Physician Certification Gets an Overhaul

In every specialty, new requirements will help keep docs up-to-date

FRIDAY, Nov. 11, 2005 (HealthDay News) -- With medical information and practice changing at lightning speed, making sure your doctor keeps up with the very latest breakthroughs could prove vital to the care you receive.

It's the job of professional certification boards to assess just how well physicians are keeping abreast of these changes.

Now, those certification methods are undergoing a major change.

One of the biggest moves: For the first time, a doctor's board certification will not be set for life but instead will be limited to no more than 10 years. In addition, periodic testing will no longer be the sole criterion in making sure doctors stay up-to-date. Instead, physicians will be subject to a more continuous process of evaluating competence.

"The nature of board certification is changing," said Dr. Robert Steinbrook, a national correspondent for the The New England Journal of Medicine, and author of one of three articles on the subject in this week's issue. "Historically, physicians were certified once. Now physicians are expected, as part of a process of continuing education, to maintain their certification."

Each specialty will have its own monitoring and assessment requirements, but certification will be for only six to 10 years.

While the new 10-year rule won't apply to doctors certified before 1990, certifying boards are actively encouraging these doctors to participate in the new certification program.

Board certified specialties include: Allergy and Immunology, Anesthesiology, Colon and Rectal Surgery, Dermatology, Emergency Medicine, Family Medicine, Internal Medicine, Medical Genetics, Neurological Surgery, Nuclear Medicine, Obstetrics and Gynecology, Ophthalmology, Orthopaedic Surgery, Otolaryngology, Pathology, Pediatrics, Physical Medicine and Rehabilitation, Plastic Surgery, Preventive Medicine, Psychiatry and Neurology, Radiology, Surgery, Thoracic Surgery and Urology.

The goal of the new process is to assess how physicians actually practice and how they relate to their peers and their patients, Steinbrook said. "The motivation behind the changes is excellent," he said. "Whether all the goals will be achieved is hard to say. I think we will have to wait and see."

One physician believes revamping the certification process will lead to better patient care.

"There is a new process for doctors to assess their practice," said Dr. Richard J. Baron, from Greenhouse Internists, P.C., in Philadelphia, and another author of one of the articles. "That process is integrated into maintaining their board certification."

Baron said that the new process was helpful to him, and he believes it will be helpful to others.

"Traditionally, we have thought about what we do as a one-patient-at-a-time approach," he said. "The new process is a way to look at the people we take care of as a population of people, and enables us to get a sense of how we are doing taking care of the whole group," he explained. "It's a different way to look at excellence in medical care."

Part of the new system involves better record keeping, a team approach to care and using systems that help achieve better care. "If your doctor is more likely to give appropriate care, than any patient seeing that doctor is more likely to get appropriate care," Barron said.

Another doctor described his own experience with the new recertification process largely positive.

"I learned a lot more stuff, and felt that I was a better doctor as a result of it," said Dr. Troyen Brennan, from Brigham and Women's Hospital. Brennan, who authored a third article in the journal, said "the move toward required recertification is way of insuring that medical practice is good, and continues to be good."

Brennan believes this change is a good way for doctors to keep abreast of the latest in medical practice, which is changing faster than ever before. "It is a reason for people to demonstrate that they have kept up and know what the most recent information is."

"A smarter doctor who is more aware of what the recent changes in health care techniques are is a better doctor," Brennan said. "And patients will get higher quality care."

Another expert agreed.

"Theses changes are very important," said Dr. F. Daniel Duffy, executive vice president of the American Board of Internal Medicine. "They move certification beyond an examination of knowledge and judgment to an evaluation of actual performance and practice."

Patients will benefit because doctors will have access to the outcomes and process of their care, Duffy said. "Doctors will have a better handle on what's going well, and what could use some improvement," he said.

Duffy admits that for many physicians the new process will be time-consuming. "We are not used to sitting down and systematically looking at our practices," he said. "Until we get accustomed to that and build that into our culture, it's sure going to seem like a burden and something we didn't choose to do."

"But when physicians do it they realize -- wow -- the value of doing this is really terrific," Duffy said. "And people really want to do the right thing."

More information

The American Board of Internal Medicine has more on physician certification.

SOURCES: Troyen Brennan, M.D., J.D., M.P.H., Brigham and Women's Hospital, Boston; Richard J. Baron, M.D., Greenhouse Internists, P.C., Philadelphia; Robert Steinbrook, M.D., national correspondent, The New England Journal of Medicine, Boston; F. Daniel Duffy, M.D., executive vice president, American Board of Internal Medicine, Philadelphia; Nov. 10, 2005, The New England Journal of Medicine
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