Specialty Board Eligibility No Longer Open-Ended, ABMS Says

Daniel M. Keller, PhD

February 27, 2012

February 27, 2012 — Physicians wishing to become board certified in a medical or surgical specialty will need to keep their eyes on the calendar. The American Board of Medical Specialties (ABMS) has for the first time set new upper and lower time limits for board eligibility. As of January 1, the minimum time after completion of residency training is 3 years, and the maximum time is 7 years. Each of the 24 member boards ABMS oversees will set its own time limits within the 3- to 7-year period.

Richard Hawkins, MD, senior vice president for professional and scientific affairs of the ABMS, based in Chicago, Illinois, explained to Medscape Medical News that the variability in the time limit allows each board flexibility in implementing the policy according to its own needs, such as a requirement for some amount of clinical experience between a written and oral examination leading to board certification, or the time intervals at which they offer the exams.

Each board will need to define the requirements for regaining board eligibility if a physician does not achieve board certification within the required time period. Regaining eligibility may include additional training, medical education, or assessment.

Before this policy change, physicians who had applied for, but not yet completed, the process of board certification could refer to themselves as board eligible for an indefinite period of time, which caused "a fair amount of confusion in the community about what was meant by board eligibility," Dr. Hawkins said, as board eligibility was not a formal term recognized by the ABMS.

"The longer that condition continued, the less likely it was that they would ultimately take the examination and become board certified." Although there is no indication of an increasing number of physicians calling themselves "board eligible" for an indefinite period, implementing a finite period for eligibility eliminates the potential for abuse of the term.

Each board will need to choose its own time limit within the 3- to 7-year period by April 16 for physicians who have completed training, but not yet taken a board certification exam. The time limit will be "at least until January 1, 2015, but no later than January 1, 2019, which will be decided by the individual board, who develops their own policy," Dr. Hawkins said.

Rationale for the Policy Change

Certification by an ABMS board consists of 2 "strongly related concepts," Dr. Hawkins explained. "One is the completion of an accredited training program in which there is a structured education assessment approach and then completion of examinations or set of examinations to demonstrate competence in that specialty. The further one got from training, the more stale the educational experience was, and the connection between the education and the assessment became less and less clear."

In addition, the ABMS encourages continual learning by board-certified physicians through its Maintenance of Certification (MOC) programs, in which physicians engage in lifelong learning and self-assessment to improve their competence and their patients' care. "The longer one took to become initially board certified, the later they entered [MOC]," Dr. Hawkins said.

The ABMS Web site describes the evolution of certification requirements. For years, certificates were open-ended and not time-limited, so they did not have to be renewed. Then a program of recertification every 6 to 10 years was introduced to ensure continuing education and current knowledge in a specialty. In 2006, the 24 member boards adopted MOC programs for all specialties, incorporating evidence-based guidelines, national standards, and best practices along with proof of continuing education and experience.

Board certification is a gold standard for competency within a specialty. Unlike medical licensure, it is voluntary, but ample evidence attests to the value of certification. "There are about 20 or so papers that show that doctors who are board certified tend to have higher levels of competence, provide higher levels of patient care, and have better outcomes in both medical and surgical specialties than doctors who are not board certified," Dr. Hawkins noted.

The ABMS estimates that approximately 750,000 physicians are certified by the 24 specialty member boards.

Dr. Hawkins has disclosed no relevant financial relationships.

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