How Maintenance of Certification in Anesthesiology (MOCA) Works

Continuing education and evaluation in anesthesiology is crucial to maintaining high standards of quality patient care. In theory, recertification programs exist for the benefit of patients and physicians alike, though changing policies for certain specialties have sparked outrage and controversy in recent history. [1]Still, it is important to understand how MOCA is relevant to the professional development of anesthesiologists now and in the future.

MOCA certification policies differ between time-limited and non-time limited certification, differentiating physicians into two groups depending on whether they were certified before or after the year 2000. Physicians who received ABA certification in or after 2000 are automatically enrolled in the MOCA program and allowed 10 years to complete all requirements. Those who received certification before 2000 are grandfathered in and participation in MOCA is voluntary, though free and encouraged by the ABA. For time-limited certification enrollees, there is a $210 annual fee for the first certificate maintained, and $100 for each additional certificate maintained. 

There are four parts to the MOCA 2.0 requirements detailed on the ABA website:

PART 1: Medical License (Professionalism and Professional Standing): Hold an active, unrestricted license to practice medicine in at least one jurisdiction of the United States (U.S.) or Canada. Furthermore, all U.S. and Canadian medical licenses that a diplomate holds must be unrestricted.

PART 2: CME (Lifelong Learning and Self-Assessment): 250 Category 1 CMEs of which 20 must be ABA-approved Patient Safety CMEs. Self-Assessment CMEs are no longer required. If you previously completed Self-Assessment CMEs, you will get credit for them in MOCA 2.0.

PART 3: MOCA Minute (Assessment of Knowledge, Judgment, and Skills): MOCA Minute® replaces the MOCA exam. Diplomates must answer 30 questions per calendar quarter (120 per year by 11:59 p.m. EST on Dec. 31), no matter how many certifications they are maintaining.

PART 4: Quality Improvement (Improvements in Medical Practice): More options for activities with points awarded for each activity based on the time and effort associated with their completion. Diplomates must complete 25 points in Years 1-5 and 25 points in Years 6-10 for a total of 50 points per 10-year cycle. An attestation is due in Year 9, but does not provide points. 

There are many relevant ways to maintain your certification through MOCA. This month, the American Society of Anesthesiologists (ASA) launched a new “Opioid Analgesic Risk Evaluation and Mitigation Strategies (REMS)” continuing medical education (CME) course, which contributes to the ABA’s patient safety CME requirement. [2] Quality improvement activity categories range from the MOCA simulation course to point-of-care learning, with points per hour reported in the MOCA portal either through self, provider, or organization-reporting.[2]

Maintaining a “Participating in MOCA” status each year over a 10-year certification cycle may seem daunting. The ABA has published a handy guide highlighting the milestones that need to be reached throughout the program[3]:

Every year candidates must:

Register for MOCA 2.0 annually in your portal account.

Answer 120 MOCA Minute questions by 11:59 p.m. EST on Dec. 31.

At the end of five years, candidates should have:

Satisfactory medical licensure.

Completed half of your CME credits (125 credits).

Completed half of the Quality Improvement activities (25 points).

At the end of ten years, candidates should have:

Satisfactory medical licensure.

Completed all CME credits (250 credits).

Completed all Quality Improvement activities (50 points).

Though MOCA certification is not required, there are significant professional repercussions to forgoing the process. Since 2014, all specialties participating American Board of Medical Specialties (ABMS) have included the status of MOC participation in their reporting of all diplomates. The American Board of Anesthesiology (ABA) diplomate and candidate directories as well as the ABMS physician directory all list MOC status indicating specifically whether an individual is “Not Meeting MOCA Requirements”.  All time-limited MOCA certifications are valid until December 31st of the 10th year after the initial certification year. [2] Understanding the process of receiving and maintaining “Participating in MOCA” status is important for all anesthesiologists who strive to be leaders in the field, to demonstrate that their medical knowledge is current, and to affirm their dedication to lifelong learning.


1.         Fisher, W.G., Boarded to Death: Physicians Sue the ABIM. 2018.

2.         (ASA), A.S.o.A. American Society of Anesthesiologists Launches CME Course to Reduce Opioid Misuse and Abuse. 2019.

3.         (ABA), T.A.B.O.A., What Does “Participating in MOC” Mean? 2018.

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