ABEM and ABPS Square Off over Board Certification

You could call it a case of the haves and the have-nots. At least that's the way it looks to John B. McCabe, MD, the president of the American Board of Emergency Medicine. As more residency graduates scramble for a place in emergency medicine, board certification has become a litmus test for career-making moves. In less than a decade, many hospitals have gone from calling board certification a preferred attribute to making it a requirement of employment. “The split between those who have [it] and those who don't has become greater,” said Dr. McCabe, the chairman of emergency medicine at the State University of New York, Upstate Medical University in Syracuse. Public recognition has risen so much that now even teens with sports injuries know to ask about board certification before undergoing any emergency treatment, thanks to the prodding of coaches concerned about preserving their players' athletic skills. But when Dr. McCabe speaks about board certification, he is referring to the board over which he presides, which is overseen by the American Board of Medical Specialties. The practice of emergency medicine historically has been through certification by ABEM or the American Osteopathic Board of Emergency Medicine. Don't Call it ‘Alternate’ That may be changing, though, as a result of what executives at another board, the American Board of Physician Specialists (ABPS) see as a growing trend toward the draw of another route — theirs. Unlike ABEM, ABPS allows candidates who have completed an ACGME- or AOA-accredited residency in family practice, internal medicine, or pediatrics, as well as other specialties, to sit for the exam if they meet a series of qualifications spelled out by the ABPS and have completed five years of continuous practice in emergency medicine. (The list of eligibility criteria may be found at www.abpsga.org.) ABPS allows doctors to take the exam if they completed a residency in family practice, internal medicine, or pediatrics, and completed five continuous years of EM practice Formed 55 years ago, ABPS came about because osteopathic physicians with allopathic residencies were excluded from ABMS and AOA board certification, according to William J. Carbone, the chief executive officer of the American Association of Physician Specialists (AAPS) and the ABPS in Atlanta. “AAPS was formed in 1950 to allow physicians to demonstrate their advanced education and expertise, which encompasses board certification, that was not otherwise possible,” he said. He disparages the use of the word “alternate” to describe ABPS or any other aspect of the certification that takes place under it. As polls by the specialty of cosmetic surgery have demonstrated, the public may understand the term “board certified,” but they generally don't know there is a difference in credentialing boards. “To our knowledge, there are no reports or studies available that demonstrate there are any differences in the quality of care rendered among diplomates certified by any of the three multi-specialty boards of certification,” Mr. Carbone said. Clinical Outcomes Board certification can trace its roots to the Civil War. By the 1860s, examinations of aptitude for new doctors had been established in several states, but physicians who accompanied Union troops were required to take another test on orders of the Civil War Surgeon General William Hammond, who worried about the level of training of the doctors who served. New government-sanctioned tests were implemented to “further eliminate unqualified individuals,” according to a recently published book on the period, Bleeding Blue and Gray: Civil War Surgery and the Evolution of American Medicine. (Random House, New York, 2005.)Figure“To our knowledge, there are no reports or studies available that demonstrate there are any differences in the quality of care rendered among diplomates certified by any of the three multispecialty boards of certification.” Mr. William Carbone Though board examinations became the rule, direct comparisons among physicians who obtained the certificate and those who did were only anecdotal. Now, with so many physicians identifying themselves as board certified, the comparison group has shrunk to the point that such studies may be problematic, according to the authors of one of the few studies trying to pool the data. They set out to determine if specialty board certification — specifically ABMS certification — made a difference in clinical outcomes. Though board certification is widely considered a mark of excellence, they wanted to determine if it had actual morbidity-preventing value as a credential. These investigators titled their research report “The Missing Link.” The researchers, a majority of whom were from Northwestern University in Evanston, IL, used 56 different papers that met inclusion criteria. But their answer seems less than definitive. Of 33 findings, 16 demonstrated a positive association between certification status and positive clinical outcomes, 14 showed no such association, and three revealed worse outcomes for board certified physicians. (Acad Med 2002;6(77):534.) Buried on the last page of the report, however, is an intriguing statistic: Board certified physicians produced a 15 percent reduction in mortality over noncertified physicians in the care of myocardial infarction patients in one Eastern state. And the results of a study outside the United States seem to support the idea that board certification predicts expertise, at least when it comes to teaching emergency medicine. The study, conducted in Canada, asked residents to evaluate 115 faculty by means of a questionnaire; 562 of them did just that. EM certification correlated with high-scoring evaluations. “These data suggest that educational administrators should focus their efforts on securing EM-certified individuals, regardless of age, with particular attention to individuals with an interest in an academic track for teaching in their training programs,” the researchers assert. (Acad Emerg Med 2003;10[7]:731.) But the study also showed no difference in scores between those who obtained certification through training or practice eligibility. The authors noted that family physicians on the faculty seemed to demonstrate good people skills, prompting them to suggest that “introducing or adapting some aspects” of family medicine training might be a good idea in EM programs. In fact, Robert Suter, DO, the president of the American College of Physicians, has expressed support for a dual residency in family medicine and emergency medicine. He said he believes several programs are poised to make that transition at some point. But he is firm in his conviction that primary care physicians who want to be emergency physicians need an EM residency program that doesn't “bypass the current legitimate residency training and board certification process.” Dr. Suter pointed out that relaxing the traditional process in any way threatens to dilute the recognition that emergency medicine's founders sought so hard to establish. Though stopping short of calling any other route unacceptable, he said “residency training is widely available” and any departure from its traditions can weaken the premium placed on board certification. Could the rigors of a credential the public finds confusing ever affect the specialty practice of medicine? A survey of doctors by the Kaiser Family Foundation indicates that it might. Nearly a third of the 45 percent of respondents who said they would not recommend the practice of medicine as a career cited lowered recognition of the profession as a reason.Figure“The split between those who have [it] and those who don't has become greater.” Dr. John McCabe Perhaps even more telling, some seemed to think they had spent too much time and money in preparation, potentially demonstrating a sizable percentage that would have preferred a different, faster track to board certification. About 16 percent said the educational process is too long, too difficult, and too expensive. (Kaiser National Survey of Physicians, March 2002.) Dr. McCabe noted that ABEM has embarked on a program of “lifelong learning” that will mean more, not less, in terms of the certification process, by requiring re-certification at decade intervals. Although Dr. McCabe acknowledged that this places more of a burden on the practicing emergency physician, he said ABEM examinations are designed with the patient, not the physician, uppermost in mind.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.