Special Feature: Maintaining Board Certification
By Kenneth L. Noller, MD
The process of achieving certification by the American Board of Obstetrics and Gynecology (ABOG) is well known. All of us who are certified have successfully completed a residency program that is fully approved and have passed 2 examinations: a written test that focused on recall of information, and an oral examination that was designed to review our methods of practice.
Several boards began to offer, and later require, recertification after a variable number of years in practice. In most cases, this involved achieving a passing grade on a written test. The shortcoming of this process is that it only tests recall, not method of practice. A physician might know many facts, but not have applied them to his/her daily practice. For example, an OB/GYN might be able to answer any number of questions about the role of HPV in the etiology of cervical cancer, but still be performing hysterectomies for CIN3/carcinoma in situ.
ABOG was the first board to develop an annual recertification process, known as Annual Board Certification (ABC). The program has been extremely successful. Many OB/GYNs who do not need to recertify because of "grandfathering" have registered to receive the test materials. In this program, the physician who has entered the process receives regular mailings of several recent articles from the literature that have been chosen because of their quality and importance to the field. After reviewing the articles, he/she takes a test on the content. This has been seen by many boards as a major improvement in the process now known as "maintenance of certification."
However, even the new ABOG process will not satisfy the requirements that will be in place in a few years. All of the boards will be required to develop a system that can judge "competency." Exactly what this term means is the subject of great debate at the highest levels. At one end of the spectrum would be actual observation of practice. Of course, that is not possible. The other end is the continuation of the present system in which passing a test every few years is considered to be evidence of maintenance of skills—an easy process to implement, but hardly a measure of performance.
While I am on dangerous ground trying to predict the future of this movement, it does seem clear that all of us (yes, even those of us who have been "grandfathered") will need to be tested and reviewed on a regular basis. In many ways, this seems to be redundant, as our hospitals are currently required to evaluate our practice and skills on a regular basis. Unfortunately, far too few hospitals make much of a genuine attempt at true evaluation. Indeed, there is a built-in conflict for the hospital to do so since the loss of a busy practitioner adversely affects the bottom line. Nonetheless, it is likely that our hospital practice will be judged in some way that is similar to the current "QA" processes with which we are familiar.
A new element will be the need to provide information about our office practices. Since an ever-increasing proportion of medical care occurs in the office rather than in the hospital, this makes great sense. However, it will add yet another layer of paperwork on top of the already huge pile, resulting in increased costs. It is unlikely that it will be possible to use data that are already collected for another purpose to satisfy the needs of the "competency-based" maintenance of certification process.
There will be other requirements such as proving that we hold an unrestricted license to practice medicine, that our list of malpractice claims is "reasonable," and that we have had no "adverse actions" taken against us. In short, we will need to satisfy the "impartial observer" that we are up to date and safe to practice obstetrics and gynecology.
By now, you are probably wondering where I’m going with this editorial. My sole purpose was to inform you that there will be big changes in the requirements for maintaining your status as a board-certified practitioner in the not-too-distant future. Many have felt comforted knowing that they would "never" be required to recertify or to take another test. It now appears that might have been too optimistic. You can be assured, though, that ABOG will try to minimize any bad effects of the new requirements when they are published. Unfortunately, ABOG will have little to say about the general requirements, as they are being developed at a level above any individual Board. We can only hope that the process does improve the quality of health care in the United States.