Monday, September 20, 2010

Board Certification - Pay to Play?

Board certification used to be a voluntary means for physicians to demonstrate their clinical competencies and separate themselves amongst their peers. Now, it looks like it will just be one more way for insurers and regulators to withhold physician payments in the name of "accountability:"
Physician licenses are issued by state medical agencies. That's not the same with specialty boards, which used to test doctors once and granted certification for life.

In recent years, these groups have changed their policies and now require physicians to be tested every six to 10 years. But many older physicians are grandfathered in and don't have to update their qualifications.

Those doctors say they stay current by reading medical journals and taking continuing-education courses that are required for their state licenses.

Plus, board recertification can require travel to Chicago or Atlanta and cost $3,000 to $4,000 for the test.

"I think the initial reaction from a lot of people is, 'This is a bunch of crap; I did all my work in medical school. Why do I have to do it now?'" said Dr. William Cotton, a Columbus pediatrician.

But constant changes in medicine can quickly make what a doctor learned in school outdated, he said.

Cotton, who graduated from medical school in 1981, was grandfathered in in his specialty but decided this year to recertify to stay current.

Who cares about up-to-date certifications beyond savvy patients? Health insurers and hospitals. Starting next year, doctors who are recertified might be paid more by Medicare under federal health-care reform.

"There needs to be accountability in showing that they are, in fact, a specialist and are up to date on changes in their medical profession," said Kelly McGivern, president of the Ohio Association of Health Plans.
Sadly, board certification is a straw dog for exceptional clinical competency. It has been devalued by the lack of enforcement of the meaning of "board certification." Even the American Board of Internal Medicine who receives large sums of money from physicians and creates the instructional material and tests admits to the sad fact there are still guys out there you can pay $500 to to get a "certificate" to hang on your "board" so you can call yourself "board certified."

By permitting the board certification process to become devalued and merely a means to justify full payment from insurers and hospitals, the American Board of Internal Medicine has officially acknowledged that they are now serving new masters. Because of this, we now understand why the board certification has become a complicated floor of minimalist competencies rather than the pinnacle of one's professional achievement.

And it's one incredibly expensive floor that will now cost you even more dearly if you don't renew.



Ormond Otvos said...

I have trouble understanding what you mean to say. Are you saying tests are no good, that recertification is a sham?

Do you object in principle to checking up on these most important specialists?

I'm asking because I had an out-of-date doctor try to subject me to needless cost and radiation because he wasn't up to date on the best practices.

And besides, I just had to recertify my driver's license because I'm 70. Don't doctors get old?

And don't doctors have a policy of not ratting each other out for incompetence?

Don't we need disinterested evaluators, a second opinion on the doctor herself?

Steve Parker, M.D. said...

I wonder if lawyers have to re-take the bar exam periodically?

I'd be surprised if they do.

DrWes said...


While I have no problem with initial certification, it is the re-certification that troubles me. It is very expensive, both in fees and for the time required. It touches on much more than clinical competence lately, insisting that doctors develop quality assurance measures for their workplace.

I agree that doctors do a bad job ratting out each other - but there are very real concerns about slander, liability, and job security that are raised should this be attempted. Where are these neutral oversight bodies in this case?

Doctors are required to learn and document that learning for state licensure. Now we must further document the learning a different way to get paid. Doctors learn throughout their careers and MUST stay current lest they also fall victim to malpractice lawyers. And sadly, all the certification won't keep doctors from over-ordering tests or performing procedures to line their pockets.

Your point about the driver's license renewal is reasonable, but drivers license re-certification is based on physical and mental cognition capabilities that may decline with age and is meant to assure safe driving practices with the content of the test being fairly static. Are a few re-certification questions on a test really a good measure of a doctor's ability to place a new stent, percutaneous aortic valve or new biventricular defibrillator? How does recertification prove those skills?

Finally, with the increasingly indistinct line between care provider (Nurse, nurse manager, doctor-nurse, who, in some cases, make for income than some primary care doctors), we must wonder if there will be enough benefit for doctors to justify the cost of the certification.