American College of Physicians: Internal Medicine — Doctors for Adults ®

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ABIM: recertification is an 'obligation and privilege'

From the June 1996 ACP Observer, copyright © 1996 by the American College of Physicians.

Editor's note: "Coming soon: recertification,"[March 1996 ACP Observer, page 1] described the American Board of Internal Medicine's new mandatory recertification requirements: every 10 years for internists who received certificates since 1990. Several internists commented on the process through letters to the editor in the May issue. Here, Richard F. LeBlond, FACP, a member of ABIM's recertification committee, explains the rationale behind mandatory recertification and its value to physicians and society.

Why recertification? To answer this, we need to reflect on the meaning of board certification: It is the profession's standard of excellence. It conveys to the public that we have the training, cognitive skills and personal and professional attributes expected of internists. Recertification means we have met that standard not only at the completion of training, but that we aspire to practice at this high level-that our skills, interest and dedication to high-quality patient care have not eroded over time, and our experience represents years of growth and maturation, not erosion and repetition.

It is a profession's obligation and privilege to be self-regulating. ABIM is responsible for setting a standard free from outside interference and for developing reliable, valid and effective evaluation methodologies. Arbitrary and more restrictive standards might be imposed upon us from outside the profession if we don't meet this obligation. We need to demonstrate to patients and an increasing number of regulatory agencies that we are able to evaluate ourselves.

Cost is often cited as an inhibition to recertification. ABIM offers recertification for a single, all-inclusive fee covering credentialing, verification of clinical competence, an open-book modular self-evaluation process and a written final exam that can be taken up to three times over six years. Simultaneous recertification in a subspecialty or an area of added qualifications requires only a 25% additional fee. The board's fees for certification and recertification are equal; they are also lower than those of all other boards except family practice. In 1995, the fee for the ABIM examination was $790, while family practice was $500, pediatrics $1,135 and emergency medicine $1,765. Fees for surgical specialties ranged from $1,200 to $2,400.

We should regard recertification fees, though not insignificant, as a cost of doing business. Compared to other costs we readily accept, such as telephones, rent and journal subscriptions, this is a small price for verifying to ourselves and our patients that we remain competent to provide excellent medical care.

ABIM recognizes that no two medical practices are identical and that we differentiate our practices according to our professional interests and prevalent diseases in our communities. It is the goal of ABIM to evaluate internists on what they actually do in practice. Clinical competence will be evaluated using local credentialing resources, such as possession of a valid and unrestricted license, hospital and/or clinic privileges and good standing in the local medical community.

The arbitrary choice of a date for beginning recertification imposes, temporarily, the appearance of a different standard for diplomates certified before 1990 compared to those certified since then. Those holding time-unlimited certificates should welcome the opportunity to voluntarily join their younger colleagues in recertification to demonstrate the commitment of internists to maintaining an independent, professional self-evaluation process.

Complete information on recertification in internal medicine, subspecialties and areas of added qualifications can be obtained from ABIM, University City Science Center, 3624 Market St., Philadelphia, Pa. 19104-2675, or by calling 800-441-2246.

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