Today marks the centennial of the first American Board of Ophthalmology examination. A century on, does board certification matter? The intent of certification, simply put, is to serve the public by certifying physicians by verifying competency. Such a mission -- to improve the common weal -- seems appropriate and, some might argue, even admirable.
But can’t participation in continuing medical education (CME) courses, along with maintenance of an unrestricted license to practice medicine, satisfactorily achieve the afore-mentioned goal? Some say yes, but I for one would not relish the assignment of proving that state licensure and accumulating 25-30 hours of continuing medical education credits annually are adequate to ensure that a physician is competent. Although important, CME and licensure are necessary but not sufficient.
Who then should do the certifying? Again, I suspect that most of us would prefer to demonstrate our “fitness for ophthalmic practice” (the description of competence by ABO founder Edward Jackson) to a group of our peers than to a governmental agency or an insurance company panel. That physicians enjoy professional self-regulation is an exceptional privilege, and not one to be taken for granted. To cite Jackson again: “Any remedy…must be found entirely outside of legal requirements and inside the profession.”
Should certification be required? Notably, those who launched the ABO envisioned the process as voluntary, as suggested by this communication between founders Alexander Duane and Walter Lancaster: “I don’t see why we should make anyone take our examination or secure our certification who did not apply for it spontaneously.” Furthermore, the founders believed that certification should be an aspirational goal, not recognition of a minimum standard.
That’s all very well, and although each ophthalmologist has the option to pursue certification or not, haven’t third parties, such as insurers, made certification tantamount to licensure? That may be a “real world” reality for many, but it is at odds with the original aim of the founders, as summarized by Robert Shaffer in his history of the ABO: “It has never been the purpose of the Board to define requirements for membership to hospital staffs or to gain special recognition or privileges for its Diplomates. Its principal purpose is to provide assurance to the public and to the medical profession that a certified physician has successfully completed an accredited course of education in ophthalmology and an evaluation including an examination.”
Why then should you and I want to be certified? Ideally, every conscientious ophthalmologist would elect to participate in the process as a means of demonstrating her/his commitment and ability to practice at the highest level. This requires that each component of certification should have a direct line of sight to meaningful, patient-centered outcomes. The current process, through a century’s work by countless colleagues, has been successful but it should and can be improved.
What will we do to get there? Maybe we can learn from the words of automotive magnate Luther Coggin: “Forget your customers. Take care of your staff, and they will take care of your customers.” I am not suggesting, “Forget your patients. Take care of your diplomates.” But I believe that patients ultimately will be best served if the certification process is clearly applicable to patient care, every day, without being burdensome. That’s our goal.
What can you do? First, I respectfully request your patience as the ABO works with a host of key partners, including the American Academy of Ophthalmology, multiple subspecialty societies, the Association of University Professors of Ophthalmology, the American Board of Medical Specialties, the Accreditation Council for Graduate Medical Education, and others to evolve the process. Second, please send me your ideas for how the ABO can best meet your needs as practicing diplomates and colleagues. Ophthalmology led the way for all of medicine a hundred years ago. Working together, we can do it again.
Dr. Bartley assumes the role of Chief Executive Officer of the American Board of Ophthalmology effective January 1, 2017.