CHICAGO -- Demonstrating its opposition to any mandatory physician secured recertification exam, the American Medical Association House of Delegates on Wednesday called for any certifying boards that still use such exams to "immediately" end these "high stakes" tests.

"There are a lot of problems related to these recertifying examinations," said Corey Howard, MD, from Naples, Florida.

"They (certifying boards) want a test that's valuable, do-able and tolerable. Well, when they create a test they say has got to be tolerable, that's a real question," Howard said. "Regardless of the profession, healthcare, law enforcement, education or accounting, there's no certification that guarantees performance or positive outcomes ... We are doing everything we can to make sure that this process that we learn from is the best it can be. This test, this secured test, really does not help our physicians, but hurts them."

The AMA house also approved a resolution to continue working with the American Board of Medical Specialties "to encourage the development by and sharing between specialty boards" of alternate ways to assess medical knowledge, other than by a secure exam. The AMA bolstered its support of using appropriate continuing medical examination courses to maintain quality assessments of doctors.

Recertification requiring physicians to maintain certification by completing educational modules at various intervals shorter than the traditional 10-year exam has been extremely controversial since more stringent requirements, and fees, were added in recent years for most of the specialty boards.

The house debated the issue at length, with special attention to the use of the words "high stakes," which means that failure to pass can result in a physician's loss of privileges or employment, and went through several amendments.

The final approved resolutions, which now are AMA policy, were:

"RESOLVED, That our American Medical Association call for the immediate end of any mandatory, secured recertifying examination by the American Board of Medical Specialties (ABMS) or other certifying organizations as part of the recertification process for all those specialties that still require a secure, high-stakes recertification examination.

"RESOLVED, That our AMA continue to work with the American Board of Medical Specialties (ABMS) to encourage the development by and the sharing between specialty boards of alternative ways to assess medical knowledge other than by a secure exam."

"RESOLVED, That our AMA continue to support the requirement of Continuing Medical Education (CME) and ongoing, quality assessments of physicians, where such CME is proven to be cost-effective and shown by evidence."

The resolution's original language stated: "MOC (maintenance of certification) programs that are intended to insure lifelong learning essentially result in lifelong testing." It added that the current ABMS MOC system "is extremely expensive when considering both time away from clinical practice and financial expenditures necessary for board review courses and materials."

Several delegates, however, opposed the house action saying it shouldn't try to do away with secure exams. "Secure simply means that it guarantees that you or the person are the person who is taking the test," said Donna Sweet, MD, of Wichita, Kansas.

Another item on the house agenda, introduced by Oran Lee Berkenstock, MD of Memphis sought to position the AMA in opposition to any policy that requires doctors to maintain certification or maintenance of certification as a condition of employment or service contract. The AMA already has such a policy, but Berkenstock said he wants the AMA to take action when any doctor's ability to practice is curtailed simply because he or she didn't complete MOC requirements.

"This is a call to action," Berkenstock said.

"The MOC program should not be a mandated requirement for licensure, credentialing, reimbursement, network participation or employment," his resolution said.

After some debate, the item was referred for further study.

In other action, the house adopted a resolution in support of more funding for graduate medical education programs, but did not specify the source of that funding. It said that federal funds have "remained stagnant" since 1997, and as a result of federal funding caps, "some institutions have received GME funding from private sources."

The house urged support of more funding in ways that "neither directly nor indirectly reduce funding levels for any other specialty." The house also called for transparency in the actual costs of residency programs, and how Graduate Medical Education (GME) funding is distributed.

The house resolution said the AMA "believes that financial transparency is essential to the sustainable future of GME funding."

It said "regardless of the method or source of payment for GME or the number of funding streams, institutions should publicly report the aggregate value of GME payments received as well as what these payments are used for, including: a. Resident salary and benefits; b. Administrative support for graduate medical education; c. Salary reimbursement for teaching staff; d. Direct educational costs for residents and fellows; and e. Institutional overhead."

The house also approved a report advocating more telemedicine training for graduate medical students. The resolution said "despite demonstrated benefits," barriers in federal and private payment policies, interoperability of electronic health records, and interstate policies and laws vary on a doctor's ability to practice with telemedicine beyond state lines. Because of these elements and others, "formalized training in the use of telemedicine in clinical practice is lacking across the educational curriculum."