Saturday, December 17, 2011

Maintenance of Certification

Board certification as a marker of competence of the medical knowledge necessary in each medical field has been touted for a long time.  Residency programs stress the importance of passing “the boards”, and provide education to residents in the form of didactics that are commonly geared not only to clinical care, but also towards this examination and the skills needed to pass it.
What does it mean to be board certified?  The official term is “Diplomate of the American Board of ___” (depending on one’s specialty).  What it means is that the physician has completed training in her/his area of expertise, and has passed the initial certifying examination (or set of written and oral examinations, for some specialties).  Currently, this certification expires after a certain time period (ten years, for example).
In the past, physicians had to sit for and pass a “recertification” examination, although now the process has changed significantly.  Physicians are now required to demonstrate a valid license to practice medicine, complete an appropriate set of practice questions to demonstrate lifelong learning, pass another certifying examination, and also complete a performance or quality improvement project.  Together, these four parts are known as “Maintenance of Certification”.  An excellent explanation of this process, from the American Board of Pediatrics, is noted here.
There are some physicians who feel that this process to “recertify” is onerous, and not necessary.  There are others who feel it is absolutely essential to demonstrate a minimum standard within the specialty.  I personally fall into this second category.  There are a select few who “grandfathered” in, meaning that their original board certificate was lifelong, thus indicating that they were never required to recertify if they so choose.  This “grandfathering” process is not done anymore in any of the specialties, but there are obviously those who still hold such certificates.
An interesting point-counterpoint as to “should someone who is grandfathered go through maintenance of certification” has been noted.  Those in favor of pushing for everyone to recertify cite this article and others, which showed that those who maintained their certification provided improved processes of care for certain populations than those who did not maintain the certification. 
The American Board of Medical Specialties is soon making public the information around whether a diplomate is undergoing or has undergone maintenance of certification.   I applaud this reason, as I believe that patients deserve to know whether their physician has or has not met this “minimum standard”.  Others do not feel the same, citing multiple reasons why maintenance of certification is onerous, costly, and takes time away from direct patient care.
What do you think?  Should maintenance of certification be public information for all to see, or not?  Should we push physicians who have not maintained their certifications to do so, or to not be permitted to practice their craft?


  1. I am bothered by the grandfathering policy. It is paternalistic and absolutely the antithesis of the purpose of MOC. The farther out a physician is from having completed training, the more concern an accrediting board should be that a physician maintains current standards of practice.

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