Primary care physicians’ perceptions of practice improvement as a professional responsibility: a cross-sectional study

Continuous quality improvement is a component of professionalism. Maintenance of Certification (MOC) is a mechanism in the USA for physicians to keep current with medical knowledge and contribute to practice improvement. Little is known about primary care physicians’ perceptions of the practice improvement (Part IV) components of MOC. We aimed to determine primary care physicians’ perceptions of their professional responsibility to participate in Part IV MOC. This was a cross-sectional study of primary care physicians using the American Medical Association Masterfile. We developed a nine-item survey, designed from expert consensus and literature to determine views on Part IV MOC as a professional responsibility. We surveyed 1500 randomly selected primary care physicians via mail from November 2014 to May 2015. The response rate was 42% (627 of 1,500): 47% (273 of 585) were family practitioners and 49% (289 of 585) were internists. Factor analysis revealed a two-factor survey, with five items pertaining to positive views of MOC Part IV and four items pertaining to negative views. Internists were more likely to view MOC Part IV as time consuming (82.0% vs. 70.3%, P = .001), expensive (50.9% vs. 38.8%, P = .004), and not relevant to practice (39.1% vs. 23.8%, P < .001). Family medicine practitioners were more likely to view MOC Part IV as improving patient care (64.5% vs. 48.8%, P < .001) and maintaining professional responsibility (48.7% vs. 32.5%, P < .001). Regardless of specialty, most physicians viewed MOC Part IV as time intensive, not beneficial for career advancement, and not a professional responsibility. Family medicine practitioners demonstrated more positive views of MOC Part IV. The difference between family medicine practitioners and internists could be related to the ABIM MOC controversy. Future changes to practice improvement requirements could focus on limiting time requirements and on clinical relevance. Abbreviations: ABIM: American Board of Internal Medicine; AMA: American Medical Association; CQI: continuous quality improvement; IRB: institutional review board; MOC: Maintenance of Certification; QI: quality improvement