AMA directed to examine recertification

Some doctors say the process can be costly, burdensome and not relevant to current practice environments; others found it important in terms of professional value.

By Damon Adams, amednews staff. July 9/16, 2001.

Chicago -- Throughout much of the medical community, recertification is viewed as a way to assess a doctor's competence and to help improve the care of patients. But some doctors say it taxes their time and creates a burden on their practice.

Responding to physician concerns about the process, the AMA House of Delegates at last month's Annual Meeting in Chicago asked the Board of Trustees to study issues surrounding it.

Among the specifics the board has been charged to consider are recertification's minimal burden, general applicability to all specialties, cost effectiveness, relevancy, potential economic impact, inclusion of practicing physicians, acknowledgment of regional differences in medical practices, avoidance of potential discrimination against lifetime certificate holders, impact on physicians with multiple board certifications and avoidance of duplication.

Delegates asked that the board report back to them in June 2002. The board likely will ask one of its councils to study the matter.

The direction resulted from a series of proposals asking the AMA to encourage the American Board of Internal Medicine to reconsider its recertification Continuous Professional Development program to take into account the needs of practicing internists; to support the American College of Physicians--American Society of Internal Medicine's dialogue with the ABIM to modify the recertification process; and to endorse a more standardized recertification process that incorporates technological advances such as online resources.

Recertification should be an educational process -- "not [used] to weed anybody out," said Stephen B. Webster, MD, a La Crosse, Wis., dermatologist and alternate delegate for the American Academy of Dermatology.

Board certification, once a one-time procedure, typically requires recertification every seven to 10 years.

Board certification used to be a one-time procedure. But after the American Board of Family Practice was founded in 1969, the board began limiting its certificates to seven years. The 24 member boards of the American Board of Medical Specialties now are encouraged to require time-limited certificates, typically for seven to 10 years.

"Just about all [boards] have a recertification exam that needs to be taken," said Liana Puscas, MD, a Los Angeles otolaryngologist and a former AMA resident trustee.

Board certification can translate to higher recognition among peers, while failing to get recertified can mean losing managed care contracts.

Topic of mixed reviews

Much of the recertification debate, however, focused on the ABIM's CPD program.

In 2000, the ABIM launched the program as a new approach to recertification. It is designed to improve the quality of patient care and to set high standards for physician competence, according to the ABIM.

The purpose of the CPD is also to give certified internists and subspecialists a means to demonstrate accountability by voluntarily meeting standards for medical knowledge and clinical skills and performance. The board recommends that all diplomates participate, but only those certified since 1990 (1987 for critical care and 1988 for geriatric medicine) must complete the program to maintain certification.

"It is a useful tool for accountability," said F. Daniel Duffy, MD, ABIM's executive vice president.

The CPD program has three components: a self-evaluation with five modules of 60 questions each, an exam and verification of professional credentials. Each diplomate should spread the program over 10 years.

"The process has to be spread out so it isn't a last-minute crunch," Dr. Duffy, a Philadelphia internist, said.

Overall, though, physicians expressed mixed feelings about recertification in general. Some said they supported the process, while others voiced displeasure.

"From the internist's perspective, this is not what everybody wants," said Daniel Edney, MD, a Mississippi alternate delegate and an internist from Vicksburg.

Wisdom is key

Some internists view recertification programs as redundant, costly, burdensome and not relevant to the current practice environment. They said recertification should consider a doctor's insight and judgment to make the right decisions.

"What you want to be tested on is wisdom," said Mahendr Kochar, MD, a Milwaukee internist and alternate delegate from Wisconsin.

Dr. Duffy said there is support for recertification. A survey of 1,760 ABIM diplomates who went through recertification from 1996-1999 found that 71% viewed the process as important in terms of professional value. Of those polled, 10% did not value recertification, while 19% were neutral.

Regardless of what shape recertification takes among various boards, physicians realize that board certification will remain important to the people they treat.

"It makes patients feel better to know that their physician has passed [certification] again," Dr. Puscas said.