Hopeman Lectureship 2012 Sagar Damle, MD September 24, 2012
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1 Hopeman Lectureship 2012 Sagar Damle, MD September 24, 2012
2 Outline History Arguments No benefit to physicians Outdated and not relevant No data Unnecessary financial burden Conclusions
3 History ABMS established in founding board members: Derm, OB/Gyn, Ophtho, ENT 1937: American board of surgery 1971: American board of thoracic surgery
4 Argument 1: Board certification does not benefit the physician.
5 Patients don t care. From the ABMS: When you choose a doctor who is Board Certified by one of the ABMS Member Boards, you can be confident he or she meets nationally recognized standards for education, knowledge, experience and skills to provide high quality care in a specific medical specialty. Patient s don t really care Show of hands
6 No guarantees for physicians Does it guarantee licensure? No. In fact, totally separate. Must have full license to practice to take board exams. Does it guarantee malpractice protection? No. Still liable for any mistakes, changes in standards of care, etc. Does it guarantee hospital privileges? No. Does it get you more business? Show of hands
7 No guarantee No guarantee for patients. No guarantee for physicians. No guarantee for hospitals. Therefore: Certification is not necessary!
8 Argument 2: The certifications exams are irrelevant for practice today.
9 Outdated ABS Exam covers Head & Neck: 3% Breast 5% Alimentary Tract 15% Thoracic 4% on an on. Total of 18 areas. This paradigm is NOT applicable anymore given the surge of specialty boards.
10 Outdated Dr. Mauchley will say, But a general surgeon in a small town does it all. Not true
11 Surgeon 1 Outdated Monday Tuesday Wednesday Thursday Friday Clinic am Call pm Surgeon 2 Lap chole Inguinal Hernia EGD/Colon Lap Chole Inguinal Hernia Call am Clinic PM Monday Tuesday Wednesday Thursday Friday Lap Chole Lap Chole EGD OR: Lap Chole Lap Ventral Hernia Clinic OR: Lipoma Lap Chole Hernia Clinic OR: Lap Chole EGD Hernia
12 Outdated Surgeon 3 Monday Tuesday Wednesday Thursday Friday OR -Parathyroid -Thyroid Clinic Academic day OR -Adrenal -Parathyroid -Parathyroid Clinic/ OR Therefore, this requirement for board certification is not applicable to real-life practice.
13 Argument 3: Although the board was established to improve outcomes and safety for patients, there is no data demonstrating certification improves outcomes.
14 The Data. Question to answer: Does board certification improve clinical outcomes? Not: How do we get more people to pass (ie, pay for) the boards. Dr. Mauchley will cite several articles NO randomized trials NO large comparisons NO prospective data Ie, NO credible data. Even the data I am about to show is marginal
15 Comprehensive review, Of 1200 papers in initial screen, only 13 papers looked at certification and outcomes. Results... Few studies suggested minor improvement in outcomes. Several demonstrated NO SIGNIFICANT OUTCOME CHANGE WITH CERTIFICATION Orthopedics- no improved outcomes Heck 1998 (pain, function, complications all same) General Surgeons- no change in mortality Kelly & Hellinger 1986 (mortality and stomach CA and aneurysms) Pearce 1999 (no change in outcomes for peripheral bypass)
16 Results Even some suggestion of WORSE results Higher malpractice claims Tussing & Wojtowycz 1993 (higher C-section rates) Sloan 1989 (More malpractice claims in certified OB/anesthesiology and surgery groups) Conclusions Despite the lack of unequivocal evidence documenting the value of board certification, we do not advocate removing it as a measure of expertise. What? How did they come to that?
17 More recent data Compared +/- certification in IM, FP, cards for tx of MI. Results ASA use slightly higher in certified groups NO difference in mortality!
18 Re-examination of Sharp et al. work Used logical analysis to determine conclusions based on studies. Conclusions:
19 Summary Board certification does not provide any guarantees to the patient, physician or really to society beyond other organizations. Most general boards (and more specialty boards) are totally irrelevant in today s medical practice. There is no data supporting the requirement for board certification.
20 Board Certification as a Money-Maker General surgery boards ~1000 GS graduates each year + 20+% fail rate applicants for certification EACH year. Application cost: $300 Application fee $800 Qualifying exam fee + $1000 certification exam fee $ 2100 PER APPLICANT
21 Conclusion Board certification does not provide benefits for the patients. Certification does not provide benefits for the physician. The certification exam places unnecessary financial strain on applicants FOR NO BENEFIT!
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