As Sun Tzu taught, “victorious warriors win first and then go to war, while defeated warriors go to war first and then seek to win.” As orthopaedic surgeons, we are challenged with foes in the form of musculoskeletal pathology that demand our knowledge and treatment. To be victorious, we must empower ourselves with the ever-expanding knowledge of these conditions and the ever-evolving techniques used to treat them. Failure is not an option, as defeat means not only a loss for us but for our patients as well. To that end, we must prepare and assess ourselves through continuous learning and feedback.
Since 1986, the American Board of Orthopaedic Surgery (ABOS), our specialty’s branch of the American Board of Medical Specialties (ABMS), has overseen the Maintenance of Certification (MOC) program. In its current form, the ABOS MOC allows us to individually tailor our development to our own needs while simultaneously providing feedback through evaluation over a 10-year period. Recently the cost of MOC across medical specialties has drawn increasing attention.
In a recent report in JBJS, LaVigne et al. estimate the costs of each of the MOC’s potential pathways on the basis of their time costs and fees. To account for time, the authors distributed a survey asking respondents to select which pathway they chose and to provide estimates on the amount of time spent performing various components. This survey was only distributed to a single state’s orthopaedic society and yielded only 33 responses for inclusion. Leveraging previous reports, the authors then determined the average hourly rate of compensation for orthopaedic surgeons. Merging this hourly compensation and the obtained time estimates, they were able to estimate the time cost of each pathway. Although most fees were established, the Continuous Medical Education (CME) fee was calculated from the Accreditation Council for Continuing Medical Education’s (ACCME’s) total income from CME in 2010 divided by the approximately 850,000 licensed physicians in 2010.
The authors calculated the average orthopaedic surgeon’s total 10-year costs of MOC to be $71,440.61 for the oral examination pathway, $80,392.78 for the written examination pathway (with dedicated study and review course), $68,871.78 for the written examination pathway (without dedicated study and review course), and $69,721.04 for the ABOS Web-Based Longitudinal Assessment (WLA) pathway.
While cost represents one side of the coin and is that which must be paid to obtain something, worth represents the other side and is that which is obtained in return. The value of continuing education, skill development, and even camaraderie or professional networking gained through CME and professional meetings must also be considered. So too the value of board certification as determined by an assessment of potential costs imposed on surgeon, patient, and society by negative outcomes at the hands of a surgeon who is not board certified.
At the same time, while orthopaedic surgeons are among the best-compensated specialists, we must also acknowledge that some of us, military surgeons for example, are not compensated with competitivecontracts, rewarded with robust surgical volumes, or reimbursed for regular fees. Given this and basic principles of finance, this study and others like it will continue to push the ABOS to evolve and develop new strategies that maintain our professional standard, minimize cost, and provide considerable value to us, our patients, and society at large.
David Vizurraga, MD is a San Antonio-based orthopaedic surgeon specializing in adult hip and knee reconstruction and a member of the JBJS Social Media Advisory Board.