Anti-maintenance of certification and elderly physician supply
Publication id: shakya-2024-anti-moc-elderly-physician
Status: verified
Citation: Shakya, S., Nepal, T., Mathew, M., & Timmons, E. (2024). Anti-maintenance of certification and elderly physician supply. Economics Letters. Download PDF
Facts¶
Policy hook¶
States argue that Maintenance of Certification (MOC) requirements are expensive and burdensome for physicians. Some states have passed anti-MOC laws to eliminate or reduce these requirements. The policy question is whether lifting MOC requirements increases the supply of older physicians who remain in practice or attract them from other states.
Main finding¶
Anti-MOC states show a statistically significant biannual increase of 1.4–1.9 percentage points in the share of older physicians (age 60+). States implementing full anti-MOC prohibition show larger effects of 1.9 percentage points (p<0.01). No significant effect appears for younger physicians under 60. This translates to approximately 4,732 additional older physicians nationwide biennially from the 1.4 percentage point increase.
Data and setting¶
State Physician Workforce Data Report, biennial intervals, covering all 50 states and DC from 2006 to 2020. Six states implemented full anti-MOC prohibition during the study period, while eight additional states implemented partial anti-MOC restrictions. The outcome is the proportion of active physicians aged 60 and older in each state-year.
Research design (plain language)¶
The paper uses a generalized difference-in-differences design with state and year fixed effects to estimate the impact of anti-MOC laws on the share of older physicians. Event study methods test for parallel pre-trends and estimate dynamic treatment effects. Regressions are weighted by the number of older physicians per state-year to account for state size variation. The identification strategy compares older physician shares before and after anti-MOC adoption, controlling for common temporal trends and permanent state-level differences.
One caveat¶
Biennial treatment effects are modest in magnitude. Full anti-MOC prohibition states show larger effects than partial-prohibition states. The analysis cannot distinguish whether increased shares reflect older physicians staying longer in practice versus relocating from other states. Workforce survey data may have measurement error, and changes could reflect data reporting changes rather than true supply shifts.
PDF or DOI¶
Why it matters¶
Physician shortages are a persistent challenge for healthcare access. MOC requirements, originally designed to maintain quality standards, impose substantial costs and time burdens on physicians—particularly those nearing retirement. This paper shows that eliminating MOC requirements noticeably increases the share of older physicians in practice. For states facing aging populations and rural shortages, anti-MOC laws may be an effective, low-cost policy tool to retain experienced clinicians. The effect is largest under full prohibition, suggesting that partial restrictions have limited efficacy. The findings suggest that regulatory burden reduction can influence workforce decisions at the margin, especially for professionals considering retirement. However, the modest magnitude of effects and focus on aggregate state-level shares means anti-MOC laws are one piece of a broader physician shortage solution, not a comprehensive fix. The policy points to a tension between maintaining certification standards and enabling continued practice for experienced providers.