Why physicians are certified by boards

Abstract

The concept of board certification of a physician in a discipline dates back more than 80 years. A certificate was awarded for life and indicated that the certificate holder had taken and passed a written examination and, often, an oral examination. This board certification indicates that a physician has met a national standard. The “Boards” of the major disciplines, such as Pediatrics, Medicine, Surgery, etc, are bound together under the American Board of Medical Specialists (ABMS), which supervises 24 specialty Boards. The programs in which ABMS trainees are instructed are carefully critiqued and evaluated by the Accreditation Council for Graduate Medical Education (ACGME). The Residency Review Committees (RRC) are appointed by the ACGME and review all residencies. Two important concepts are that individual physicians are certified by “Boards” on the basis of their knowledge, skills, and attitudes and residency programs are accredited by the RRC and, hence, the ACGME and not by individual “Boards.” The individual physician is certified by the following process: training for a designated period in an approved residency program, completing a prescribed curriculum, being approved to sit for a certifying examination by a program director, and passing a secure examination in a testing center. Since the 1930s, new concepts have been incorporated; key among these are that the individual trainees have the attitudes and moral behavior required of an excellent physician (attested by the program director) and the certificate is time limited. Physicians must recertify to maintain their Board status. Similarly, training programs are required to renew their status with the RRC in 5-year intervals, thus, assuring that residency program development is ongoing. Most critical, however, is that the Board assures the public of the knowledge, skills, and attitudes of each physician who receives a certificate. Because the Board certifies physicians, it must have an arm's length and objective relationship with medical-led professional societies. Hence, the American Board of Pediatrics (ABP) is separate from the American Academy of Pediatrics, the American Board of Internal Medicine is separate from the American College of Physicians, and so forth. Similarly, subboards are independent of subspecialty societies (eg, American Society of Nephrology/American Society of Pediatric Nephrology, etc). All Boards have nonphysician public members who represent views of the public (stakeholders). A specialty board can develop subspecialty boards. For instance, the ABP certifies pediatric nephrologists through the subboard of Pediatric Nephrology. It is the role of the ACGME, through the RRC, to approve the length and content of each Pediatric Nephrology fellowship program; this is how each program receives its accreditation. However, the examination, which must be passed by each trainee, is written by the members of the ABP Subboard of Pediatric Nephrology and supervised by the ABP. This process of training and certification is again not influenced by professional societies or by pharmaceutical companies. The examination fee is paid by the trainee. This process assures the public of the lack of undue influence by the profession on the certification process. The Boards of clinical disciplines also have “third-tier” examinations and certificates. These are known as “certifications of added qualifications” or CAQ. “Third-tier” is defined as specialized skills within a subboard of a discipline. Under the ABP are third-tier Boards in Toxicology and Laboratory Medicine. A third-tier certificate also exists in Cardiac Electrophysiology within Internal Medicine/Cardiology. The development of a third-tier certificate or CAQ requires approval of the ABMS. A developing concept concerns the maintenance of certification, which assures that physicians remain aware of the advances in medical progress. In the past, this has involved either a lifetime certificate or periodic recertification (frequently every 7 years) using only a test of knowledge. The new concept that is being established is to assure that certified physicians remain current on an ongoing basis. This is described in the accompanying essay by Ham and Stockman.1Ham HP Stockman JA. Why maintenance of certification?.J Pediatr. 2002; 141: 299Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar In conclusion, the certification process involves a series of steps by which individual physicians can be evaluated and certified by a specialty board. On the other hand, the training program in which that physician trains is accredited by a residency review committee that is supervised by the ACGME. This process, which has been in place for many years (80+), has served our discipline well and is now being emulated by organized medicine in the nations of the European Union. Most importantly, the established processes ensure an arm's length relationship with professional societies and avoid any real or perceived conflicts of interest.