A FRESH APPROACH TO BOARD CERTIFICATION National Board of Clinical Medicine, Inc.

Introduction

Board certification is a process in which physicians participate to show they have knowledge of material by being tested on this material by a board certifying organization.

Introduction

Board certification is a process in which physicians participate to show they have knowledge of material by being tested on this material by a board certifying organization. Set up in part due to concerns of discrepancy between training programs in the 1950’s and later.

Introduction

Board certification is a process in which physicians participate to show they have knowledge of material by being tested on this material by a board certifying organization. Set up in part due to concerns of discrepancy between training programs in the 1950’s and later. It has no legal mandate to exist.

Introduction

Board Certification is NOT

A measure of competence

Introduction

Board Certification is NOT
 

A measure of competence A measure of quality

Introduction

Board Certification is NOT
A measure of competence  A measure of quality  A distinguishing factor between a good doctor vs. a bad doctor

Introduction
But it has become necessary for  Hospital privileges  Insurance networks  ?advertising

Board Certifying Organizations 2010

American Board of Medical Specialties

By far the largest organization

 

American Board of Physician Specialties Miscellaneous Other Board Certifying Organizations

Growth of an Industry

Board certification started out as a one time exam

Growth of an Industry

Board certification started out as a one time exam Then time limited

Growth of an Industry

 

Board certification started out as a one time exam Then time limited Then Maintenance of Certification (MOC)

Growth of an Industry

  

Board certification started out as a one time exam Then time limited Then Maintenance of Certification (MOC) Then Continuous Maintenance of Certification (CMOC)

Growth of an Industry

  

Board certification started out as a one time exam Then time limited Then Maintenance of Certification (MOC) Then Continuous Maintenance of Certification (CMOC) ?Daily Continuous Maintenance of Certification (DCMOC)

Statistics

“Today, there are more than 450,000 physicians involved in ABMS Board MOC programs” – ABMS Website “We project that by 2020, 93 percent of Board Certified physicians will hold time-limited certificates and will be engaged in on-going MOC activities.” – ABMS Website

American Board of Medical Specialties

“Physicians benefit from participating in MOC because they receive focused learning based on individual practice needs, increase efficiency and reduce malpractice premiums as well as the need for duplicate assessments of credentials, among other benefits.”

WRONG

“Patients experience fewer medical errors, better communication and quality clinical outcomes when they choose a board certified physician. Medical specialists who participate in MOC use the most current evidence-based guidelines and standards in their specialty and are widely recognized as leaders in the national movement for healthcare quality.”

WRONG

American Board of Medical Specialties

To prevent even more regulation by government entities

WRONG

All 50 states have government agencies that regulate doctors!

American Board of Medical Specialties

“To protect the public”

FROM WHOM – FROM YOU????????????

Options
 

For allergists, only one option was available American Board of Allergy and Immunology
 

A subsidiary of the ABMS Board certification, recertification, and MOC

The American Board of Allergy and Immunology

Certification/Recertification Exams
 

Clinically irrelevant questions Did not reflect what we do as clinical allergists/immunologists

The American Board of Allergy and Immunology

Certification/Recertification Exams
 

Clinically irrelevant questions Did not reflect what we do as clinical allergists/immunologists What content were the test questions based on? – old data? Prohibition on discussing test content

Lack of transparency

Costs of Board Certification
Cost from the ABAI Website  Certification Examination $2,650  MOC Examination $2,800  MOC Annual Fee $150  Late Application (non-refundable) $500  Rescore $100 Verification $75 Duplicate Certificate $250 Returned Checks $50

Costs of Board Certification/Recertification/ MOC

The costs do NOT include the following:
   

Time away from the office Coverage for patients (locum tenens) Travel/hotel/food Review courses

Options
 

Don’t participate Put up with it – ABAI claims 54% or 30% of allergists are participating in MOC Offer an alternative

After over 10 years of complaining of the process, with a go-ahead from my wife, I embarked on a new path.

The National Board of Clinical Medicine, Inc.
 

Created in February 2011 Goals

Offer programs that are
Clinically relevant  Transparent  Cost-effective

The National Board of Clinical Medicine, Inc.
 

S Corporation – why? Because it is the easiest entity according to my accountant. Each specialty is a section

Rules for the certification are flexible.

As of May 2013, only one specialty is established – allergy/immunology

The National Board of Clinical Medicine, Inc. for Allergists/Immunologists
  

Certification Recertification Continuous Update of Certification™

The National Board of Clinical Medicine, Inc. for Allergists/Immunologists

Certification involves an open book homebased test

  

Sources of test questions listed (practice parameters) 6 sections Passing score 80%; no curves If not passing, only retake sections that did not score 80% at no cost to applicant 6 months to take it

The National Board of Clinical Medicine, Inc. for Allergists/Immunologists

Timeline:

2010 Ron Benbassat, MD got me fired up on this issue; Dr. Eck discussion; AAPS article

The National Board of Clinical Medicine, Inc. for Allergists/Immunologists

Timeline:

2010 Ron Benbassat, MD got me fired up on this issue; Dr. Eck discussion; AAPS article 2011 Established corporate structure for NBCM

The National Board of Clinical Medicine, Inc. for Allergists/Immunologists

Timeline:

 

2010 Ron Benbassat, MD got me fired up on this issue; Dr. Eck discussion; AAPS article 2011 Established corporate structure for NBCM 2012 Established the exam/developed website

The National Board of Clinical Medicine, Inc. for Allergists/Immunologists

Timeline:

  

2010 Ron Benbassat, MD got me fired up on this issue; Dr. Eck discussion; AAPS article 2011 Established corporate structure for NBCM 2012 Established the exam/developed website 2013 Advertise to practicing allergists/immunologists

The National Board of Clinical Medicine, Inc. for Allergists/Immunologists

Timeline:

  

2010 Ron Benbassat, MD got me fired up on this issue; Dr. Eck discussion; AAPS article 2011 Established corporate structure for NBCM 2012 Established the exam/developed website 2013 Advertise to practicing allergists/immunologists Over $15,000 spent in legal/accounting/advertising

The National Board of Clinical Medicine, Inc. for Allergists/Immunologists

Cost $750 to certify
 

Time-unlimited If recertification requirements are required, then the recert exam is the same as the original exam Continuous update of certification™
25 hours of CME of the applicant’s choosing  $25/year

The National Board of Clinical Medicine, Inc. for Allergists/Immunologists  Three main goals

Clinical relevancy

Practice parameters or similar sources

The National Board of Clinical Medicine, Inc. for Allergists/Immunologists  Three main goals

Clinical relevancy

Practice parameters or similar sources

Transparency
Sources of information readily available  No limits on discussing test content with others  Open book/open colleague

The National Board of Clinical Medicine, Inc. for Allergists/Immunologists  Three main goals

Clinical relevancy

Practice parameters or similar sources

Transparency
Sources of information readily available  No limits on discussing test content with others  Open book/open colleague

Cost effective
No significant time lost from practice or family  Less than ¼ of ABAI Exam

The National Board of Clinical Medicine, Inc. for Allergists/Immunologists

Challenges

Do not become a bureaucracy

The National Board of Clinical Medicine, Inc. for Allergists/Immunologists

Challenges
 

Do not become a bureaucracy Recognition with various entities

The National Board of Clinical Medicine, Inc. for Allergists/Immunologists

Challenges
  

Do not become a bureaucracy Recognition with various entities Realize the limitations of any board certifying entity.

The National Board of Clinical Medicine, Inc. for Allergists/Immunologists

Challenges

Earn CME

The National Board of Clinical Medicine, Inc. for Allergists/Immunologists

Challenges
Earn CME  Board certification does not make one a good doctor but can be one of many avenues to help one be a good doctor.

The National Board of Clinical Medicine, Inc. for Allergists/Immunologists

Challenges
Earn CME  Board certification does not make one a good doctor but can be one of many avenues to help one be a good doctor.  Don’t get in the crosshairs of the AAPS.

The National Board of Clinical Medicine, Inc. for Allergists/Immunologists

As of May 2013

Advertising is just starting to let allergists know we exist. Will apathy, fear, or “just say no” predominate? Time will tell.

Thank You to The AAPS for Your Interest in Issues Related to Board Certification

Martin Dubravec, MD PO Box 849 Cadillac, MI 49601 231-920-9738