Table 2

Provider qualitative dissatisfaction with PIMs—codes and example quotations

CodeCode definitionExample quotation
CostDiscussion of monetary costs associated with certification or QI activities (personal, clinical or other)“It basically came down to… run through these surveys really quick and you know, fill out these forms, and upload your data. Then I paid tons of money for that, and I don't know why.” [ID 20, generalt, non-academic, private practice)
CreditComments about obtaining credit for QI activities, or adapting QI for ABP guidelines or systems“One of our groups had created a QI project, went through the whole QI project proposal, and was told that was a reasonable project, did the project, submitted it back to the person that was overseeing it and she decided that wasn't good enough.”(ID 7, specialist, academic, children’s hospital)
Extra workDiscussion of the additional effort associated with certification or QI activities“It’s busy work. It’s meaningless busy work… and it makes us document things we’re already doing in a way that’s not helpful.”(ID 1, general, FQHC)
FitStatements indicating the provider’s opinion or appropriateness or fit of MOC/QI to their practice, patients, profession, or personal life“The truth is, I don't have the ability to change at these hospitals. I'm not someone that can change policies and procedures. So what’s the point of doing them, you know?… It’s one thing maybe to change my own practice, but… they really weren't set up to do that.”(ID 20, general, non-academic, private practice)
ImpactComments about the impact of QI activities on the provider (eg, professional development), practice, or patients (eg, clinical outcomes).“I thought it was not helpful in any part of my practice. I thought it was a huge waste of time. It was tedious. I thought it was completely inappropriate and not anything that helps me prove that I'm a good doctor, being certified or anything like that.”(ID 17, general, academic, children’s hospital)
MistrustStatements indicating the provider mistrusts ABP or the MOC process, including references to the ABP operating in bad faith, for the sake of money, with ulterior motives or politically driven“I think the perception I have personally, and talking with others, it’s 100% driven politically. It has nothing to do with improving anyone. That’s why Internal Medicine said as a group, as a whole, they said, ‘We're not doing this.’”(ID 7, specialist, academic, children’s hospital)
ProcessFocus on the logistics of maintaining certification, including the complexity, ease/difficulty, clarity or bureaucracy involved in getting MOC pointsI don't look at the other options, because either they'll cost me, like you have to pay a fee, or because I find them like really complicated. Like I tried one, I'm trying to think what the name of it was. I tried one that was a little different online and it was very convoluted.”(ID 13, specialist, academic, group practice)
TimeDiscussion of the time it takes to complete MOC or QI activities“I mean the way it’s structured is you need multiple weeks to gather all the information, and it takes time to enter it in. Then once you've collected enough, you still have to wait before you can put more.”(ID 21, specialist, academic, children’s hospital)
UndervaluedStatements indicating the provider feels undervalued, not trusted or mistreated by the MOC process“They all were kind of eye rolling … rolling their eyes at it… And then I have them, ‘Did your doctor wash her hands?’ ‘Did the medical assistant wash her hands?’ They're kind of like, ‘What is this?’… You know, it’s like if somebody’s fourth grader was doing a science project.”(ID 9, generalist, non-academic, group practice)
  • MOC, maintenance of certification; PIMs, performance improvement modules; QI, quality improvement.