“ABO diplomates are professionals and colleagues, and we honor them accordingly.” For me, this is the most personal and, arguably, the most important of the ABO’s guiding principles.
In the nine months since I assumed the role as CEO of the ABO, I have been impressed by the breadth and depth of our diplomates’ perspectives about board certification. At one end of spectrum, there is a dedicated core of volunteers who ardently believe in our mission and support it with their time and talent. As an example, last month 89 of our colleagues gave up a long weekend to cloister themselves in Philadelphia, crafting more than 700 questions that will be used on future written and oral examinations as well as our new Quarterly Questions program. And in a couple of weeks, 126 ophthalmologists will convene in Chicago, at their own expense, to administer the oral examination. This commitment to a shared future is essential to our profession. I cannot thank our colleagues enough for such service.
At the other end of the spectrum are colleagues who believe that state medical boards and payors provide sufficient oversight and regulation, and who perceive the ABO as a self-serving, self-perpetuating cabal that enriches itself on the sweat of their fellow physicians. When individuals who feel this way consent to a thoughtful dialogue, almost always I find that the views are based on misinformation and, almost always, these colleagues quickly “get it” once they understand the facts and appreciate that the ABO cannot serve the public without simultaneously being mindful and respectful of the needs of all of our colleagues. At its core, the privilege of professional self-regulation is intimately tied to board certification, and the demise of certification likely would create a vacuum for payors and political entities to expand their oversight of our daily activities.
Most ophthalmologists are in the large swath between these two poles. All of us are busy with work, family, the joys and challenges of daily life. We seek to provide the best possible care to our patients and try to keep up by reading journals and attending continuing medical education courses. So far, I have heard almost universally that initial board certification is valued, but after passing our oral board examination it is easy for us relegate the certification process to a quiet cul-de-sac of our minds.
Many of our colleagues regard maintaining certification as a troublesome duty more than an opportunity for professional development. Please know that your ABO colleagues understand this and are working hard to re-design the continuous certification process to be an activity that we all elect to do rather than feel coerced to do. The above-mentioned Quarterly Questions pilot is one example, and we are grateful for the more than 1200 early adopters who have participated thus far and are helping us to refine and improve it. There needs to be sufficient value to make this attractive for all of us, and we are heartened that 96% of those who have participated would recommend Quarterly Questions to their colleagues.
Another way the ABO has tried to make the continuous certification process less onerous is the opportunity for diplomates to take the DOCK examination remotely rather than at a testing center. This became a personal priority for me after hearing the experience of George Williams, who is well-known to most ophthalmologists as the American Academy of Ophthalmology’s Secretary for Federal Affairs. Dr. Williams became board certified in 1983 and has voluntarily recertified twice. When he took the DOCK during the last cycle, he was battling a nasty head cold. To add insult to injury, his handkerchief was confiscated by the testing center monitor as part of the pre-examination security screen. In its place, Dr. Williams was given two tissues, with the assurance that he would be provided with two more tissues, if needed. The ABO already was planning to move away from testing centers when this episode occurred, but Dr. Williams’ story catalyzed the process and I was pleased that we offered remote testing to all who were eligible for the DOCK this year. About 40% of those who took the examination last month did so from their home or office. Feedback from these diplomates was gratifyingly positive, so much so that we will continue to offer the DOCK remotely through the remainder of the calendar year to those interested. (For more information, click here.)
Although the ABO regards its diplomates as colleagues and professionals, what happens when a diplomate’s conduct does not reflect well on themselves, their fellow ophthalmologists, or the profession of medicine? I am occasionally asked why diplomates who appear to have violated statutory, legal, policy, or ethical standards do not immediately lose their board certification. The process of revoking a colleague’s hard-earned certificate requires extensive information gathering and verification, intensive review and discussion by the ABO’s Hearing Committee, independent legal review, and ultimately a disposition by the full Board of Directors. Sometimes the decision is straightforward, for instance, if a diplomate loses his or her license to practice medicine. Such an action automatically results in loss of certification, as well. Other circumstances are more complicated. For example, if a diplomate voluntarily enters and complies with a rehabilitation program for chemical dependency with the approval of a licensing entity, s/he is not considered to have a restriction on his/her license during that time. On the other hand, ABO policy permits the organization to take action if a diplomate “demonstrates questionable judgment, poor judgment, unethical behavior, or immoral personal or professional behavior” or if the individual is convicted of a felony or misdemeanor. Ultimately, the ABO’s charge is to serve and protect the public. Doing so requires thoughtful consideration, deliberation, and due diligence. As colleagues, we owe each other the utmost in professionalism and respect.
Fortunately, serious transgressions are uncommon. The ophthalmic community is overwhelmingly populated by individuals who are trustworthy and dedicated, honest and honorable. In a word, I am impressed that our colleagues are professionals. It is a privilege to serve you.