When picking a doctor, people consider various factors, including: proximity, gender and reviews from friends or family. One attribute that many suggest you add to that list is whether the chosen provider is board certified. But what does that really mean and what does it suggest about a doctor?
[See: Who’s Who at Your Doctor’s Office.]
When physicians graduate from medical school and do the appropriate residency, they are eligible for licensure. This is a state-issued permit to practice medicine that means the minimal training and competency requirements have been met. Board certification, on the other hand, implies that the practitioner has gone above and beyond that minimal standard in a particular specialty or subspecialty by way of extra education and study, and has passed a test to prove it.
The basic premise of board certification is a good one: The board is supposed to set the nationally accepted standards for physician knowledge and practice, enabling the optimal quality of care to be maintained. However, board certification has recently come into question as to whether the current process is living up to the goal.
Physicians are first and foremost scholars. The grueling premed courses followed by intense work experience and testing requirements only can be accomplished by commitment to study. This dedication to learning and skill development doesn’t end with graduation. In addition, all doctors are required to complete a certain number of hours of ongoing scholarly pursuit, known as certified medical education, or CME, in order to maintain licensure. The requirement is usually at least 25 hours per year.
What’s more, the desire to serve patients well is an impetus for providers to continue learning. Most are always looking up case studies or reading the latest journal articles that relate to their field of practice. One concern is that competing demands on doctors’ time may limit the opportunity for this self-study to keep up with the ever-changing face of medicine. This is where the boards are supposed to come into play — a set of testing requirements and structure that forces the commitment to ongoing education.
[See: Which Practitioner Do I See and When?]
Initially, people were board certified for life, meaning if they took their initial tests, they were bestowed the moniker of certified and never needed to test again. Concerns arose that because medicine is an ever-changing landscape with new discovery, perhaps repeat testing should occur. At some point, the various boards came up with a testing schedule for new graduates and imposed it on everyone beginning practice after that time. However, most of the lifelong certifications were honored, setting up a different standard between providers that are denoted as board certified. The question arose: Is it OK to honor those who only took the test once if ongoing education was the purpose of the boards?
Still, the tests continued with the interval determined by the various boards. In an effort to ensure the goals were indeed being met, a new concept was introduced about a decade ago: maintenance of certification, or MOC. This required significantly more time by the practitioners, as there are online review modules that must be passed to amass enough points to even be eligible to sit for the test. Add to that quality improvement projects that must be done every five years for eligibility, and the time and effort increased exponentially. Already stressed by demands on their time from the ever increasing administrative burdens of the medical system, physicians began to question the value of the MOC.
In addition to the hours spent on pre-test activities, independent study is still required for most physicians to pass the certification test. Some practitioners have to take time off from very busy practice settings to prepare, which exacerbates access-to-health-care issues even more. These certification tests are also pricey, costing up to several thousands of dollars for each specialty.
Physicians in some settings may have little choice with regard to the pursuit of board certification. In the current climate, certification can pose high stakes for doctors. Many hospital systems require board certification to receive privileges to practice. Health plans and various payers may also change reimbursement of professional fees based on board certification. As patients become savvier health care consumers, they may equate board certification with higher-quality physicians, whether that is indeed the case or not. For these reasons, the status of board certification is a pressure many providers feel they must pursue regardless of the costs in time or money.
In the medical field, we believe in practicing in an evidence-based manner. Unfortunately, there is no data showing patient outcomes are better because of board certification. While it intuitively makes sense that ongoing structured reviews should have impact on best practice, there is to date no proof that the current model accomplishes that goal.
[See: 10 Questions Doctors Wish Their Patients Would Ask.]
So where do we go from here? There is great disagreement, even among physicians. Do we eliminate the testing principle altogether? Do we test every 10 years? How do we incorporate other elements of practice that are so important to the patient experience, such as bedside manner, into the certification mechanism? How do issues such as physician well-being, which obviously affects the quality of care patients receive from their practitioner, fit into the equation? Will the onus of board certification add to the impending workforce shortages that are predicted in the next decade and will that further limit the access patients have to necessary care?
In the end, it’s important to remember: There are actually very few incompetent providers, and the ways they are identified and mitigated do not derive from the board certification processes. Physicians are a unique and overall mission-driven group of individuals. In no other profession is the commitment to lifelong learning in order to serve any greater. Maybe that is evidence enough to have faith that physicians will take up the challenge as a professional body and govern themselves. Perhaps this assignment is actually an internal expectation rather than one that has to be thrust upon them. After all, we trust physicians with our lives.
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Board Certification for Doctors: What Does It Really Mean? originally appeared on usnews.com
