“Board certified” and “board eligible” are bywords in the physician recruitment industry. Both recruiters and physicians use these terms to describe the qualifications required for employment – and hospital employers use these as criterion in many of their employment contracts.
Medical specialty certification in the United States is a voluntary process with medical licensure setting the minimum competency requirement for diagnosing and treating patients. “Board Certification” demonstrates a physician’s expertise in a particular specialty and/or subspecialty of medical practice. “Board Eligible” on the other hand means a physician has met all prerequisites for taking the board examination, such as completing a residency program, but has either not taken or passed the examination.
History. Physician board certifications began in the 1900s where 50% of all physicians were general practitioners and provided all types of healthcare to patients. Ophthalmology was the first specialty to form a board certification process through the American Board of Ophthalmology, and in 1933, the American Board of Medical Specialties (ABMS), then named, Advisory Board of Medical Specialties, was established.
The American Board of Medical Specialties (ABMS) is a non-profit physician-led umbrella organization for 24 of the 26 approved medical specialty boards in the United States. It is the largest voluntary-based physician specialty certification organization in the United States with over 750,000 US physicians having achieved certification by one or more of its 24 medical specialty boards, referred to as “Member Boards.” The ABMS works closely with the Member Boards to set educational and professional standards for the evaluation and certification of physician specialists.
Trends In Certification. At one time, physicians who became board-certified were not required to renew their certification. However, advancements in the medical field have made periodic re-certification necessary (every six to ten years) – recognizing the need for continuous expertise and competency within specific medical specialties.
In the last several years, Member Boards have implemented maintenance of certification requirements to provide ongoing education and assessment of physicians. In a consumer survey commissioned by ABMS, 95% of those surveyed stated that their doctor’s participation in a Maintenance of Certification program is “important” with two thirds (66%) saying it is “very important.”
As of August, 2011, ABMS began making information available to the public on whether individual physicians are meeting those requirements. Consumers can find out if their doctor is board certified at www.certificationmatters.org which provides profiles of physicians and then answers the question of whether that physician is “meeting the MOC requirements” of his or her certifying Member Board(s).
Board certification processes have also been reworked over the last several years. While board certifications vary depending on the medical specialty, key factors are now being integrated aside from the examination, including patient assessments, quality benchmarks, performance metrics and peer reviews. These features have already been applied to the American Board of Internal Medicine and the American Board of Pediatrics.
Effective January 1, 2012, the ABMS established limits on the time period that can elapse between a physician finishing their residency training and achievement of Board Certification. All of the 24 member boards have established a time limit of no less than three years and not more than seven years for doctors to complete their training and certification. The flexibility in the time limits for achieving board certification recognizes that 24 ABMS Member Boards, each certifying physicians in a specialty, have different requirements for board certification and offer their certification exams at different intervals.
After the time prescribed by the Member Board, a physician who has not attained Board Certification will be ineligible until they complete the requirements of that Member Board for re-entry into the examination process. The policy creates negative consequences for physicians who do not attain board certification, since they can no longer claim “board eligibility”. ABMS President and CEO Kevin B. Weiss, MD, MPH has said “The new policy ensures that physicians enter into this process of lifelong learning and professional development without too big a gap after their training.”
In addition to varying time limits by specialty, specialty boards have also developed individual related policies. For example the ABFM board of directors defined board eligibility as the first seven years after residency training or loss of certification. If physicians are not certified after seven years, they must complete at least one more year of a family medicine residency. Neurosurgeons also have seven years to become certified. Surgeons who don’t meet the time restrictions must restart certification, which includes retaking the board’s written exam and submitting 150 operative cases. All doctors face sanctions if they designate themselves as board eligible beyond the time limit. “We recognize that physicians sometimes need to signal their intention of becoming board certified when they apply for jobs and attending privileges in hospitals and other facilities,” said Dr. Weiss. “This policy legitimizes the term ‘board eligible’ during a specific time period, but shuts off the potential for abuse of the term.”
Board Certification and Physician Recruitment. These new trends in board certification and eligibility can have a negative impact on physicians who have not been certified but can no longer be called “board eligible” due to the new guidelines. Physicians seeking employment must ensure that they meet the requirements of the healthcare organizations that employ them. Since certification or eligibility are most commonly required by insurance companies in reimbursing hospitals, these new certification processes can disqualify physician candidates from being hired by a hospital.
Craig Fowler, VP for Recruiting, Training and Public Relations for PHG, commented, “These requirements will have a greater impact on international medical graduates (IMGs). We have observed occurrences of IMGs not being board eligible because of their lack of American residency training. Some will complete fellowships that are shorter in length, in an attempt to meet the post-graduate year (PGY) requirement for State licensure, but may still have trouble becoming eligible depending on the requirements for board eligibility as defined by their specialty. We have seen this scenario in orthopedics, neurosurgery and urology. Physicians without board certification have lesser marketability with patients and employers. Therefore, they find themselves with limited job opportunities in less desirable practices such as those in remote areas, VA hospitals and correctional facilities. Bottom line, the current rules on board certification and eligibility, may greatly hinder the International Medical Graduate’s practice options.”
Pinnacle Health Group’s Senior Vice President of Recruiting Rob Rector shared, “I have encountered many doctors who have completed three or four fellowships without doing residency training. A board eligible and board certified medical staff helps facilities become an in-network provider with most health insurance companies. When a facility searches for a new physician, they will look for doctors who are certified or eligible in their specialty. If I could give any advice to these doctors, it would be to do residency trainings and be sure that you are satisfying the current requirements for board eligibility and ultimately certification, before completing multiple fellowships.”
References:
“ABMS establishes time limits for attaining board certification,” Carolyne Krupa, American Medical News, March 5, 2012.
“Advertising “Board Eligible” Creates Trouble for Texas Physicians,” Joyce McLaughlin, Physicians News Digest, April 13, 2012.
“Facts About the ABMS Consumer Survey: Lifelong Learning and Other Qualities in Choosing a Doctor,” American Board of Medical Specialties, April 2011.
“Is Board Certification Overrated?,” Robert Anthony, Physicians Practice, July 14, 2010.
“New AMA policies target certification and licensure,” Carolyne Krupa, American Medical News, July 4, 2011.
“Older physicians may have fewer job options than younger colleagues,” Victoria Stagg Elliott, American Medical News, December 26, 2011.
“The True Value of Board Certification,” Keith L. Martin, Physicians Practice, September 8, 2010.