The Evolving Benefit of Maintenance of Certification

In 2000, the 24-member boards of the American Board of Medical Specialties (ABMS) agreed to evolve their recertification programs to one of continuous professional development — ABMS Maintenance of Certification. The goal, says Tom Granatir, senior vice president, health policy and strategic partnerships for ABMS, was to move beyond a single test to create a system that’s going to help physicians improve their performance over time.

“In part, it was a response to a new way of thinking about what it means to be a good physician and specialist,” Granatir says. “And each specialty has taken its own approach to developing its maintenance of certification programs. But all the boards are moving in the same direction, and that’s really towards what we’re calling continuous professional development.”

The challenge, however, has been educating physicians — already feeling stressed and overburdened by workloads and decreasing reimbursement — that the value of the maintenance of certification is well worth the investment.

Awareness factor

Granatir explains that the ABMS board has a very strong desire that maintenance of certification be something physicians truly value, and that the physicians perceive maintenance of certification as something that makes them better. The organization is going to great lengths to make that happen.

To that end, the ABMS board has recently completed a strategic planning process and adopted some strategic initiatives. One of those initiatives is to make sure that it creates a good balance of the effort and the value that physicians experience from this process.

“We want physicians to feel that maintenance of certification is something that will actually make them better doctors and they will value it,” Granatir explains.

The process has to be relevant to the physicians if they are going to value it, Granatir says. So it has to provide assessment and feedback that will help them improve their skills.

“I believe that’s what all physicians want — to improve their skills,” he says.

But the goals of the ABMS board go beyond that. Those goals include integrating maintenance of certification into the fabric of health care. However, the challenge is that physicians are being bombarded with requests for performance assessments from all directions. And according to Granatir, that bombardment is not coordinated, integrated or synchronized.

“One of our primary goals is to make sure that maintenance of certification activity isn’t crowded out by these other activities, but also that it doesn’t simply add to the burden of all these activities,” Granatir says. “We’re working very hard with the federal government to see whether maintenance of certification can help us satisfy other external requirements from the federal government, from the health plans, from hospitals and from big government. And so what we call alignment is a significant goal of our board over the next several years.”

Charting the evidence

The results of a recent survey conducted by ABMS reveal that 95% of Americans say it is important to them that their doctors participate in a program to maintain their Board Certification. More importantly, nearly 45% would look for a new doctor if they learned theirs was not participating in such a program.

“That’s useful information,” says Granatir, but he believes it’s equally important that physicians “experience something that’s worth the effort.”

ABMS is working to develop a multi-purpose approach to the activities of maintenance of certification that will satisfy other assessment requirements. For example, if physicians are participating in maintenance of certification they will also be satisfying their hospital’s requirements.

“We’re trying to figure out how to integrate the activities that physicians engage in at their hospitals and their health systems,” Granatir explains. “Or figure out ways that the data collection that’s done through maintenance of certification could be shared to satisfy other requirements from the federal government. We’re trying to add more value to the activities. Make sure that the value of the maintenance of certification is recognized by physicians as something that helps them.”

The key point, Granatir says, is that the maintenance of certification process is continuing to evolve.

“We have a set of standards which were adopted in 2009, so that all specialties will be, more or less, conforming to the same general structure and trying to address all of these competencies which physicians a dozen years ago decided were important,” Granatir says. “We’re continuing to evolve. And we hope it’s continuing to get better.”

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