Invited Article: Maintenance of certification

Abstract

Certification by one of the 24 Member Boards of the American Board of Medical Specialties (ABMS) is widely used as an indicator of higher standards and better care. That certification is linked to quality care is largely borne out by the research.1–15 Some of the data are quite striking, for instance, linking certification to a significant reduction in mortality for acute myocardial infarction,1–3 colonic resection,4 and peptic ulcer surgery.5 Certification has been associated with a decrease in complications as well as mortality for other major surgical procedures, including carotid endarterectomy and abdominal aortic aneurysm resection.6 A review of the evidence from multiple studies suggests that board certification is associated with positive clinical outcomes and that certification examination results are correlated with other measures of physician competence.7 Another study found that Medicare beneficiaries who saw board-certified internists were significantly more likely to receive appropriate preventive care services (including hemoglobin A1c monitoring, colorectal cancer screening, mammography, and pneumococcal and influenza vaccine) than those whose physicians were not board certified.8 Furthermore, patients cared for by board-certified physicians received recommended care (such as aspirin and beta-blockers) for heart attacks9 and the recommended number of prenatal visits10 more often than those who were cared for by noncertified physicians. Also, the lack of anesthesiologist board certification has been associated with poorer outcomes.11 In general, the lack of board certification has been associated with a greater risk of disciplinary action.16,17 The physician specialty movement began in earnest 90 years ago, and in 1933, four medical boards (American Board of Dermatology, American Board of Obstetrics and Gynecology, American Board of Ophthalmology, and American Board of Otolaryngology) formed the forerunner of ABMS to advance the cause of specialty certification. Currently there are 24 ABMS Member Boards, which certify …