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Tuesday Apr 17, 2018

Make Our Voices Heard on Continuing Board Certification

In September of this past year, the American Board of Medical Specialties (ABMS), in conjunction with its 24 member boards, announced the formation of the Continuing Board Certification: Vision for the Future initiative.(visioninitiative.org) The intent is to bring together a group of stakeholders to look at the state of continuing board certification across all medical specialties and consider the future of this process. The work plan for the commission consists of several phases that include assessing the current state of certification systems, obtaining feedback from stakeholders, identifying key questions to be answered and delivering final recommendations for consideration by the ABMS and its member boards.

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This commission was developed in response to the continued concerns that have been voiced across the country about the process for continuing board certification (also known as maintenance of certification). AAFP members informed us of their angst through multiple avenues. Resolutions on this topic have been presented to the Congress of Delegates for years, asking the AAFP to advocate to the American Board of Family Medicine (ABFM) for changes to the process. Members routinely give feedback to AAFP officers and directors who attend constituent chapter meetings about issues they are facing related to the process and its relevance to their practices.

Board certification was among the top three items members asked for the Academy's help with in the 2017 Member Satisfaction Survey. Concerns that have been voiced range from the overall cost of the process -- not just in the yearly fee paid to the ABFM but also in the time required to study and prepare for the exam, lost revenue while away from the practice setting, and personal time required to complete the process, which in our environment of declining physician well-being is perhaps one of the greatest costs. Major concerns centered around the high-stakes proctored exam, including its validity and necessity, the time required and the lack of alternative options as part of overall continuing board certification.

Perhaps the greatest issue in the entire process of continuing board certification, however, is the misuse of board certification as a sole or threshold criterion for credentialing, privileging, employment and payer participation. The sad reality is that it is being used in just this manner in parts of the country. Although board certification should be considered as one important component in these decisions, documented experience, training, expertise and demonstrated competence are equally important. Family physicians who may elect to not maintain board certification should not be penalized and should be able to rely on these other factors.

Another concern is the basic question of who the ultimate stakeholders are from the perspective of the ABMS and its member boards. The answer, according to the ABMS, is the public, and its commitment is to ensure that physicians are competent to meet the public's needs. Perhaps nothing summarizes this better than the first paragraph of the press release announcing the formation of the Vision for the Future commission:(www.abms.org) "The commission will bring together multiple partners to vision a system of continuing board certification that is meaningful, relevant and of value, while remaining responsive to the patients, hospitals and others who expect that physician specialists are maintaining their knowledge and skills to provide quality specialty care."

Physicians are also important stakeholders in this process, and this sort of omission is largely why we've reached this point of discontent with the continuing certification process. Many physicians see the certifying bodies as insular and out of touch with the realities of daily practice and the patient care environment. Some specialty boards have heard this message loudly and pointedly.

The AAFP Board of Directors formed a Task Force on Continuing Board Certification to consider these issues in July of 2017. The task force has been charged with looking at alternative ways to achieve continuing board certification for family physicians; developing additional recommendations for the ABFM regarding options for demonstrating knowledge in addition to the high-stakes proctored exam; developing AAFP policy regarding professional self-regulation and continuing certification, and its appropriate use; and developing policy regarding criteria by which members and others can evaluate specialty certifying boards. The AAFP Board has also advocated regularly with the ABFM on the need to develop alternatives to the proctored exam.

To be clear, the AAFP supports the Council of Medical Specialty Societies Principles of Self-Regulation.(cmss.org) We take seriously our responsibility to fulfill professional self-regulation by continually educating our members through lifelong learning and facilitating performance improvement in practice.

However, failing to recognize physicians as stakeholders and valued partners in this process creates friction and stifles collaborative efforts. We must strive to work together with our specialty boards to improve the system such that physicians find value and relevance to their practice. The processes deployed must improve and enhance patient care, not simply be more of the check-box activities that we are exposed to far too often. Accomplishing this will provide meaning to the other key stakeholder: our patients.

On March 19, I attended the Vision of the Future Commission's hearing for member boards and medical specialty societies. Representing you, AAFP members, I provided pointed comments on our behalf. I outlined the need for physicians to be considered important stakeholders; asserted that the continuing board certification process must be made meaningful and aligned with our practice, rather than be yet another burden detracting from patient care; and most importantly, stated that continuing board certification must never be used as the sole or threshold criterion for employment, credentialing, privileging or payer participation.

Now, it is your turn. The ABMS commission has created an online survey,(visioninitiative.org) asking physicians for their thoughts. Please take the time to respond. The ABMS needs to hear from all family physicians. Their perception is that we are all happy with the current process, but that is far from what I hear when traveling to chapters around the country. Having large numbers of members responding to this survey will speak volumes, and it is critical that our voices, comments and concerns be heard.

We know that the current continuing board certification environment needs improvement. This is our chance to provide input and help shape a future in which continuing certification is a meaningful process that will incorporate what is truly important to delivering excellent quality patient care while satisfying our obligation of professional self-regulation.

Michael Munger, M.D., is president of the AAFP.

Posted at 03:02PM Apr 17, 2018 by Michael Munger, M.D.

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