Last year, the AAFP Board of Directors created a task force on continuing board certification in response to our members, many of whom have asked the Academy to address the current certification process with the American Board of Family Medicine (ABFM). It was my honor as AAFP president-elect to chair a task force composed of family physicians who cover a wide geographic and practice-style spectrum. The AAFP's Commission on Continuing Professional Development, a group of more than a dozen member volunteers, also has devoted significant time to this issue, and the task force sought to build on those efforts.
This is an extremely complex topic dealing with the nature of medical professionalism, the historical development of our specialty societies and boards, the constitutional basis of medical licensure and protection of the public, as well as changes in technology that are fundamentally changing how we practice medicine. Further complicating matters is the increasing stress that our members are experiencing due to excessive administrative burden, changes in payment and meeting documentation requirements with poorly functioning electronic health record systems.
The AAFP has been involved in intense conversations with the ABFM to address our members' concerns. Remember that the AAFP and the ABFM are separate organizations and do not have shared governance or an overlying umbrella organization. Unlike the American Osteopathic Association, which includes both the American College of Osteopathic Family Physicians and the American Osteopathic Board of Family Physicians, the AAFP is an organizational member of the Council of Medical Specialty Societies while the ABFM is part of the American Board of Medical Specialties (ABMS). Within this framework, there is autonomy among the certifying boards.
The ABFM, which historically has been the most rigorous specialty board within ABMS, was officially recognized in 1969. The need for family medicine's specialty designation was apparent at a time when general practitioners were being denied hospital privileges. Family physician leaders felt the need to prove that a specialty in breadth was just as rigorous as a specialty in depth. Thus, family medicine became the first specialty to require periodic recertification.
The task force thought that much of the recent anger about continuing board certification can be traced to the perceived value of certification. Value is benefit divided by cost. It can be improved either by increasing the benefit or decreasing the cost. In this case, the costs are more than just fees; they include the significant administrative burden of continuing board certification processes. We look to the ABFM to be mindful about decreasing this unnecessary burden.
In addition, a major issue of concern to the AAFP is that board certification is often being used inappropriately as an absolute or sole requirement for credentialing and privileging, and sometimes for employment and payment. Although board certification is an important criterion for such purposes, the AAFP has always believed that documented training, experience and demonstrated competence are equally important and must be considered in such decisions. And it is important to note that the ABFM shares this policy position with the AAFP.
The ABMS is aware of the need to change and is engaged in a project called Vision for the Future. That project includes a survey that allows physicians to provide feedback through May 11. Family medicine has an excellent representative participating in that initiative. Nonetheless, we do not know what the outcome will be or whether it will align with our mission of serving our members with creativity and, through our members, improving the health of our patients, communities and nation.
Thus, we are moving forward with our own efforts to improve the process. At its recent meeting, the AAFP Board of Directors approved recommendations submitted by our task force on continuing board certification. They cover a range of issues involving certification, including making the case that Board certification should not be an absolute or sole criterion for privileging and credentialing. Further, the recommendations call for the Academy to provide guidance on how to evaluate other certifying organizations.
Based on the task force's recommendations, we believe significant changes are needed to the certification process. Options include improvement of the ABFM certification process, as well as possible assessment of other entities that may provide alternative certification choices for members. And while not being actively pursued at this time, the AAFP will undertake a preliminary evaluation of the steps that would be involved in establishing a certifying body that would meet the needs of members. All this points to the need for process improvement, whether through the ABFM or elsewhere.
Finally, we will continue to strive for more dialogue with the ABFM to work on a common vision that recognizes that physicians are key stakeholders in the certification process, and that our needs are an important consideration in the process. We plan to discuss improvements to the continuing board certification process, including the need for multiple alternatives to the current proctored exam requirement.
This is an area where family physicians have strong opinions. As an organization, we will ensure those opinions are heard.
John Cullen, M.D., is president-elect of the AAFP.