So, you have passed your medical physics board exam and put behind you one of the greatest professional challenges that you will encounter during your career.  The question arises…, “now what…?”.  Well, with or without your knowledge, you have been enrolled in a process referred to as Maintenance of Certification (MOC).  Your MOC status will be maintained and monitored by the ABR, but the process itself extends well beyond the ABR and is a non-trivial, cross-organizational system.  As a result of this, keeping your hard-earned certification in compliance can become a convoluted system that is difficult to successfully navigate.  What information you can find is often scattered over different sources with sometimes contradictory or outdated information.

Unless you know someone directly involved in the ABR’s MOC Service Division, you’ll probably even find out that your colleagues that have been involved in this process for some time don’t have a clear picture of where they stand or what they need to accomplish and in what timeline.  But, take heart; this process is digestible and take comfort in knowing that your veteran colleagues (with the exception of those that were grandfathered into lifetime certification) are trying to figure this out at the same time as you.

One of the most difficult hurdles that newly wreathed DABRs face is simply knowing where to start with this process.  This is exacerbated by the fact that there are so many MOC certifications managed by the ABR (including certifications for radiologists, radiation oncologists, nuclear medicine physicists, diagnostic physicists, radiation therapy physicists, etc.).  Each of these branches (with their respective subspecialties) all have different rules for MOC.  If you are visiting this page, then chances are that you are looking for answers as a therapeutic medical physicist.  Even with this specificity, there are still different certifications that exist (or have existed).  Some of the more notable classifications include lifetime, the 10-year cycle (otherwise known and referred to as the “valid through” certification), and the new continuous certification models.  But, we can get even more specific if we say that if you received your certification in 2012 or after, then you became automatically registered in a Continuous Certification MOC program.

If you are included in the above statement then, note that the summary provided here is our approach to compiling the information that you need to know for Continuous Certification MOC in a neat, organized, and complete manner that informs you, in clear, detailed instructions what steps to take and when.  Furthermore, we’ve included this page on the public side of ABRPhysicsHelp.com so that this resource remains available to you after you’ve succeeded in passing your medical physics board exam and are no longer in need of an ABRPhysicsHelp.com subscription.  we hope that this information helps demystify the MOC process, and, keep in mind, that MOC is an ever-evolving system so always refer to the official sources for the final word on your requirements but, of course, we will do our best to maintain an up-to-date guide.

Within this guide, you’ll find a comprehensive guide prepared for your continuous certification MOC.  The features found on the following pages include:

• An Index of Acronyms Commonly Associated with MOC

  • It can be very easy to feel as if you were drowning in a sea of acronyms for MOC.  There are a plethora of these acronyms that, as a newly drafted DABR, will become significant to you for the first time in your career.  Many of them are associated with specific tasks needed to keep you in compliance, some of them are organization-specific with the many players in this MOC theater, and some of them are simply redundant.

• A Compilation of Links to Various Resources

  • There are many resources available to help you with MOC needs, but, as we referred to in the section above, it can sometimes be difficult to determine which rules are applicable to which certification types.  In this list of resources, we will limit the list to keep the links to those of interest for continuous certification type certificates, and we will define, as best as we can, what significance the link holds for you.

• A Simple Summary of the MOC Components

  • This will include discussion on each components' significance and what you need to do to satisfy the requirements for each component.

• Timelines

  • And road-signs that will help keep you on the right track to satisfy the statement on your new certificate that reads, “...ongoing certification is contingent upon meeting the requirements of Maintenance of Certification.”  This is the first MOC program that has included such a statement.

• Tips and Descriptions of Potential Pitfalls and how to avoid the ever-threatening “lapse of certification”.

• Frequently Asked Questions

  • Many of the questions that you may have regarding this MOC program have been asked by others.  At the end of this guide, we have compiled a list of questions and answers for some of the specific questions that commonly are asked.

As with all good programs, your continuous certification MOC classification will involve money.  No one will tell you, while you are dishing out for a three-part exam with all of the associated study resources and exam expenses that you are effectively entering into a contract that will require you to make annual payments, as the name suggests, continuously, but...you are and you will be required to make annual payments for as long as you would like your certification to remain valid.

This is probably an obvious statement to you.  After all, a good MOC program really does help our profession and keeps us on our toes and engaged in learning new technologies and new science.  The ABR is a non-profit organization relying heavily on volunteers gleaned from the finest in our profession, but, even so, a good program cannot operate without dues from its members.  We just mention it here because it seems fair to know what you are buying into while you may be distracted with priorities of simply getting through the testing process.  With that being said, MOC annual fees are $205 (at the time of this writing) with subsequent years growing in cost (sounds like it might very well be in your clinic’s best interest to keep you certified...just saying).

The previous certification program (with its participants now all reassigned to continuous certification) used a “valid-through” approach.  This meant that, if you had a time-dependent requirement you could either satisfy that requirement on the first day of that time period or the last and it would count until that period was restarted.  As a hypothetical example, if you needed 250 continuing education credits in ten years, then you could, conceivably wait until the ninth year and the three hundred and sixty-fourth day and try and get all of those credits at that time and still remain compliant (barring certain annual limits, of course).

However, with continuous certification (with focus on the key-word “continuous”), the MOC program is encouraging its participants to take a more active approach and continually engage in MOC components.  To do so, they have introduced the concept of the “look-back”.

The look backs occur every year but different components of the program have different periods through which they look back.  For example, the educational credits component of the program has a three-year look-back whereas the MOC exam component has a ten-year look-back.  This does not mean that the audits for these programs occur every three years and ten years, respectively.  Rather, the audit occurs each year, but the period in which the criteria can be met is either three or ten years.

In this regard, it may be best to think of the different requirements of the MOC program as having a window that, each year on March 15th, can see the appropriate number of years whether it be one, three, five, or ten years.  Each year then, if each window can see the correct item that needed to be accomplished in its entirety, then you continue to be certified, meeting requirements.  The window philosophy of this program is illustrated in the following animation:

Maintaining your certification has been divided into four categories with each category reflecting a separate facet of the ABR’s philosophical core.  Furthermore, each component comes with its own set of requirements and look-back periods.  The following is a simplified breakdown of these four components with their requirements explicitly stated.

What is it?

The professional standing category exists to evaluate one’s active involvement in their specialty field of medical physics with particular emphasis on six areas of competency: practice knowledge, patient care, interpersonal/communication skills, professionalism, practice-based learning and improvement, and systems-based practice.

What do I need to do for it?

There are two ways to satisfy this requirement that are dependent upon the particular state in which you practice:

1. For license-based states - you need to submit documentation of a valid, unrestricted license to practice medical physics.  An active license must be maintained and documented with the ABR.  This should be reviewed on an annual basis.

2. For states that do not require a license - you need to submit a letter of attestation from both an ABR certified medical physicist and an ABR certified radiation oncologist (physician).  This attestation process is initiated in your account on myabr.theabr.org with your attestors performing their requested actions under their logins on the same site.  Your first attestation must be submitted during your sixth year of MOC.  The window of validity for attestation is five years.

How can I get this?

Logged in at myabr.theabr.org, go to the professional standing tab and either add a license or select the link to MP attestation.  Here, you can enter the contact information for your two attestors.  Your attestors will then be contacted via email and by letter and instructed on how they can provide their attestations.  They will also notice a badge icon appear under their myabr.theabr.org logins notifying them that they need to complete an attestation for you.

* Update: Per the ABR, 2022 will be the last year that DABRs will be required to complete SA-CEs as long as the candidate is completing OLA.  For more information, reach out to the ABR at This email address is being protected from spambots. You need JavaScript enabled to view it. *

What is it?

This section includes your continuing education and the associated CE credits that you must accomplish.

What do I need to do for it?

There are three types of credits that you will need to acquire for each look-back period of three years:

1. SA-CEs - Self Assessment CEs are a new concept to the MOC certification for physicists.  There are three ways to acquire these credits:

   1. SAMs (self-assessment modules) - These are developed by medical physics-related societies specifically to become SAMs.  You can get these credits at the AAPM annual meeting, the AAPM Summer school, or the AAPM Spring clinical meeting.  You can also get these online at aapm.org if you have a subscription to the AAPM’s Online Learning Center (highly recommended).

   2. “Enduring Materials” CEs - In order for a CE to count as “enduring material” or an SA-CE, there has to be an associated test with the materials that has an explicit pass score (that you achieved).  Also, there have to be sources associated with the materials that would facilitate the option of further study.

   3. SDEPs (see more details below) - These are projects that you can self-pursue with format available on the ABR’s website (https://www.theabr.org/medical-physics/maintenance-of-certification/self-directed-educational-projects).

2. CMEs - These are available, in great quantity, at aapm.org if you have a subscription to the Online Learning Center.  Also, you can often get credits from approved vendor webinars.

3. SDEPs (Optional):

   1. An outline summary necessary for the submission of a Self-Directed Educational Project (SDEP) is as follows (also note that the ABR decided in 2013 to start counting SDEPs towards the SA-CE goal of 25 credits every three years):

      1. Significance

      2. Approaches/Resources to be Utilized

      3. Evaluation of Achievement

      4. Impact on Practice/Outcome Statement

   2. In order to be considered an SDEP, the project must be educational, must be developed prospectively, and documentation must be maintained.

   3. Up to 15 hours of SA-CE category credits can be claimed.

   4. Only one SDEP can be counted per year.

Final Note: CAMPEP is the governing body that decides if something is accredited for provided CEs.

The following illustrates the numerical requirement for this component of MOC in which 75 CME credits must be obtained for each three-year look-back audited with 25 of those being SA-CEs:

How can I get this?

Some Sources of SAMs:

1. Various accredited symposia

2. RSNA and ASTRO meetings

3. The AAPM’s Summer and Spring annual meetings

4. AAPM Online Learning Center

5. Accredited AAPM chapter meetings

Some Sources of SA-CEs:

1. AAPM Online Learning Center

2. Various organizations: AAPM, ASTRO, RSNA, SNMMI, and ACR

Some Sources of SDEPs:

1. This one’s on you!  (Though there is a way to get a group-based SDEP.  For more information, see the FAQ question associated with this pathway).

New: This section of MOC has recently undergone major changes in the replacement of the 10-year requirement for the proctored exam with a continuous assessment system.  Updates coming soon for this section.

What is it?

The MOC exam is a computer-based multiple-choice exam that you will need to take somewhere within a 10 year look-back period.  You can consult your personal database on the myabr.theabr.org website, but a new feature of the continuous certification MOC is that the exam can be taken in any year during your 10-year window.  Note, however, though that you must have an exam (initial or MOC) within a 10-year window.  Thus, if you take your MOC exam early, that means that your next exam must fall within a 10-year window from that date (see the discussions below for recommendations).  The exam itself is carried out at a Pearson VUE testing center (in a similar fashion as your parts 1 and 2 initial certification exams).  An example of their testing format can be found here: http://www.pearsonvue.com/athena/athena.asp.

What do I need to do for it?

A new feature of continuous certification is that you can take this exam at any point in the 10-year window as long as you haven’t let 10 years elapse since your last MOC or initial certification exam.

How do I go about that…?

You can register for this exam at the Pearson VUE website.  The only prerequisites that you need in order to take the exam are that you currently be enrolled in the continuous certification MOC program and that all of your outstanding MOC dues are paid.  According to Pearson, appointments can be made to take the exam up to one day before the year’s exam date.  This exam date is only offered on a single day within each calendar year.  The exam schedule is provided on the ABR’s website under the heading Maintenance of Certification Exams: https://www.theabr.org/medical-physics/calendar

As far as studying is concerned, the ABR does provide a study guide.  They emphasize that 30% of the questions in the exam will be core material while the remaining 70% will be pulled from recent advances in the field.  The exam is 150 questions long (though this has been subject to change), and you will be given 3 and a half hours to complete the timed portion of the exam.  Thirty minutes is allotted for pre-registration at the testing center to make the total estimated exam time 4 hours.

What is it?

This is the PQI project component that shows your commitment toward facilitating improvement in the clinic and for the profession as a whole.

What do I need to do for it?

You need to complete one PQI project every three years.

How do I go about that…?

There are five categories that should be the focus of your PQI project:

1. Safety for patients, employees, and the public

2. Accuracy of analyses and calculations

3. Report turnaround time and communication issues

4. Practice guidelines and technical standards

5. Surveys (including peer review of self-assessment reports)

The requirements for a PQI project are that they must:

1. Include an improvement plan.

2. The plan must have been implemented.

3. The efficacy of the plan over time must be measured.

4. And the project must be practice-relevant.

In September of 2015, the ABR introduced a long list of alternative activities that could be used to satisfy the Part 4 requirement.  This list, along with descriptions of the appropriate documentation needed in case of an audit, is provided here. 

The following information is presented as a means of determining when something should have been completed along your continuous certification process.  It is important, though, that you avoid thinking about timelines in a cyclical fashion with the continuous certification philosophy.  That is, you may want to retrain your brain stop thinking in terms of, “I need to do x every y years” and start thinking, “I need to do x during y years”.  This may seem like a small distinction but there are some very real situations (described later) that can get you in trouble if you insist on applying the former statement to your MOC participation instead of the latter.

The following list presents the initial steps that should be taken as soon as you are enrolled in MOC.  Remember that you are automatically enrolled in continuous certification as soon as you pass Part 3 of the initial certification.  Also, the ABR will send you a letter with some information regarding your MOC enrollment, but this is not usually received until the next year following your initial certification.

1. Step One: Pass your oral exam.

2. Step Two: You are automatically enrolled in Continuous Certification.

3. Step Three: Visit myabr.theabr.org and confirm that you have been enrolled in the appropriate MOC.

4. Step Four: Visit cmegateway.org and register for a free account.  Visit the Organizations page and enter the appropriate societies that are tracking your CEs.  These will include, but not be limited to CAMPEP, AAPM (SAMs only), and the ABR.  You will need to enter your username and password for these sites in order to effectively share your information.

Once you have these steps in place, you can start working on your requirements for your upcoming look-backs.  Recall that these occur every year on March 15th but each component has a different look-back window extent.  To help clarify, see the following illustration:

If you follow this chart, this means that each look-back checks each of these components but with varying valid-during periods.

We recommend that, after you accomplish a continuing education exercise and are expecting credits, that you frequently check your MyABR account to make sure that they are being accounted for properly where it counts.  If you find that they are do showing up with an expected time frame or with the appropriate quantity, don’t hesitate to give the ABR a phone call to ask for clarification.  Much better than waiting until your look-back to find out.

There are three statuses that you can fall under in the continuous certification program:

The two negative classifications are what you’d like to avoid along your MOC path, and, in order to stay on track, it will be important for you to know how the look-back process works.  Namely, different tasks for your MOC are assigned with different periods for how long the look-back will review your components for each annual audit.  If ever you have reached a look-back period without meeting the requirements of that part of MOC, then you will enter into a built-in catch-up period of one year that will allow for you to make up the needed requirements while being classified as certified, not meeting the requirements of MOC.  This is a large advantage compared to the 10-year cycle certification in which there was a certain point within the 10 years that, if you hadn’t met a certain amount of credits, then you could never make up those credits (due to the maximum annual credits limit that has been done away with).  Note though that, if you don’t meet your requirements during the catch-up year, then your status will shift to “not certified”.

The first look-back review that you’ll encounter that could result in you slipping into a status of “not meeting the requirements of MOC” could be the first March 15th annual look-back.  You are, again, at risk of incurring this status at every subsequent year following this.  Compare this to the former 10-year cycle program (which was replaced by continuous certification) and note that now your certification status can change from year-to-year versus every ten years.  The good news about this is that there is only one calendar date that you can go from “Certified, Meeting Requirements” to “Certified, Not Meeting Requirements” and that is March 15th during the annual look-back.  However, you can revert from “Certified, Not Meeting Requirements” to “Certified, Meeting Requirements” at any point within the year as soon as you satisfy your failing components of MOC.

If for some reason you still could not meet the MOC requirements in the catch-up year then your status would become “Not Certified, Certification Lapsed.”  You can return to being certified and meeting MOC by contacting the ABR and informing them of your desire to return to a certified status.  Then, within that calendar year, you must fulfill all the MOC requirements (Parts 1-4) in order to return to the status of “Certified Meeting MOC Requirements.”

1. AAPM - American Association of Physicists in Medicine

2. ABMS - American Board of Medical Specialties

3. ABR - American Board of Radiology

4. ACCME - Accreditation Council for Continuing Medical Education

5. AMA - American Medical Association

6. AMA PRA - American Medical Association Physician’s Recognition Award

7. CAMPEP - Commission on Accreditation of Medical Physics Educational Programs

8. CE - Continuing Education

9. CME - Continuing Medical Education (most often associated with CME credits)

10. MOC - Maintenance of Certification

11. MPCEC - Medical Physics Continuing Education Credit

12. OLC - Online Learning Center (AAPM)

13. PDB - Personal Database

14. PQI - Practice Quality Improvement

15. SA-CE - Self Assessment Continuing Education

16. SAM - Self Assessment Module

17. SDEP - Self-Directed Educational Projects

https://myabr.theabr.org/login

Type of Site: “Personal Database” for MOC status.

Notes: This site replaced the former personal database and is designed to be your reference, go-to site throughout your examination process and continuing through your MOC process.

https://www.theabr.org/

Type of Site: Informational

Notes: This link takes you to the ABR’s Medical Physics MOC landing.  Here you’ll find information about the requirements of the MOC program and the four components to achieving their so-called “continuous certification”.

https://www.theabr.org/medical-physics/maintenance-of-certification/moc-faqs

Type of Site: Informational

Notes: This link takes you to a FAQ page for Medical Physicists MOC; very useful.

https://www.theabr.org/medical-physics/maintenance-of-certification

Type of Site: Informational

Notes: This link takes you to a very nice summary of the MOC program, albeit a little brief to allow for the answering of any complex questions.  These tend to be sent out with your first ABR bill for MOC.  This brochure describes the new continuous certification process.

http://www.campep.org/default.asp

Type of Site: Informational

Notes: This link takes you to the main page of CAMPEP who takes a lead role in the accreditation (not certification) of educational programs and establishes what resources can be classified as CEs.  This site also has a link to the CME Gateway.

https://cmegateway.org/

Type of Site: CME Credit Collection and Report Generation

Notes: This link takes you to your so-called CME Gateway.  This website is, essentially, a net that exists to scoop up your CME credits from all possible sources and collect them so that you can generate a universal report for your specific member ID inclusive of all credits from ABR relevant sources.  (In other words, the CME Gateway is an aggregating tool for a user for collecting credits for MOC certification in a single location).  Participating sites of interest to you will include, but not necessarily be limited to, CAMPEP, the ABR, and the AAPM.  Visit this site to create a CME Gateway account.  Under the “Participating Organizations” tab will be the ability to sign up for sharing information between different organizations.  Important step: you need to OPT-IN for organizations that your CME Gateway pulls from.  Most likely, the relevant organizations that most of the readers of this page should opt into include the “American Association of Physicists in Medicine (SAMs/SA-CME) and the “Commission on Accreditation of Medical Physics Education Programs, Inc.”.

https://www.aapm.org/education/ce/info.asp

Type of Site: MPCEC and SAM Library

Notes: This site is a wonderful resource for your professional education and accumulating CEs once you’ve established your CME Gateway.  The Online Continuing Education subscription with the Online Learning Center through the AAPM is an extra charge option available with your membership, but it is one that is well worth it (costing an additional $75 per year at the time of this writing).  When you successfully complete a SAM or MPCEC, your credits should be available for viewing on your CME Gateway within 24 hours provided that the same email address you have registered with the AAPM is the one registered with your CME Gateway.  (Note that there is also a link to the Online Learning Center through the ABR’s site under SAMs Available located at the following link: https://www.theabr.org/medical-physics/maintenance-of-certification/lifelong-learning-self-assessment/sams-available).

https://www.theabr.org/medical-physics/maintenance-of-certification/self-directed-educational-projects

Type of Site: Informational

Notes: This site offers information on how you can formulate a self-directed educational project.  Each project is worth up to 15 CE credits which can be attributed toward your SA-CE credit goal.

https://www.certificationmatters.org/

Type of Site: Informational Search

Notes: This site, run by the ABMS, is a certification search engine for the public that is used to complement the Continuous Certification approach.  It allows users who go through a quick registration process to search for their doctor to obtain information about their doctor’s certification status.  There is a “Therapeutic Medical Physics” specialty available in the search criteria for board-certified physicists in radiation oncology.

https://aapm.onlinelibrary.wiley.com/journal/24734209

Type of Site: Journal Article

Notes: This link takes you to a 2007 publication in the journal Medical Physics.  It describes the PQI project for the 10-year MOC cycle.

https://www.theabr.org/medical-physics/maintenance-of-certification/moc-attestation-video-faqs

Type of Site: Informational Video

Notes: This link takes you to a video discussing how to perform MOC attestations (produced by the ABR).

Because of the history of the MOC evolution, there may be a tendency for you to think of the look-backs as occurring with the frequency of their period of review.  For example, for the Part 2 requirements (Lifelong Learning and Self Assessment), participants may incorrectly interpret the three-year look-back to mean that the look-back is occurring every three years and that, therefore, they would need to satisfy the credit requirements within every three-year cycle.  The DABR gets certified in 2015, then in 2018, the ABR would review for three years with this repeating again in 2021.  But, what is actually going to occur is that the ABR’s Part 2 three year look-back will occur each year on March 15th.  Hence, why this program is called Continuous Certification as opposed to cyclical (or “valid-through”).  So, how could such a misinterpretation get DABRs in trouble?

Well, consider the following hypothetical DABR that enters into the Continuous Certification MOC program in 2015.  Let’s say this person is planning to follow the following credits strategy to apply towards their Part 2 requirements:

Recall that the three-year look-back for Part 2 of Continuous Certification MOC requires 75 CMEs of which at least 25 must be SA-CEs.

The first annual look-back for this individual that would examine the Part 2 requirements would occur on March 15th, 2018.  This look-back would audit 75 total CMEs with 25 coming from SA-CEs.  Thus, the Part 2 requirement would be satisfied.

The next year’s look-back, on the other hand, would reveal that this person only achieved, in the reviewed prior 3 years, 25 CMEs with only 13 of them being SA-CEs.  This person would now be granted the status of, “Certified, Not Meeting Requirements” despite their intention to meet their requirements quota in 2020.  This potential pitfall is illustrated in the following plots:

The point of this hypothetical exercise is to emphasize the new way of thinking of Continuous Certification and the possible hazards of not heeding this new mindset.  Had this been a cyclical program for our hypothetical physicist, then their three-year look-back for Part 2 would have occurred in 2018 and then again in 2021.  For both of these checks, this person would have met the requirements of the program.

Another pitfall related to continuing education credits involves how you account for your credits.  Recall that there are three ways that your myabr personal account can record credits: you can enter them manually, they can be transferred to your account via the CME Gateway, and they can be transferred directly to the ABR.

Because of the multiple pathways that credits can take, it will be very important for you to not double count your credits.  Let’s say that you take an AAPM quiz from the Online Learning Center and achieve one credit.  If you count this credit manually in your myabr account, then you must also watch out that this credit isn’t counted because the AAPM informs the CME Gateway that you have taken and passed this quiz who, in turn, will transfer the credit to your myabr account thereby falsely doubling the credit earned.

Because the myabr website does not have detailed information on where each credit came from that can be viewed by the users, it can be difficult to account for each credit.  Our advice is, either use the automated transfer systems in place to account for your credits or use the manual system.  Using both can get you into trouble when it comes to audit time and also when it comes to planning how many credit hours you still need before March 15th of each year.

The other thing to watch out for regarding credit accounting is the knowledge that “every SA-CE is a CME, but not every CME is an SA-CE.”  Thus, when you get an SA-CE credit, it will be counted in your SA-CE tally for the year.  But, it will also be counted in your CME tally.  Don’t misinterpret to think that you have received one CME and one other SA-CE.  It still only counts as one either SA-CE or one CME.

Each year, the ABR will conduct random audits of participants.  If you are selected, you will be asked to provide documentation for parts 1, 2, and 4 of the MOC program.  This means that you should provide evidence of Part 1, details of Part 2, and you should be able to outline elements of the Part 4 PQI project including data collection, data analysis, improvement plan, creation and implementation, and re-measurement.

The materials that you will be asked to produce for an audit are records that aren’t, “conveyed to the ABR electronically from the awarding societies/organizations”.  The means, for example, that, for those manually entered CE credits, you will need to have records to back them up.

You will find out that you are being audited either by letter, email, or by phone.  From the point of notification, you will have 60 days to produce the requested documentation.  When this is produced, the ABR will conduct a review as to the appropriateness of that documentation and the result of the look-back audit as it is reflected on your certification status.