Board Certification and Credentialing Discussed in JAMA

When it comes to ensuring that pediatricians who are granted privileges are board certified, neither hospitals nor health plans appear to be up to snuff, according to two studies undertaken for an American Board of Pediatrics advisory committee. Gary Freed, M.D., of the University of Michigan reported his findings in the Feb 22 issue of the Journal of the American Medical Association.

Christine Cassel, M.D., president of the American Board of Internal Medicine, added "It would be valuable to have this study reproduced in several other major specialties or perhaps across physician groups involved in hospitals or health plans."

A few years from now, they wrote, studies such as those of Freed and colleagues might well show a more rigorous approach to monitoring.

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This study could hardly be considered non-partisan as it was conducted at the behest of the American Board of Pediatrics, however, it does revisit long-standing questions.  The issue of whether to require board certification has been (hotly) debated over the years by many a Credentials Committee.

1.  Should board certification and recertification be required for hospital privileges and health plan credentialing? 

2. Are there excellent, highly-qualified physicians who are not board certified? 

3. In the US should the claim of Board Certification status be limited to those who acquire and maintain certification from an ABMS (American Board of Medical Specialties) or AOA (American Osteopathic Association) Board? 

4. If you answer No, board certification should not be required and Yes, there are excellent physicians who are not boarded, what benchmark should be used to determine who qualifies?   In the world of credentialing we often use the phrase 'or equivalent training and experience'.  Who determines equivalency?

These are difficult questions.  I suspect the trend in US hospitals is toward not requiring ongoing certification, partially because enforcing the requirement can become so onerous and even litigious.

Would you be willing to see a non-board certified physician? 

Read full text of the article Lapses Found in Pediatrician Credentialing in MedPage Today:
http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb/2729

Comments

[Narayanachar Murali]

Do not forget that Board certification is just the minimal credentialing requirement for people who want to do a consultant's work. . This usually indicates the person has at least gone through a period of closely supervised training. I DO NOT agree that just because someone is "good at a particular job", they should be granted privileges to do procedures. The cognitive component of medical care is tremendously important. Fellowship training is arduous, very intensive and exposes the consultant in training to different clinical situations to the point that management of these conditions becomes second nature by the time training is completed. Hospital administrators of small community hospitals have no regard for quality of medical care. They create credentialing committes , usually consisting of physicians receiving kickbacks or those sympathetic to the hospital's cause. The administrators just want physicians utilizing their facility for which they bill unholy amounts of money. It is sad that the Insurance companies that reimburse doctors and also the malpractice carriers who indemnify medical mishaps, have chosen to remain stone silent on this matter. They consistely state that the state licensing boards need to look into this. Barring the state of California, few other state boards even bother to discipline errant physicians. Unless we have an enlightened consumer base demanding high quality of work and better outcomes and a court system that inflicts very high penalty for pain and suffering caused by untrained physicians dabbling in subspecialty medicine, the quality of medical care in this country will continue to decline.