Published On July 23, 2010
For physicians an important measure of competence is board certification—a way to demonstrate knowledge in a specialty, subspecialty or both by passing a rigorous test of expertise. Though only state licensing exams are legally required for practicing medicine in the United States, board certification has come to be expected by some medical groups and hospitals, health plan payers and knowledgeable consumers. About 85% of U.S. physicians are certified by one of the two dozen American Board of Medical Specialties member boards, which cover 145 medical specialties.
Though some specialties, such as general surgery, have long required recertification, until recently most board certifications were good for life. Since 2006, however, physicians have been subject to new ABMS rules: They must pass a written exam every six to 10 years, and they’re asked to complete “modules” every one to five years that may include analyzing medical records to see whether patients received care that was up to the latest standards and assessing communication skills with patients. Only doctors who received board certification before 1990 are exempt from recertification.
It’s no secret that physicians find the recertification process time-consuming and costly, with test fees of $3,000 or more. And in a recent online poll by the New England Journal of Medicine—which asked doctors to consider the hypothetical example of a 55-year-old physician, board certified in endocrinology and in practice for 24 years—63% of 2,512 physicians said the specialist shouldn’t volunteer for recertification testing.
“Recertification is a good idea in theory,” says Lee Goldman, a cardiologist and dean of health sciences at Columbia University, who co-authored an article criticizing recertification that accompanied the NEJM poll. But passing a written exam doesn’t necessarily make for a better mid-career doctor, argues Goldman, particularly if the required knowledge isn’t useful in day-to-day practice. “It would be ideal to ask doctors to identify the most common problems and diagnoses they encounter in their practices,” he says. ““For some doctors, much of the exam may be irrelevant.”
ABMS president Kevin Weiss counters that member boards have created recertification programs that will build physicians’ knowledge base and improve their skills. “The intent is to derive a higher-quality workforce,” says Weiss. “We’re finding that physicians aren’t concerned about the time recertification takes if it adds value to their experience.“
Recertification is part of a broader push toward accountability that also includes employers and health plan payers assessing physician performance. Doctors who choose to go through the process may collect additional reimbursement, and the new health care law mandates bonuses, starting next year, for physicians who are recertified and participate in Medicare pay-for-performance programs.
Though encouraged that some specialties are supplementing exams with elements that may more directly relate to physician practices, Goldman remains skeptical. “A secure test of recall may not be nearly as relevant as knowing how to use the myriad modern sources of information,” he notes.
Goldman, who became board certified in the 1970s, says he has no plans to recertify. Many of the 250,000 other physicians grandfathered in with lifetime certificates, and the 150,000 or so physicians who have never earned board certification, are likely to feel the same way.
Stay on the frontiers of medicine