Is greater participation in maintenance of certification associated with a decrease in malpractice litigation or medical board disciplinary actions?

Objectives: With much attention focused on medical errors and patient safety issues, maintenance of certification (MOC) is recognized as one professional response to the need for public accountability. There have been few studies used information from malpractice claims and medical licensure databases to study its relationship with MOC participation. We examine whether internal medicine MOC contributes to lowering overall malpractice litigation and state medical board disciplinary actions in internal medicine.

Methods: The analyses are conducted using the American Board of Internal Medicine (ABIM) certification files linked to data from the National Practitioner Data Bank and the Disciplinary Alert Notification System from 2000 through 2010. In our main analysis, we aggregate MOC rates by state and year and test whether five years lagged average in MOC rates related to subsequent state-level malpractice litigation and medical board disciplinary actions. Malpractice litigation is measured by number of malpractice claims and median damage amounts awarded, while medical board disciplinary actions is measured by number of adverse action reports in each state. Using physician-level logistic regression models, we also conduct additional analyses to estimate the effect of completing the MOC program on the likelihood of an internist having any adverse disciplinary action reports. 56,953 internists whose last initial certificate was granted between 1990 and 1999 are included in the analysis.

Results: The main results show that increases in state-level MOC rates significantly decrease the number of malpractice claims. A one percentage point increase in MOC rates in state is associated with a 3.7 percent decrease in the number of overall malpractice claims (p<0.01). There is no significant difference in the size of malpractice payment amounts and adverse disciplinary actions. However, the results from the physician-level analyses show that there is a significant lower likelihood of having any adverse disciplinary actions for those who completed the MOC program. An internist who completed the MOC program is 89% less likely to ever get suspended (OR 0.11, 95% CI 0.09 to 0.14), and 95% less likely to ever get revoked (OR 0.05, 95% CI 0.03 to 0.09).

Conclusions: Higher rates of completing the MOC program in a state are associated with lowering the frequency of malpractice claims, but not the severity of liability claims and medical board disciplinary actions. As medical specialty boards try to promote quality of care through MOC for all physicians, an association between board MOC status and physician performance needs to be validated.