Letter From a Cleveland Jail to the ABIM: MOC Madness

Mikkael Sekeres, MD, MS
Director of the Leukemia Program at the Cleveland Clinic in Cleveland, Ohio

American Board of Internal Medicine
Philadelphia, PA

March 2016

Dear ABIM,

Got your last email.

Are you just not that into me anymore?

There it sat, an unsightly wart amidst the usual compelling missives occupying my Outlook inbox, with the subject header: “Important update about your certification status.” I opened the message immediately, because you said it was important.

You didn’t beat around the bush. No elaborate salutations, or inquiries into the general well-being of me or my family.

“We want to let you know that on 2/1/16 your certification status changed because one or more of your Maintenance of Certification (MOC) requirements was not met by 12/31/15.”

My God. The hot, steaming cup of coffee I was holding slipped out of my hand and into my lap. I didn’t even flinch. You continued, trying to soften the blow, but it was too late.

“We understand how busy you are and encourage you to view your MOC Status Report to learn how you can fulfill any outstanding requirements.”

“Encourage.” It sounded so encouraging, like maybe there was a glimmer of hope for me. And you said that you understand how busy I am – almost as if you really know me. I am a busy guy, after all. Some days, I don’t even have time for hot, steaming cup of coffee. I drink it lukewarm.

I kept reading, but your message ended there. No closing remarks. No “Warm regards,” or “Best,” or “Your friend.” Not even a “Sincerely.” Just a cursory “© 2016 American Board of Internal Medicine.”

Wow. I tried to reconstruct the events over the past few months: I had completed a practice assessment activity with a bunch of my colleagues. We instituted processes in our emergency department that led to patients with fever and neutropenia receiving their antibiotics four times faster than they had in the past and even cut the length of their hospitalizations by a full day. We did this because our patients told us there was a problem and we listened to them – not because you told us we had to complete a practice assessment project. We published the results in the Journal of Oncology Practice and submitted this module to ABIM in October 2015.1

Wasn’t that good enough for you?

I decided to give you a call. We don’t talk often enough, anyway. I held for the next available representative and you treated me to 15 minutes of music that sounded like Enya on a pretty bad bender. Finally, your representative was available to assist me, which was awesome.

I explained to her what had happened. She seemed perplexed, and, after much cogitating, came to the conclusion that it appeared that ABIM hadn’t posted the credit I should have received for my activity on my ABIM home page.

“I know,” I told your available representative. “That’s why I’m calling.”

I was told it was a “technical problem.” Had the other 12 people who participated in the quality improvement project received credit from you? It turns out they all had.

Now, I don’t tend to be the paranoid type, but it seems odd to me that the only person from our project subjected to “technical problems” preventing him from getting credit for his MOC activity was also the only person who has been writing you yearly letters informing you about your shortcomings.

Probably just a coincidence though, huh?

Your available representative promised me a colleague of hers would “look into the matter,” and that my credit would be posted in the next day or two.

In the meantime, I was considered Board Certified, but not participating in the MOC program.

Would anybody notice?

I went to see some of my patients in clinic. Was it my imagination, or were they looking at me funny – as if they questioned my ability to practice either hematology or oncology at an MOC level of competence? I started to doubt myself. What was that regimen we used to treat acute myeloid leukemia? 7 + 2? 8 + 9? Was there an 11 in it?!

That night, I called my mother. I could tell by the tone in her voice that she knew I had let my MOC participation lapse. I had become lesser in her eyes. She sounded so disappointed; I was sure this was all about my being an MOC reprobate – never mind that I had forgotten to send her flowers for Valentine’s Day.

This continued for days, as my reputation in the greater hematology and oncology community probably sunk to levels lower than Chris Christie’s standing in the Republican presidential nomination polls. I kept calling you to check on my MOC status, and you kept claiming continued technical problems in acknowledging my credit.

Finally, a week later, you dropped me a quick note:

“Congratulations!” You said. “You have successfully completed the following activity for ABIM MOC points.”

My lukewarm cup of coffee dropped from my hand and into my lap as I raised my arms into the air to exclaim “Hallelujah! I am an MOC participant once again!”

Tears of joy fell from my eyes as I kept reading your email. I could log onto your website to view my MOC activities, and, if I wanted to talk again, I could call you between the hours of 8:30 a.m. to 8 p.m. (EST) Monday through Friday, or Saturday morning. I could even email you.

What glory, to be in your good graces once again!

I wish I could say that, in the end, the catharsis of your acceptance was worth the emotional rollercoaster you put me through.

But it wasn’t, ABIM.

Because in the end, participation in the MOC program doesn’t correlate with the quality of care I provide my patients, or my medical knowledge, or whether or not I’m a good person.

It’s just another box I have to check.


Mikkael A. Sekeres, MD, MS
Board-certified through 2022


  1. Keng MK, Thallner EA, Elson P, et al. Reducing time to antibiotic administration for febrile neutropenia in the emergency department. J Oncol Pract. 2015;11:450-5.

The content of the Editor’s Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated.

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