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Home E-Weekly June 7, 2011

Is Physician Recertification Relevant?

Published: June 6, 2011

Lee D. Hieb, MD, nearly lost her standing as a board-certified orthopedic surgeon. You won't believe why.

Was she guilty of malpractice? Did she fail to keep up to date with current practices and procedures? Was she incompetent? No. The president of the Association of American Physicians and Surgeons says she failed to include a signature sheet in forms sent to the office that oversees applications for recertification testing.

Now she's fed up with the amount of influence recertification has on the practice of medicine. "Does it improve medical care? Does it improve doctor competence? In this age of evidence-based medicine, where is the evidence that recertification matters?" she asks in the Summer 2011 issue of the Journal of American Physicians and Surgeons.

Board recertification has become a clinically irrelevant, bureaucratic cottage industry that's driving mature physicians into retirement and exacerbating surgeon shortages, says Dr. Hieb, a spine specialist with 20 years' experience in the OR. She recalls preparing for a board exam by studying total joint theory, even though she hadn't replaced a joint since her residency training. "Such preparation takes time that could be more productively used to study and improve performance in those areas that target one's specific practice," she argues.

Shepard Hurwitz, MD, executive director of the American Board of Orthopaedic Surgery, disagrees. "Certification gives legitimacy and validity to one's training as an orthopedic surgeon," he says. "It's a voluntary process. We estimate about 10% of practicing orthopedists never were certified or have let their certification lapse after 10 or more years."

He says all 24-member boards of the American Board of Medical Specialties recently implemented maintenance of certification programs, which require physicians to take an exam every 10 years. Compare that to the annual or biannual state medical license renewal process that often requires CME credits and a statement of good standing, says Dr. Hurwitz.

The value that outside stakeholders such as health systems and insurers place on board certification is not generated by any of the ABMS specialty boards, points out Dr. Hurwitz. "Without certification, most surgeons can find a community in which to practice," he adds. "Without a medical license, no physician or surgeon can practice and earn a living. Is the state medical board a cottage industry?"

Daniel Cook

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