Dr. Richard Baron remembers meeting a friend of his parents many years ago and hearing how the man – an internist – briefly went AWOL from the army during World War II so he could take his board exam.
The story goes that the young doctor was helping transport a patient with tuberculosis from Florida to upstate New York and jumped off the train in Philadelphia to take the exam.
Dr. Baron, who will become president and CEO of the American Board of Internal Medicine (ABIM) and the ABIM Foundation in June, said he thinks internists still take that kind of pride in board certification.
"Here’s somebody who says, ‘I want to demonstrate to myself, to my patients, that I have what it takes to do this very hard, very important work,’ " Dr. Baron said in an interview. "I think that impulse is alive and well in most internists in America."
As Dr. Baron takes over the top job at the ABIM, his first priority will be revising maintenance of certification (MOC) to make it a more continuous process.
"A 10-year cycle is simply not credible," Dr. Baron said.
Currently, physicians who wish to recertify through the ABIM must take an exam, engage in continuing medical education, and complete a series of self-evaluation modules over a 10-year period.
Other certifying boards have already taken steps toward a more continuous process. The American Board of Pediatrics, the American Board of Family Medicine, the American Board of Psychiatry and Neurology, and the American Board of Radiology have all eliminated specific "end dates" for their board-certified physicians.
The ABIM will be announcing revisions to their process over the next year.
While the move toward continuous MOC may sound daunting to some physicians, it could help the ABIM forge agreements that would ultimately reduce some of the demands on physician time, Dr. Baron said. For instance, the ABIM has been working over the last few years to make the work put into MOC count toward other quality reporting programs.
Last July, the ABIM and the Centers for Medicare and Medicaid Services announced that physicians would be able to earn bonus payments from the federal government by participating in a new voluntary program called the Physician Quality Reporting System (PQRS) Maintenance of Certification Program Incentive.
And 20 health plans now allow physicians to use their participation in MOC to qualify for the plans’ quality recognition programs.
"Part of making the credential rewarding and relevant is having it do double duty and triple duty for a variety of other initiatives and programs that are interested in gauging the performance and abilities of physicians," Dr. Baron said.
The ABIM is also working with state licensing boards to see if participation in MOC can be part of that process as well – but that’s still a work in progress, Dr. Baron said.
Fulfilling the goal of making MOC count in as many ways as possible will be one of Dr. Baron’s biggest challenges, said Dr. Steven Weinberger, the executive vice president and chief executive officer of the American College of Physicians.
"In the same way that we look to continuous quality improvement on the practice side, I think we should be looking to continuous quality improvement on the certification side and on the maintenance of certification side," he said.
Another challenge is that the U.S. health care system is running out of money, said Dr. Robert M. Wachter, chair of the ABIM board of directors.
Dr. Baron and the ABIM board will need to revise the MOC process in an era when it’s not just important to assess the quality of care, but the efficiency as well, Dr. Wachter said.
"What it looks like to be a good doctor today has to include stewardship," said Dr. Wachter, who is also the chief of hospital medicine at the University of California, San Francisco.
Dr. Baron has had plenty of experience looking at how to improve efficiency of care. In the late 1980s and early 1990s, at the height of the managed care era, Dr. Baron served as chief medical officer for Health Partners, a not-for-profit Medicaid HMO. And recently, he ran the Seamless Care Models group at the CMS Innovation Center, where he worked on models for Accountable Care Organizations.
But Dr. Baron’s primary care roots also run deep. He spent most of his nearly 30-year career practicing general internal medicine and geriatrics.
He began his career with the National Health Service Corps in the early 1980s in rural Tennessee. Later, while working for the Medical College of Pennsylvania, he established a community-based satellite practice. And in 1989, he opened his own primary care practice in Philadelphia. That practice, Greenhouse Internists, grew into a seven-physician practice with more than 10,000 patients.