If you make things too onerous, there will be pushback. My boss has the American Board, and every few years he has to go over the States and sit a MOC exam. From their website.

Maintenance of Certification program participation includes meeting all four components of the MOC Program. Diplomates are only required to complete one set of MOC activity requirements (CME, SA and PIP activities) for all specialties/subspecialties in which a physician is certified.

Certification in the subspecialties (with the exception of child and adolescent psychiatry) are dependent upon the primary specialty. Diplomates must maintain certification in their specialty in order to maintain certification in the area of subspecialization.

Diplomates must sit for a MOC examination at least once every 10 years for each certification they hold. Diplomates who have multiple certifications may elect to take a Combined MOC exam.

Diplomates who do not maintain their certification according to the requirements of the MOC program in which they are enrolled are no longer certified.

Diplomates are required to update their Clinical Activity Status information in their Folios account ‘Diplomates Information and Status” section.

By way of contrast, here is the British College: the local college is somewhere in between.

The College has approved new guidance Continuing Professional Development – Guidance for Psychiatrists (OP98) which replaces the previous guidance document (College Report 157).

Key developments in the new guidance include:

Psychiatrists involved in any clinical practice will need to undertake at least 30 hours of ‘Clinical’ CPD each year to be in good standing with the College. This is out of a total of at least 50 hours of peer group-approved CPD activity each year.
There is no requirement to undertake specific amounts of ‘internal’ or ‘external’ CPD but the peer group should support the psychiatrist to access learning in the most appropriate way.
During periods of extended leave (sick leave, parental leave or other career breaks), the psychiatrist can either continue to meet the requirements of the College’s CPD scheme or ‘stop the clock’ and resume their CPD on their return to their work. In these circumstances, a certificate of good standing will not be issued.
Reading, if accompanied by evidence of appropriate reflection can count for up to 5 of the maximum 25 credits allowed for e-learning.

What has happened is that the American Psychiatric Association is beginning a rebellion. It is stating that board certification should not be considered in promotion and appointments because the requirements are too onerous and not related to clinical practice. The educationalists are being ignored.

Decisions regarding physician licensure, hospital privileges, credentialing, or participation in insurance panels shall not in any way be contingent on completion of or participation in Maintenance of Certification (MOC).

That’s the policy approved by APA’s Board of Trustees at its meeting in Washington, D.C., last month. During the meeting, the Board also addressed physician burnout and wellness and updating of DSM-5, and approved policy opposing restrictions on international medical graduates (IMGs) entering U.S. graduate medical training and legislative attempts to permit pharmacists to alter prescriptions, among other issues.

The position statement on MOC was approved in response to an action paper by the Assembly in May and to widespread concern about MOC, especially the Part IV Performance in Practice component (also known as Improvement in Medical Practice). “Performance in Practice” refers to a requirement that physicians build into their routine practice the capacity to assess their performance continually against guidelines for best practices and make improvements to meet those guidelines.

“APA is strongly supportive of life-long learning for all physicians,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “However, many members have expressed their frustration with the current structure of MOC, many of whose requirements are unnecessarily burdensome and often irrelevant to clinical practice. We are committed to working with the American Board of Psychiatry and Neurology to improve MOC. In the meantime, however, we strongly oppose any attempt to penalize physicians for licensure or credentialing purposes for failure to participate in or complete MOC.”

APA President Anita Everett, M.D., echoed those comments. “This is an issue of professional satisfaction and physician well-being,” she said. “Physicians are alre ady burdened with administrative and other requirements unrelated to taking care of patients. Maintenance of Certification is a major concern for physicians of all disciplines, contributing significantly to professional dissatisfaction and burnout. It is unacceptable for licensing or other bodies to use MOC as a criterion for licensing, hospital privileges, or insurance empanelment.”

Everett has made addressing physician burnout and wellness a major priority of her presidential year.

The risk here is that over regulation and reliance on paperwork and over credentialing will not improve care. We need to continually recall that Harold Shipman, before he hung himself in prison awaiting sentencing for the murder of many patients, had a perfect CPD record.

One has to keep up to date, but this has to be achievable. The American Board has made it hard: difficult to manage in private work, and the consequences are that many will opt out and do nothing.

It is better to have something that is reasonable and not perfect that can be managed within the clinical week. Again, the educationalists, in trying to make something perfect, have made it unfit for purpose.