Making better doctors: A hard look at Board Recertification

When most of us head to the doctor, chances are that the person wielding the stethoscope has been certified to practice in their specialty by a member board of the American Board of Medical Specialties (ABMS). Board certification is an important measure of competence for American physicians. But just when did your doctor receive that badge of approval?

Until recently, most doctors who gained board certification did so at the start of their careers. That means a doctor who is 65 years old could have been certified as far back as 1973. What does this say about his or her competence today, 40 years later?

The answer given by most physicians is that they are as competent as ever. But how can you be sure? One approach to providing an answer is recertification - requiring that doctors retake the certification exam every few years.

Recertification by ABMS member boards demands that doctors pass a written exam every six to 10 years. In addition there are "modules" to complete every one to five years. These involve presenting practical scenarios for which a doctor is asked to analyze medical records to decide whether patients received care that met the latest standards.

Though only state licensing exams are legally required to practice medicine in the United States, board certification has come to be widely expected. Board recertification has not yet reached the same level of expectation.

For some doctors, completing recertification is not an easy choice. It can cost over $3000 for the test and preparation. This has led one physician group to file an antitrust suit against the ABMS in federal court calling recertification "a money-making, self-enrichment scheme."

And some experts believe that recertification is not the best way to assess continuing competence. Lee Goldman, a cardiologist and dean of health sciences at Columbia University co-authored an article criticizing recertification in which he argues that "passing a written exam doesn't necessarily make for a better mid-career doctor."

There are many studies that show some link between board certification and improved patient outcomes. However, hard evidence is still hard to find. In theory, requiring physicians to maintain current certification sounds like a great idea. However, in practice, the benefits are not fully known.

Many insurers, hospitals, and government agencies disagree. ABMS former president Kevin Weiss states, "the intent is to derive a higher-quality workforce ...We're finding that physicians aren't concerned about the time recertification takes if it adds value to their experience."

But what or where exactly is that value? For doctors, one place where value can be found is in their reimbursement. Insurers are increasingly offering incentives, and in some cases penalties, for recertification. In doing so, they are becoming part of the new physician accountability movement.

And as the Affordable Care Act comes into full effect in 2014, more incentives are in store for doctors who recertify. The law allots Medicare bonuses for those who are recertified and participate in the program's pay-for-performance initiative.

As the health care industry pushes towards more accountability and higher performing doctors, the question remains, is recertification actually making doctors better? It is vitally important that we find out.

However, regardless of the answer, regular assessment of physician competence in some form is an idea whose time has come. Recertification may not remain an expectation, but stricter quality oversight is here to stay.