The following is a review of factors leading to enhanced programs to ensure Maintenance of Certification (MOC) of physician specialists. ABCMO requirements can be found in Article 19 of the ABCMO Bylaws and on the Maintenance of Certification webpage.
Background theory and general information
In 1999 some medical specialist boards still issued lifetime board certifications, while others required continuing education or training to renew the time-limited board certifications they issued. Medical specialist certifications are only earned after completing medical school and being issued an initial state license to practice medicine and they require residency training and passage of specialist examinations administered by specialist certifying boards.
Medical specialists had developed (the American Board of Ophthalmology was first, in 1930) prior to WWII and were supported by hospital organizations as medicine developed specialized, complex treatments necessarily best performed within hospitals. And because these procedures carried more risks, hospitals began to favor, and some to require, that medical specialists be board certified to join their medical staff. There are 24 recognized specialties in medicine governed by the American Board of Medical Specialists. Dentistry, podiatry and optometry only later developed specialties and certifying boards for them that, like medical specialties, require postgraduate clinical residency training and passage of specialty examinations.
The development of these specialties arose independently at the clinical level, begun by medical practitioners who sought to learn more about a particular aspect of medicine and traveled to spend time working with a known expert as a “resident”. They rapidly grew in numbers after WWII when returning veterans used GI benefits to seek additional training. By 1980 medical specialization had become the norm and today about 90% of medical school graduates become specialists by serving specialty residencies and most hospital higher risk procedures are performed or diagnosed by medical specialists.
In 1999, the Institute of Medicine (IOM), one of the National Academies, completed a study designed to recommend changes in American hospital care. The IOM study was one of many reactions to previous estimates that as many as 98,000 hospital patients died each year from medical errors. The estimates created such interest they raised the question whether lifelong specialty certifications should end and more rigorous standards be established for renewals of specialty certifications.
The IOM Committee on Quality of Health Care in American completed its study and published its recommendations in the book “To Err is Human: Building a Safer Health System”.
Among the IOM recommendations were these^
Health professional licensing bodies should:
- Implement periodic re-examinations and re-licensing of doctors, nurses, and other key providers, based upon both competence and knowledge of safety practices; and
- Work with certifying and credentialing organizations to develop more effective methods to identify unsafe providers and take action.
At about this time other similar studies were issued which also led to questioning the wisdom of issuing lifetime specialty board certifications.
- Issue initial board certifications not for life but carry expiration dates.
- Renewal of expired board certifications should require evidence the specialist has undertaken steps to maintain their initial competence and keep pace with diagnostic and treatment developments.
To Err is Human: building a safer health system, Committee on Quality of Health Care in America, Institute of Medicine, The National Academies, June 2000, National Academy Press, 2101 Constitution Avenue, N.W., Washington, DC 20418. ISBN 0-309-06837-1. Full text available at www.nap.edu/readingroom. Report can be purchased at The National Academies Press.
^ It is important to note these recommendations were directed at board certified medical (allopathic and osteopathic) specialists holding hospital privileges and treating hospitalized patients since the reported deaths occurred within hospitals. The IOM made no recommendations for medical practitioners, whether board certified or not, treating patients within their private offices.
# No study or recommendations were made regarding dentists, optometrists and podiatrists although each profession has certifying boards for residency trained specialists. ABCMO is the only board certified optometry specialty at this time.
* Some optometry opinion makers believed the IOM study, insurance plans or Medicare regulations would soon require general practice optometrists become “board certified”. This created a “hot debate” within optometry, much angst and confusion, and led to formation of the American Board of Optometry that offers board certification to general practice optometrists as does a similar one for general practice dentists. About 4% and less than 1% respectively of general practice optometrists and dentistry hold these board certifications that are essentially additional CE in general practice.