We all celebrate our anesthesiology residency and fellowship graduations. We’re finally done with scrambling to mandatory lectures at 6:15am. We’re finished with the multiple-choice question banks and cross-country oral exams. When I finished critical care fellowship, I toasted a tall glass of sparkling champagne with my friends and family, satisfied with the journey. I looked forward to the imagined freedom of post-training life.
Turns out, life after fellowship isn’t entirely like that. Although I don’t scramble to all of the 6:15am lectures, I’ll actually be giving some of them. I’ll be getting multiple choice questions weekly from the ABA. And my subspecialty exams are just around the corner. My certification as a diplomate of the American Board of Anesthesiology was just that — an initial certification. To retain my board-certified status I’ll need to meet the requirements of MOCA 2.0, the ABA’s Maintenance of Certification in Anesthesiology Program. MOCA 2.0 is how the ABA helps us stay safe and current as anesthesiologists.
All of this sounds like a lot on top of starting independent clinical practice. I’m a relentless optimizer, so I waded into the details, determined that it I wasn’t going to let MOCA 2.0 requirements take over my last bits of free time. I’m happy to report that I’ve returned triumphant, with a few key pearls that will help all of us crush our MOCA 2.0 requirements with the ruthless efficiency of a Brazilian Jujitsu master.
1. Know what you’re dealing with.
The requirements for MOCA 2.0 (here’s the original source) are detailed, but I’ve extracted the essential information here.
§ MOCA 2.0 requirements are divided into four parts.
§ Some of these requirements are due quarterly, yearly, or every 10 years.
§ A quick call to the ABA clarified that the 10 year cycle begins the day after you become board certified. That means that your 10-year cycle has a different due date from your friend’s 10-year cycle.
Ok, so here are my cliff notes to the requirements for parts 1 through 4:
MOCA 2.0, Part 1 — Medical License:
Hold an unrestricted license in at least one jurisdiction of the US or Canada. In the US, this is your state license.
MOCA 2.0, Part 2 — CME:
§ Earn 25 AMA PRA Category 1 Credits™ per year. Your credits are actually due every 10 years, but you’re not allowed to cram them all into one year.
§ Once every 10 years, makes sure that 20 credits come from an ABA-approved patient-safety activity. The Orbit CME activity is now the only ABA-approved patient safety activity that lets you earn that credit based on your browsing history.
MOCA 2.0, Part 3 — MOCA Minute:
Answer 30 questions per quarter (120 per year) from the ABA. The ABA sends this to your email inbox and has a dashboard for tracking progress and adherence to the requirement.
MOCA 2.0, Part 4 — QI:
Earn 25 points in Quality Improvement Activities every 5 years as detailed here by the ABA.
Recertification requires completion and documentation of these four parts.
2. Sweep away Parts 1 and 3 off your checklist
Let’s face it — we have plenty to deal with between patient care and life outside of work. There’s not much time left for us to meticulously review this requirements list every day. So how do we get through this?
Parts 1 is straightforward. Your state’s medical board should alert you to your renewal timing, fees, and forms. If you have questions, every state medical board has a website, and if you’re lucky, their phone number doesn’t keep you on hold for more than a few minutes.
Part 3 is also easy. The ABA sends frequent emails prompting you to answer MOCA Minute questions. When you answer questions, the ABA tracks your performance for you.
Parts 2 and 4 have plenty of room for optimization — time and money — because you’re expected to choose how you’re going to earn those credits, and how you’re going to track them for audits.
3. Knock out Part 4 QI at the enterprise level if possible
The Quality Improvement points requirement sounds like a huge hassle and yet another expense. The overall goal was noble — to get individual providers to contribute to the overall betterment of the healthcare system. Sounds great, right?!
Well, however you feel about it, there’s good news and bad news when it comes to earning these Part 4 QI points. The good news is that you don’t need to actually pay money for Part 4 QI points. There are enough free options among the activities that count for Part 4 QI points. For example, doing self-reflection about a single patient interaction and how it could have been improved qualifies you for 1 point. Presenting at M&M in front of your peers qualifies for 1 point.
The bad news? Getting credit for these activities requires documenting and tracking them, which can be a massive pain. The activities require that each individual provider record answers on ABA reporting templates. You’ll need to upload your templates to your ABA portal account. You’ll also probably want to record that in an Excel spreadsheet and set a Google calendar event to remind yourself to do more points.
If you’re part of an anesthesiology group, you may want to consider having your group sign up for Orbit’s enterprise version. Orbit coordinates the Part 4 requirement for your entire group, lets you record these templates from your phone, and shows you more templates when you need to catch up on your Part 4 credit. Since it’s customized to each user, it will track your requirements based on your specific 10-year cycle. Orbit is almost nearly set it and forget it when it comes to earning Part 4 points.
4. Crush your Part 2 CME requirements using this secret weapon — boredom not required
I saved my pearls on Part 2 for last, since we’re going to crush your Part 2 requirement in light speed. Here’s a quick preview:
You know how your colleagues shell out society fees, watch online videos, answer long multiple choice quizzes, and draw vacation time to earn CME credits? It turns out, you don’t have to do any of that to fulfill the MOCA 2.0 CME requirement as an anesthesiologist.
Orbit, a new service designed by physicians and engineers out of Palo Alto, installs in your browser and lets you convert your visits to abstracts and articles into ABA-approved patient safety credit and AMA PRA Category 1 Credit™ for Part 2 of MOCA 2.0. The credits you earn in Orbit automatically sync to your ABA Portal, and these credits are certified by Tufts University School of Medicine.
— Marissa Wagner Mery, MD, MBA