a fresh approach to board certification

A FRESH APPROACH TO A FRESH APPROACH TO BOARD CERTIFICATIONBOARD CERTIFICATION

National Board of Clinical National Board of Clinical Medicine, Inc.Medicine, Inc.

IntroductionIntroduction

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



Set up in part due to concerns of discrepancy Set up in part due to concerns of discrepancy between training programs in the 1950’s and between training programs in the 1950’s and later.later.



Set up in part due to concerns of discrepancy Set up in part due to concerns of discrepancy between training programs in the 1950’s and between training programs in the 1950’s and later.later.

It has no legal mandate to exist.It has no legal mandate to exist.


Board Certification is NOTBoard Certification is NOT A measure of competenceA measure of competence


Board Certification is NOTBoard Certification is NOT A measure of competenceA measure of competence A measure of qualityA measure of quality


Board Certification is NOTBoard Certification is NOT A measure of competenceA measure of competence A measure of qualityA measure of quality A distinguishing A distinguishing

factor between a factor between a

good doctor vs. good doctor vs.

a bad doctora bad doctor


But it has become necessary forBut it has become necessary for Hospital privilegesHospital privileges Insurance networksInsurance networks ?advertising?advertising

Board Certifying Organizations Board Certifying Organizations 20102010

American Board of Medical SpecialtiesAmerican Board of Medical Specialties By far the largest organizationBy far the largest organization

American Board of Physician SpecialtiesAmerican Board of Physician Specialties Miscellaneous Other Board Certifying Miscellaneous Other Board Certifying

OrganizationsOrganizations

Growth of an IndustryGrowth of an Industry

Board certification started out as a one time Board certification started out as a one time examexam



Then time limitedThen time limited



Then time limitedThen time limited Then Maintenance of Certification (MOC)Then Maintenance of Certification (MOC)



Then time limitedThen time limited Then Maintenance of Certification (MOC)Then Maintenance of Certification (MOC) Then Continuous Maintenance of Certification Then Continuous Maintenance of Certification

(CMOC)(CMOC)



Then time limitedThen time limited Then Maintenance of Certification (MOC)Then Maintenance of Certification (MOC) Then Continuous Maintenance of Certification Then Continuous Maintenance of Certification

(CMOC)(CMOC) ?Daily Continuous Maintenance of ?Daily Continuous Maintenance of

Certification (DCMOC)Certification (DCMOC)

StatisticsStatistics

““Today, there are more than 450,000 Today, there are more than 450,000 physicians involved in ABMS Board MOC physicians involved in ABMS Board MOC programs” – ABMS Websiteprograms” – ABMS Website

““We project that by 2020, 93 percent of Board We project that by 2020, 93 percent of Board Certified physicians will hold time-limited Certified physicians will hold time-limited certificates and will be engaged in on-going certificates and will be engaged in on-going MOC activities.” – ABMS WebsiteMOC activities.” – ABMS Website

American Board of Medical American Board of Medical SpecialtiesSpecialties

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

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


To prevent even more regulation by government entitiesTo prevent even more regulation by government entitiesWRONGWRONG

All 50 states have government agencies that regulate All 50 states have government agencies that regulate doctors!doctors!


““To protect the public”To protect the public”

FROM WHOM – FROM FROM WHOM – FROM YOU????????????YOU????????????

OptionsOptions

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

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

The American Board of Allergy The American Board of Allergy and Immunologyand Immunology

Certification/Recertification ExamsCertification/Recertification Exams Clinically irrelevant questionsClinically irrelevant questions Did not reflect what we do as clinical Did not reflect what we do as clinical

allergists/immunologistsallergists/immunologists

The American Board of Allergy The American Board of Allergy and Immunologyand Immunology

Certification/Recertification ExamsCertification/Recertification Exams Clinically irrelevant questionsClinically irrelevant questions Did not reflect what we do as clinical Did not reflect what we do as clinical

allergists/immunologistsallergists/immunologists Lack of transparencyLack of transparency

What content were the test questions based on? – What content were the test questions based on? – old data?old data?

Prohibition on discussing test contentProhibition on discussing test content

Costs of Board CertificationCosts of Board Certification

Cost from the ABAI WebsiteCost from the ABAI Website Certification Examination $2,650 $2,650 MOC Examination $2,800 $2,800 MOC Annual Fee $150 MOC Annual Fee $150 Late Application (non-refundable) $500Late Application (non-refundable) $500 Rescore $100 $100 Verification $75 Duplicate $75 Duplicate

Certificate $250 Returned Checks $50 $250 Returned Checks $50

Costs of Board Costs of Board Certification/Recertification/ Certification/Recertification/

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

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

OptionsOptions

Don’t participateDon’t participate Put up with it – ABAI claims 54% or 30% of Put up with it – ABAI claims 54% or 30% of

allergists are participating in MOCallergists are participating in MOC Offer an alternativeOffer an alternative

After over 10 years of complaining of the After over 10 years of complaining of the process, with a go-ahead from my wife, I process, with a go-ahead from my wife, I

embarked on a new path.embarked on a new path.

The National Board of Clinical The National Board of Clinical Medicine, Inc.Medicine, Inc.

Created in February 2011Created in February 2011 GoalsGoals

Offer programs that areOffer programs that are Clinically relevantClinically relevant TransparentTransparent Cost-effectiveCost-effective

The National Board of Clinical The National Board of Clinical Medicine, Inc.Medicine, Inc.

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

Each specialty is a sectionEach specialty is a section Rules for the certification are flexible.Rules for the certification are flexible.

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

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

CertificationCertification RecertificationRecertification Continuous Update of Certification™Continuous Update of Certification™


Certification involves an open book home-Certification involves an open book home-based testbased test Sources of test questions listed (practice Sources of test questions listed (practice

parameters)parameters) 6 sections6 sections Passing score 80%; no curvesPassing score 80%; no curves If not passing, only retake sections that did not If not passing, only retake sections that did not

score 80% at no cost to applicantscore 80% at no cost to applicant 6 months to take it6 months to take it


Timeline:Timeline: 2010 Ron Benbassat, MD got me fired up on this 2010 Ron Benbassat, MD got me fired up on this

issue; Dr. Eck discussion; AAPS articleissue; Dr. Eck discussion; AAPS article



issue; Dr. Eck discussion; AAPS articleissue; Dr. Eck discussion; AAPS article 2011 Established corporate structure for NBCM2011 Established corporate structure for NBCM



issue; Dr. Eck discussion; AAPS articleissue; Dr. Eck discussion; AAPS article 2011 Established corporate structure for NBCM2011 Established corporate structure for NBCM 2012 Established the exam/developed website2012 Established the exam/developed website



issue; Dr. Eck discussion; AAPS articleissue; Dr. Eck discussion; AAPS article 2011 Established corporate structure for NBCM2011 Established corporate structure for NBCM 2012 Established the exam/developed website2012 Established the exam/developed website 2013 Advertise to practicing 2013 Advertise to practicing

allergists/immunologists allergists/immunologists



issue; Dr. Eck discussion; AAPS articleissue; Dr. Eck discussion; AAPS article 2011 Established corporate structure for NBCM2011 Established corporate structure for NBCM 2012 Established the exam/developed website2012 Established the exam/developed website 2013 Advertise to practicing 2013 Advertise to practicing

allergists/immunologists allergists/immunologists Over $15,000 spent in legal/accounting/advertisingOver $15,000 spent in legal/accounting/advertising


Cost $750 to certifyCost $750 to certify Time-unlimitedTime-unlimited If recertification requirements are required, then If recertification requirements are required, then

the recert exam is the same as the original examthe recert exam is the same as the original exam Continuous update of certification™Continuous update of certification™

25 hours of CME of the applicant’s choosing25 hours of CME of the applicant’s choosing $25/year$25/year


Three main goalsThree main goals Clinical relevancyClinical relevancy

Practice parameters or similar sourcesPractice parameters or similar sources



Practice parameters or similar sourcesPractice parameters or similar sources TransparencyTransparency

Sources of information readily availableSources of information readily available No limits on discussing test content with othersNo limits on discussing test content with others Open book/open colleagueOpen book/open colleague



Practice parameters or similar sourcesPractice parameters or similar sources TransparencyTransparency

Sources of information readily availableSources of information readily available No limits on discussing test content with othersNo limits on discussing test content with others Open book/open colleagueOpen book/open colleague

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


ChallengesChallenges Do not become a bureaucracyDo not become a bureaucracy


ChallengesChallenges Do not become a bureaucracyDo not become a bureaucracy Recognition with various entitiesRecognition with various entities


ChallengesChallenges Do not become a bureaucracyDo not become a bureaucracy Recognition with various entitiesRecognition with various entities Realize the limitations of any board certifying Realize the limitations of any board certifying

entity.entity.


ChallengesChallenges Earn CMEEarn CME


ChallengesChallenges Earn CMEEarn CME Board certification does not make one a good doctor but Board certification does not make one a good doctor but

can be one of can be one of many many avenues to help one be a good avenues to help one be a good doctor.doctor.


ChallengesChallenges Earn CMEEarn CME Board certification does not make one a good doctor but Board certification does not make one a good doctor but

can be one of can be one of many many avenues to help one be a good avenues to help one be a good doctor.doctor.

Don’t get in theDon’t get in the

crosshairs of thecrosshairs of the

AAPS.AAPS.


As of May 2013As of May 2013 Advertising is just starting to let allergists know Advertising is just starting to let allergists know

we exist.we exist. Will apathy, fear, or “just say no” predominate? Will apathy, fear, or “just say no” predominate?

Time will tell.Time will tell.

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

Martin Dubravec, MDMartin Dubravec, MD

PO Box 849 Cadillac, MI 49601PO Box 849 Cadillac, MI 49601

231-920-9738231-920-9738

a fresh approach to board certification

Documents

industryboard certification

time examgrowth

knowledge of material

timelimited certificates

medical specialists

training programs

ongoing moc activities

concerns of discrepancy