Getting on Board: A Brief Primer on Board Certification

For many older physicians, board certification was a crowning achievement in their post-residency career. It was considered a measure of competency. But the process has evolved, and not everyone is pleased with it. In this issue we define key terms, address a new recertification process, and discuss ‘physician extenders.’

[who’s on first?]
What it means if your physician is board-certified, board-eligible or not listed on the ABMS at all.

What is a board-certified physician?
According the American Board of Medical Specialties (ABMS), a board-certified physician is a doctor who has passed a rigorous examination of his/her competence in a medical specialty and has kept current with recertification requirements. The ABMS recognizes 24 medical specialties; some have subspecialties. Internal medicine, for example, has 20 subspecialties, including cardiovascular disease and rheumatology. More than 150 medical specialties and subspecialties are recognized by the ABMS.

Although board-certification is voluntary, hospitals and insurance companies increasingly require their physicians to have this distinction. Additionally, some federal health programs reward board-certified physicians who report quality data with an optional payment incentive. Doctors don’t have to be board-certified to practice medicine, but they do have to be licensed in the state in which they work. There are 31,280 licensed physicians in Missouri. To find out if your physician is board-certified by the ABMS in one or more medical specialties, go to: certificationmatters.org/is-yourdoctor-board-certified.aspx.

What does board-eligible mean?
This term is often used to describe physicians (M.D.s or D.O.s) who completed their residency in an accredited program and have applied for but have not yet been certified in one of the 24-member specialty boards of the ABMS. However, some physicians never take the test, fail the test and/or use this term just to market their practice.

In January 2013, the ABMS enacted a new policy that limits the time that may lapse between completion of a physician’s residency (or its equivalent) and his/her board certification. Physicians now have no fewer than three years and no more than seven years to achieve their initial certification. If that doesn’t occur, physicians must complete requirements of that member board for re-entry into the certification process.

What if your doctor is not listed by the ABMS?
There are a couple of reasons a physician may not be listed. They may never have been board-certified, they may have requested that their information be kept private, or they may have let their certification lapse. A lapse could occur because of illness or military service. However, some physicians, especially those in private practice, have opted not to become recertified for a variety of reasons, including cost and time. Some also view the new recertification process, called Maintenance of Certification, as yet another regulatory burden placed on physicians, with certifying boards, medical societies or others profiting from the educational products they sell to physicians seeking recertification. But Dr. Norman Kahn, executive vice president and CEO of the Council of Medical Specialty Societies, says organizations that offer and sell these educational products are simply recouping their costs, which include research and development.

Over the years, board certification has evolved from a one-time assessment that lasts a physician’s lifetime, to a continuous process in which physicians are certified only for a given period, depending on their specialty. Today, once a doctor becomes board-certified, the process to remain certified is ongoing.

[physician facilitators]
Physician assistants and nurse practitioners expedite an overburdened system.

Carol Danter, director, Saint Louis University Physician Assistant Program:
A physician assistant (P.A.) is a medical health practitioner. We diagnose and treat patients under the supervision of a physician and work as part of a team. P.A.s provide care in outpatient clinics and in-patient settings, including hospitals. They can assist a physician during surgery, suture a patient and prescribe meds, to some level.

Our education is modeled after a physician’s education, but it’s more compact and clinically oriented. Most P.A. programs require that applicants have prior patient experience. Some of our students were previously physical therapists, respiratory therapists, dieticians and nurses. Our program requires applicants have at least a bachelor’s (of science) degree to enter. It’s a 27-month, full-time program.

Although you’ll find P.A.s in a variety of specialty medical practices, we are trained to take care of people from birth to the grave. Our education is general. When a P.A. joins a specialty practice, he or she gains more specialized training in that field. A P.A.’s education continues after they graduate from the program. They’ve been given a good foundation but they have to keep learning.

Lisa Burnitt, assistant professor, Barnes-Jewish College Goldfarb School of Nursing:
A nurse practitioner (N.P.) is a registered nurse with advanced training and education who is focused on providing primary care to diverse populations. There are several types of nurse practitioners. Most certifications are in pediatrics, adult care, adult gerontology and women’s health. We also have a newer form of acute-care nurse practitioners who deliver care in the hospital setting. Most people are familiar with adult and family care nurse practitioners.

All have to be board-certified as a registered nurse first. They also are required to have additional education at the master’s degree level, but we’re moving the educational minimum toward the doctoral level. N.P.s undergo extensive training, similar to an internship, anywhere from 600 to 1,000 clinical practice hours.

Although our scope of practice is determined at the state level, N.P.s are certified nationally. We function similarly to physicians. We can take extensive medical histories, conduct full examinations, order diagnostic tests, diagnose conditions, and prescribe medication and therapy. Prescribing privileges vary from state to state. In many states N.P.s can practice independently, although most work collaboratively with a physician, which is required in Missouri.

[maintenance of certification (MOC)]
Some private practice physicians are unhappy with the new process, but the ABMS says it’s a good thing.

Karen Metropulos, communications manager, American Board of Medical Specialties:
Board certification is not an end but rather a new start point to lifelong learning. That’s why the 24-member boards of the American Board for Medical Specialties (ABMS) agreed in 2000 to change their recertification programs. Maintenance of Certification (MOC) is the result. It’s meant to be rigorous, but voluntary.

MOC is a four-part continuous learning program that assures patients that their physician is committed to lifelong learning and competency in a specialty and/or subspecialty. It requires ongoing measurement of six core competencies: patient care, interpersonal communication, professionalism, systems-based practice, practice-based learning and medical knowledge. Measurement of these competencies occurs in a variety of ways, some of which vary according to the specialty. In 2006, all member boards received approval of their MOC program plans. The boards are now in the process of implementation. Some states are considering MOC to replace their continuous medical education (CME) requirements.

Board-certified physicians participating in MOC are committed to ongoing professional learning and assessment throughout their career and as part of their daily medical practice. Serving patients well requires this.

Dr. Paul Martin Kempen, board certified anesthesiologist, Ohio:
I became board-certified in 1989 and voluntarily recertified in 2005. Never again! In 2000, the American Board of Medical Specialties (ABMS)—the organization that develops the physician tests—mandated that its 24-member specialty boards limit certification to 10 years. Some boards balked, but eventually gave in. In order to retain their certification status, physicians now are required to subscribe to continuous and yearly educational programs developed by ABMS certifying boards or specialty medical societies. These products are part of Maintenance of Recertification (MOC).

MOC is meant to instill a false sense of confidence in patients. The ABMS even says that MOC doesn’t guarantee better patient outcomes. Physicians have to stay current to compete, and they have to acquire significant hours of continuing medical education for their state licensure. By virtue of my profession, I am a lifelong learner. That’s why I don’t think MOC is necessary.

MOC affects all physicians but especially those in rural private practice. In addition to program fees, occasional travel expenses and finding a physician replacement, MOC cost most doctors time away from patients. It’s unnecessary busywork for a profession that’s already over-regulated. Its value has not been validated by independent research.

[american board of medical specialties]
The list below identifies the 24 specialty member boards of the ABMS. Some boards have subspecialties.

American Board of Allergy & Immunology
American Board of Anesthesiology
American Board of Colon & Rectal Surgery
American Board of Dermatology
American Board of Emergency Medicine
American Board of Family Medicine
American Board of Internal Medicine
American Board of Medical Genetics
American Board of Neurological Surgery
American Board of Nuclear Medicine
American Board of Obstetrics & Gynecology
American Board of Ophthalmology
American Board of Orthopaedic Surgery
American Board of Otolaryngology
American Board of Pathology
American Board of Pediatrics
American Board of Physical Medicine & Rehabilitation
American Board of Plastic Surgery
American Board of Preventive Medicine
American Board of Psychiatry & Neurology
American Board of Radiology
American Board of Surgery
American Board of Thoracic Surgery
American Board of Urology

[words & organizations to know]

Missouri Board of Healing Arts: The state’s medical licensing authority and member of FSMB.
American Board of Medical Specialties (ABMS): A national, not-for-profit umbrella corporation representing the 24 medical specialty boards that certify physician specialists. The ABMS sets the standards implemented by each certifying board.
Board-certified: A physician (M.D. or D.O.) who has completed specialty training beyond basic state licensure competency requirements by passing a rigorous test developed by an ABMS member board.
Board-eligible: A physician (M.D. or D.O.) who has completed his/her residency in an accredited program but has not yet received board certification. There are now time constraints as to how long a physician can stay board-eligible before completing the process.
Maintenance of Certification (MOC ): An ongoing recertification requirement for physicians who want to maintain their board-certified status.
Federation of State Medical Boards (FSMB): A nonprofit organization that represents state medical and osteopathic licensing boards in the United States and its territories. It keeps a database profile of U.S. licensed physicians that’s accessible to the public.