American anesthesiologists certified as diplomates by the ABA after January 1, 2000, are issued a “time-limited” board certification valid for 10 years. A formal process culminating in the recertification of an anesthesiologist for an additional and then subsequent 10-year intervals has evolved and now appropriately is called “Maintenance of Certification in Anesthesiology” (MOCA). Because certification by a medical specialty board is now often expected or actually required by medical staff bylaws in order to obtain and maintain medical facility privileges, even anesthesiologists who were certified (without a time limit) prior to the year 2000 likely will be engaging in the MOCA process.

In 1999, the American Board of Medical Specialties (ABMS) initiated a process to better ensure continuing professional development of diplomates certified by the member boards. An enhancement of the traditional CME process, this initiative by the ABMS is designed to provide a transparent public system of accountability that the physician's skill and knowledge base do not wane after completion of formal training. Centered on the American Council for Graduate Medical Education core competencies of (1) patient-centered care, (2) medical knowledge, (3) interpersonal and communication skills, (4) professionalism, (5) system-based practice, and (6) practice-based learning improvement, each member board designs a curricular process to enhance and evaluate continued development of the competencies throughout the professional career of the certified clinician.

The MOCA program of the ABA has had significant evolution since its introduction (http://www.theaba.org/MOCA/MOCA-Timeline), much of which was prompted by input from participants in the program. As of the 2016 “MOCA 2.0” update, the elements of the program include Professionalism and Professional Standing; Lifelong Learning and Self-Assessment, based on CME; Assessment of Knowledge, Judgment, and Skills (based on the MOCA Minute concept that involves the anesthesiologist answering 30 questions per calendar quarter online-each of which includes an explanatory learning module-thus replacing the written examination component of the process); and Improvement in Medical Practice, for which participants complete activities (each with a point value counting toward the required total) during the 10-year cycle, demonstrating participation in practice improvement activities and evaluations of their clinical practice.

Clinicians with subspecialty training in Critical Care and Pain Medicine also have an MOCA process available. The updated version, also “MOCA 2.0,” launches in 2017 and will have many of the same type of features as regular MOCA, but oriented to the specific subspecialty.

It is reasonable to project that the MOCA process will continue to evolve and likely will become more comprehensive over time as the overall emphasis on assuring both quality and efficiency of medical care in the United States increases further due to the expectations of accrediting bodies, government regulators, third-party payers, malpractice insurers, and, above all, the public.