing board certification

Four internists on Dec. 6 filed a class-action antitrust lawsuit in U.S. District Court for the Eastern District of Pennsylvania on behalf of more than 100,000 internal medicine physicians, alleging that the American Board of Internal Medicine (ABIM) has engaged in the creation and maintenance of a monopoly relating to maintenance of certification (MOC).

The lawsuit alleges that ABIM illegally ties its initial board certification to MOC exams that internists and internal medicine subspecialties must pay in order to keep their certification – an effort, the suit charges, that purposely prevents competition in the certification milieu.

"To drive sales of MOC and to monopolize the market for MOC, the ABIM has forced physicians to purchase MOC, charged inflated monopoly prices for MOC, and thwarted competition in the market for MOC," the complaint reads.

The plaintiffs allege that the MOC program is designed primarily to produce revenue for the board. "One analysis projected that complying with MOC costs internists an average of $23,607 in money and time over a 10-year period, with costs up to $40,495 for some specialists," the suit states.

It asks the court to rule ABIM's actions illegal; to halt any further such monopolistic action; and to award damages to the plantiffs and the class, as well as court costs (where and when applicable).

ABIM expressed disappointment in the filing and said in a statement that it will "vigorously defend itself, recognizing that doing so will consume resources far better dedicated to continuous improvement of its programs."

The timing of the lawsuit coincides with the launch of the public comment period for The Continuing Board Certification: Vision for the Future Commission, an effort to provide a set of recommendations about the future of continuing board by the American Board of Medical Specialties (ABMS).

The commission was announced in October 2017, with ABMS saying it wanted to "ensure a continuing board-certification program that remains relevant and meaningful to physicians and the patients they serve." In addition to reviewing published literature, reports and testimony, as well as convening meetings and gathering data, the public comment period opened Tuesday and will run through Jan. 15, 2019. More information is available at

ABMS itself was the target of a similar legal challenge in 2015 when the Association of American Physicians and Surgeons filed a class-action suit accusing the organization of antitrust law violation and deceptive trade practices related to MOC. Although the suit was found to be without merit and dismissed in federal court in 2017, AAPS filed an amended lawsuit in January 2018 that's still under review.

In a recent interview with PSN, ABMS President and CEO Richard Hawkins, MD, made clear that board certification or continuing certification should not be a requirement to obtain a medical license, but added that he understands some of the criticism directed at MOC. Dr. Hawkins added that the organization is committed to working with physicians in practice to figure out how to create programs that are integrated into their practice.