Things keep getting “interestinger and interestinger” to paraphrase Alice in Wonderland. As mentioned in my previous post, there is currently a bill being pushed by the Florida ACEP chapter in the Florida legislature which states the following:
A physician licensed under this
chapter may not hold himself or herself out as a
board-certified specialist unless the physician has received
formal recognition as a specialist from a specialty board of
the American Board of Medical Specialties or other recognizing
agency approved by the board which requires completion of an
approved residency or fellowship training program from the
Accreditation Council for Graduate Medical Education in the
specialty of certification.
If this bill passes, it means that ONLY physicians who underwent ABMS approved residency/ fellowship training in a specialty can say that they are board-certified in that specialty. This excludes all the doctors who were “grandfathered” in relatively new specialties which, until recently did not have residency/ fellowship training such as Emergency Medicine, Pediatric Emergency Medicine, Pain Medicine, Hospice and Palliative Medicine, and Sports Medicine, among others. Isn’t it ironic that of all states, Florida, is being “anti-grandfather”?
The bill also wants to exclude all the physicians who are certified by the American Board of Preventive Medicine, the American Board of Pain Management, and the American Board of Facial Plastic Reconstructive Surgery all of whom allow non-specialty trained physicians to be certified, not to mention all the BCEM certified emergency room physicians who are not allowed to take the ABMS approved ABEM exams (see previous posts).
Board certification status is a big deal since it affects the ability of a physician to obtain hospital privileges, be included in the network of health insurance companies, and significantly affects compensation.
So, one may ask, what is the real purpose of this bill? Of what conceivable use is it other than to limit patient access to specialists, possibly create an artificial physician shortage in certain specialties, and tick off a lot of doctors across a wide range of specialties? Those are questions to ask ACEP and the Florida legislation.
If you live or work in Florida and this makes no sense to you, write to your state representative and express your opinion. If you really want to get involved, contact ABPS or USAEM (see links below).Groups supporting both sides of the issue will be rallying at the Florida legislature on March 14.
Make your voice heard.
Emergency Medicine News: Volume 28(11) November 2006 pp 1,30,36
ACEP, AAEM Defeat AAPS Bid for Recognition in North Carolina
SoRelle, Ruth MPH
The American Academy of Emergency Medicine and the American College of Emergency Physicians teamed up in July with other professional medical groups to defeat an attempt by the American Board of Physician Specialties, the certifying arm of the American Association of Physician Specialists, to be recognized as a board certifying agency in North Carolina.
The North Carolina Medical Board refused the ABPS request, but has yet to issue a pubic reason for its decision. Under the 10-year rule, physicians seeking licensure in the state who meet all other requirements can, instead of taking a new test, prove their competence by having certification or re-certification from a specialty board recognized by the ABMS or the AOA or certification or re-certification with added qualifications from a specialty or subspecialty board recognized by the ABMS or AOA or completion of formal postgraduate medical education.
Basically, ABPS was seeking to get that same sort of recognition, said Todd Brosus, an attorney with the North Carolina Medical Board. Mr. Brosus said the board plans to issue its rationale for denying the request soon.
Florida’s medical board accepted the certifying arm of AAPS as a certifying body in 2002 and refused to change that rule in 2003 when petitioned by the Florida Medical Association to reconsider its stance. A later attempt to have the board’s rule made into law failed. After that, AAEM began monitoring every state medical board for such actions, said Tom Scaletta, MD, the group’s president.
We sent them a letter asking that they let us know when there is a request from AAPS, he said. It paid off in North Carolina. The board let us know that there had been a letter requesting consideration of AAPS.
That letter prompted action from AAEM, ACEP, the Society for Academic Emergency Medicine, and other organizations, said Dr. Scaletta, who said many groups sent letters to the North Carolina board. AAEM asked Howard Blumstein, MD, the group’s secretary-treasurer, to testify.
It was pretty straightforward, said Dr. Scaletta. We explained to them that we don’t want a board that doesn’t require emergency medicine residency training accepted as a certifying board in North Carolina.
He said AAPS created another avenue for gaining board certification in emergency medicine and other specialties for those who applied after the practice track closed. That route closed in 1989 after 10 years of warning, said Dr. Scaletta.
Vivek Tayal, MD, the president of the North Carolina College of Emergency Physicians, also testified against the AAPS request after being alerted by officials from the American College of Emergency Physicians. Both he and Otto Rogers, MD, another NCEP member, told the North Carolina board that while the practice track once might have been an acceptable method of training, it is no longer.
Dr. Roger’s testimony was particularly effective because he was practice-track trained, said Dr. Tayal. His testimony suggested that emergency medicine is too sophisticated and complicated to just go through the practice track.
Representatives of AAPS disagreed with that characterization and with the North Carolina decision. They expressed dismay that the North Carolina board had yet to give them a formal reason for the denial, which they received during the July meeting.
Robert Cerrato, DO, the vice chairman of the group, said many members of the AAPS staff presented evidence to the board. There was a lot of Q&A, he said. I thought there was a favorable exchange, and they never gave us any criteria for the rejection.
Dr. Cerrato added that AAPS’ entry into the board certification field represents a threat to the American Board of Medical Specialties, the most accepted and longest-lived board certification agency, which requires residency training as well as a test for its certification. I’ve been in medicine 20 years, he said. When I started, it [board certification] was not needed. Now it is difficult to practice without it.
We hear about physician shortages, said Dr. Cerrato. If they had the public interest at heart, they would not do anything to block other well-trained physicians from getting into the system. The bottom line is that board certification is required for emergency physicians to be employed. That’s a problem.
ABPS and its emergency medicine arm, the Board of Certification in Emergency Medicine (BCEM), do not require emergency physicians to complete an emergency medicine residency. Instead, according to the eligibility requirements on the ABPS web site, physicians can:
▪ Complete a residency in anesthesiology or a primary care specialty, or
▪ Be certified in a primary care specialty or anesthesiology by the ABPS, ABMS, or AOA boards of certification, or
▪ Complete a 12- or 24-month emergency medicine graduate training program approved by BCEM and have practiced emergency medicine full-time for five years, accumulating at least 7,000 hours of practice. The graduate course cannot be substituted for a primary care or anesthesiology residency.
It is the failure to require residency training and board certification in emergency medicine that concerns them, said members of AAEM and ACEP. Dr. Cerrato of the AAPS noted that some emergency physicians who are members of ACEP did not complete residency training, and that some were grandfathered in under the practice track provision that ended in 1989.
He said AAEM and ACEP now oppose the practice track as a route to board certification, while AAPS holds that a practice track policy is a good one. In actuality, isn’t that what residency training is? he said. Isn’t it on-the-job training? He disputed the notion that residencies are more highly supervised now than they were in the past. On-the-job training is on-the-job training, he said.
Lewis Marshall, MD, a former president of AAPS, said his group closed eligibility for board certification without a full residency in 1999. Physicians who work in the emergency department have dedicated themselves to providing emergency care, he said. Physicians who train in internal medicine and family practice have shown a commitment by submitting themselves to a test that shows their level of skill in specific areas of emergency medicine practice. He said when ABEM closed the practice track in 1988, they closed out a lot of people who had been practicing emergency medicine. AAPS then became the only certifying organization that would permit those with primary care residency [or certification] and five years’ practice to prove to themselves and their patients that they had a commitment to provide quality emergency care.
The group has not yet decided where it goes from here in North Carolina, said attorney James Wilson, JD, who represented the firm. AAPS members said they might seek similar recognition in states where it is an issue. In many states, it makes no difference, said Dr. Cerrato. They don’t have these kinds of rules. Many medical boards do not require board certification, but some have rules about the training of those who run advertisements in which they state their board certification.
Dr. Tayal noted that some members of his state’s organization have followed the practice track, and they are good physicians. We value the service they provide to the society and medical system, but we are not going to accept their certification.
Dr. Scaletta said he expects AAPS to continue to seek recognition. This is definitely a tenacious group, he said. They are really pushing because for them it’s important. But he said using a backdoor route to enter emergency medicine is not something that should be condoned by mainstream medicine.
He compared it with licensing airline pilots. When you fly somewhere, you have faith that the pilot is credentialed by the organization that does that. You have faith that someone is not learning on the job. The public has the same faith in emergency medicine. Patients presume they are being taken care of by board certified physicians.
ABPS Requirements for Emergency Medicine Board Certification
▪ Conform with the ABPS Code of Ethics, be known as an ethical professional, be active in emergency medicine, and be a member in good standing with AAPS.
▪ Be a graduate of a recognized college of medicine confirmed by a copy of an allopathic/osteopathic degree or a letter of verification. Foreign medical school graduates must submit an English transcription of the document and a copy of the ECFMG Certificate.
▪ Have a valid, unrestricted license to practice medicine in the U.S.
▪ Be certified as a provider in ACLS, ATLS, and PALS.
▪ Complete residency training in an ACGME- or AOA-approved program acceptable to BCEM, including substantial, identifiable training in emergency medicine as determined by BCEM and approved by ABPS.
▪ Complete an ACGME- or AOA-accredited emergency medicine residency.
▪ Practice emergency medicine full-time for five years (minimum of 7,000 hours) and complete an ACGME- or AOA-accredited primary care or anesthesiology residency or be certified in a primary care specialty or anesthesiology by an ABPS-, ABMS-, or AOA-recognized board of certification.
▪ Complete either 12- or 24-month emergency medicine graduate training approved by BCEM. Physicians completing a 12-month program must have practiced emergency medicine full-time for an additional 12 months before or after completing the training. (Full-time practice is defined by BCEM as at least 1,400 hours per 12-month period.)
▪ Verified staff privileges by the administrator of each hospital that privileges are in good standing.
▪ Submit 10 documented emergency medicine cases for which the physician had the lead management role.