Hitting the books again
Posted: Wednesday, May 12, 2010 8:01 pm
CHATTANOOGA, Tenn. (AP) — A decade-old change in board certification requirements is hitting home for many doctors, some of whom are hitting the books for the first time in years.
Aiming to ensure that all doctors keep their skills and knowledge up to date, all U.S. medical boards now require that younger doctors periodically renew their board certifications that, in most cases, used to be good for life.
Older physicians are exempt from the new requirements — or “grandfathered in” — and some specialties such as general surgery already have required recertification for years. Most who are exempt are over 50.
But other specialists only now are facing the demands of recertification, and many are frustrated by what they say is burdensome and unnecessary testing.
“It’s a very time-consuming process, and it is financially demanding, as well,” said Dr. Eugene Ryan, internal medicine specialist at the Diagnostic Center in Chattanooga. “The whole kit and caboodle could be several thousand dollars.”
Most recertification programs include a test every six to 10 years as well as other assignments, such as the review of patients’ medical records, to confirm that the care provided was in line with the latest standards. In some fields, feedback is gathered from dozens of former patients and referring physicians.
In interventional cardiology — a cardiology subspecialty dealing with minimally invasive cardiac procedures — last year was the first year in which the specialists could be tested for recertification. The specialty only gave its first board certification test in 1999.
Dr. Alexander Stratienko, a local interventional cardiologist, renewed his credentials in that subspecialty last year. He said the process “probably made me a better doctor,” but the days it took him away from the office were a huge disadvantage.
“It’s just a tremendous amount of time,” he said.
For Dr. Tiku Bhutwala, a Fort Oglethorpe-based internal medicine specialist, the intensive testing was a worthwhile effort that paled in comparison to the rigor of his first board exams in internal medicine, which he took in 1998.
“It’s another hoop you have to jump through, but when you measure what we do against the importance of keeping up (in the field) … it’s just necessary,” he said. “Standards of care change and evolve over time. If you’re not keeping up with that in some way, shape or form, then ultimately you become obsolete.”
Some argue that the periodic testing requirements can help direct the continuing education that physicians already undertake on their own.
Dr. David Adair, a local maternal-fetal medicine specialist, said he’ll take his first renewal exam in two years and must do so every six years that follow. The exercise is valuable, he said.
“In medical school, they told us once, ’Everything you’re learning now I know you think is important. But in 10 years, half of what we’ve taught you will be proven to be wrong or will have expanded beyond our current understanding,”’ he said. “At the end of the day, this is a good thing for patients.”
But others say continuing medical education requirements already accomplish that goal, and periodic — and expensive — testing only adds an inconvenient new requirement to doctors’ already full plates. Taking and preparing for the test can cost $3,000 to $5,000, doctors said.
In the future, the cumbersome obligation could encourage some physicians nearing retirement age to forgo recertification and just stop practicing, said Dr. Collin Cherry, internal medicine specialist with Beacon Health Alliance physician group. Dr. Cherry is not required to get recertified in internal medicine under the new rules.
“If they’re up to their eighth year of recertification, do they decide to forgo recertification and retire? We don’t need any physicians retiring now,” he said.
The American Board of Medical Specialties is hoping many physicians who have been “grandfathered” in voluntarily will choose to recertify to set an example for younger physicians, said Lori Boukas, communications director for the board.
But many of those physicians are resisting, she said.
The debate among physicians prompted the New England Journal of Medicine in March to pose the question of whether a fictional 55-year-old physician voluntarily should be recertified by the American Board of Internal Medicine, even though he was “grandfathered” in and wouldn’t need renewal of his board credentials.
A majority of 63 percent said no, and many physicians commented that the costs of recertification don’t outweigh the educational benefits. Some called it a method for raising revenue for the Board of Internal Medicine.
Plastic surgeon Dr. Jeanne Scanland said she is exempt from the requirement to recertify in plastic surgery, but she eventually might choose to recertify if certain reforms for the test are made.
One change she suggested would allow a physician to be tested solely on his or her area of specialty — in her case, aesthetic surgery. Some plastic surgeons focus almost solely in areas such as hand surgery, she said.
But “if you’re not doing hands and you’re never doing hands, why are you spending your time on that? It makes more sense to be spending it on what you’re doing every day,” she said.
WHAT IS BOARD CERTIFICATION?
Board certification is not required for a doctor to practice medicine in the United States. About 85 percent of U.S. physicians are certified by boards that are members of the American Board of Medical Specialties, an umbrella group for 24 boards that cover 145 medical specialties. That means they have passed a rigorous test of expertise in their field, according to the ABMS. Many medical institutions now require their physicians to be certified by a member board of the American Board of Medical Specialties. Erlanger hospital, Memorial Hospital and Parkridge Medical Center all require their physicians be certified within five years of hire and to maintain certification requirements.
Source: American Board of Medical Specialties, local hospitals
WHAT’S GOING ON?
In some specialties, board recertification has been a requirement for years, including general surgery, which began requiring recertification in 1976, said Dr. Joseph Cofer, surgery residency program director for the University of Tennessee College of Medicine in Chattanooga.
Over the years, more medical boards began independently developing recertification programs. In 2000, the American Board of Medical Specialties — an umbrella group for 24 boards — required that all boards create a “maintenance of certification program” to prove doctors still are up to par in their specialties. It took until 2006 for all boards to have a recertification program up and running.
Published in The Messenger 5.12.10