Credentialing and privileging monthly: ABP may point maintenance of certification in a new direction
On January 1, 2010, the American Board of Pediatrics’ (ABP) announced an amendment to its board certification process that may change the future maintenance of certification (MOC). Starting in 2010, newly issued certificates of board certification will not contain a specific end date. This means that copies of this certificate cannot be used to verify a physician’s board certification status. Rather, a physician’s board certification status will be linked to his or her status in the MOC process, which can change over time depending on whether the physician is up to date in the MOC process. Medical staffs can verify MOC on the ABP Web site.
To set the stage for understanding this new change, we need to remember that when boards initially introduced board certification, it was a once-in-a-lifetime event. A physician “passed the boards” shortly after training, and he or she was henceforth considered board certified.
Starting in the 1970s, some boards began to require recertification, usually every 7 to 10 years. This meant that a physician’s board certification expired at the end of that period. The physician was no longer considered board certified unless he or she went through the recertification process. Those who had achieved board certification previous to this change were grandfathered in, meaning they were allowed to keep their permanent board certification. Those who achieved board certification after the change had time-limited certification. Whether the physician was permanently certified or certified for a specified time, there was a clear yes or no answer to the question of whether or not the physician was board certified.
The next change in board certification occurred in 2000 when all 24 member boards of the American Board of Medical Specialties (ABMS) developed and adopted an MOC program. This meant that certification or recertification would no longer be a singular event dependent on a physician’s ability to pass an examination. The goal was to enhance the link between board certification and a physician’s demonstration of current competence. As a result, maintaining certification became an ongoing process.
The ABP has taken MOC to the next level with their decision not to list an expiration date on certificates. Interestingly, the change that is effective as of January 1 has implications for those with temporary and permanent board certification and MSPs who credential physicians. Temporarily board certified physicians will no longer be considered board certified if they are not current in the MOC process. Physicians can download documentation of their status at no charge; this information is also open to the general public. Permanently board certified physicians who have been grandfathered will be listed as “board certified,” and the site will identify whether they are up to date in the MOC process.
The implications of this change are significant for the credentialing process. It should prompt a discussion between the credentials committee, medical executive committee, and governing board about the role of board certification in the hospital’s criteria for membership and privileges. There is little evidence that achieving or maintaining board certification can be linked to improved patient care or clinical outcomes. However, this may be a result of the previous board certification process, which usually involved a frenzied effort on the part of the physician to prepare for and take a certification examination, whether once in their lives or every seven to ten years.
The question of whether a physician is board certified will not always have a clear yes or no answer. Each medical staff will have to determine what being current in the MOC process means to them. This will be even more challenging because determining whether a physician is current in the MOC process may involve examining major issues, such as licensure. It may also include examining minor issues, such as a physician falling a few months behind the MOC process due to life circumstances. Credentialing specialists can obtain the real-time board certification status of each physician (which reflects where they are in the MOC process at that moment) at no charge.
The process for verifying board certification status will need to change, at least for pediatrics. The ABMS is actively exploring implications for how the ABP’s decision affects the ABMS’s board certification verification service. As of this moment, to our knowledge, the ABMS has not made a decision regarding this question, so stay tuned.
The question that remains unanswered is whether the evolving MOC processes will do a better job of helping physicians maintain current competence. Whether to require achieving and maintaining board certification for medical staff members is not a simple question, and will be explored in a future edition of Medical Staff Leader Connection. For now, it is an excellent topic to be addressed by those responsible for credentialing in your organization.
Questions about these changes can be addressed to Amy Hodak, ABP's Manager of MOC Administration, at MOC@abpeds.org.
Rick Sheff, MD, CMSL, is chair and executive director of The Greeley Company, a division of HCPro, Inc.