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American Board of Internal Medicine and the Maintenance of Transparency

      To the Editor:
      In the May 2013 issue of Mayo Clinic Proceedings, a compelling editorial by the American Board of Internal Medicine (ABIM) leadership entitled “Physician Responsibility and Certifying Examinations” outlined a continual need for integrity and a high standard of ethical behavior.
      • Cassel C.K.
      • Holmboe E.S.
      • Slass L.B.
      Professional responsibility and certifying examinations [editorial].
      Using the search function on the ABIM website for the terms transparency or transparent, these terms are used at least 14 times in reference to various topics.

      American Board of Internal Medicine website. http://www.abim.org. Accessed January 21, 2014.

      However, in remodeling their maintenance of certification (MOC) program and its expectations, the ABIM has taken a large step backward in its efforts to make board certification status more transparent to members, patients, hospitals, and care organizations.
      The ABIM strongly encourages all diplomates certified before 1990 to complete the MOC process. In the past, the ABIM website clearly identified whether “grandfathered” diplomates had voluntarily recertified. However, when one attempts to verify internal medicine board certification status on the current ABIM website (“Verify a Physician’s ABIM Certification” window), it is no longer possible to differentiate certificate holders who are grandfathered and voluntarily recertified from those who are grandfathered without recertification. Furthermore, for nongrandfathered diplomates, the ABIM no longer identifies the most recent board recertification.

      American Board of Internal Medicine website. http://www.abim.org. Accessed January 21, 2014.

      In 2003, the ABIM commissioned a Gallup poll to survey patients’ awareness and attitudes toward board certification of physicians. The survey found that 90% of patients thought that physicians being “re-evaluated on their qualifications every so many years” was important or very important, and 95% of survey respondents felt that recertification of physicians was either very important or somewhat important.

      Gallup Organization, American Board of Internal Medicine. Awareness of and Attitudes Toward Board-Certification of Physicians. http://www.abim.org/pdf/publications/Gallup_Report.pdf. Accessed January 21, 2014.

      Despite this nearly unanimous view from the consumers of health care, few of the ABIM physician leaders had actually successfully completed the recertification process if they held grandfathered status.
      • Hayes J.M.
      Professional responsibility and certifying examinations [letter].
      With the latest changes in ABIM reporting methods, this type of credential review of ABIM leadership is no longer possible.
      With little evidence in hand to support the MOC process, recent ABIM leadership has dusted off a 10-year-old study of patient attitudes to justify pushing ahead MOC changes.

      Wachter B. Reflections On My Year as Chair of the American Board of Internal Medicine. Wachter’s World website. http://community.the-hospitalist.org/2013/06/30/reflections-on-my-year-as-chair-of-the-american-board-of-internal-medicine/. Published June 30, 2013. Accessed January 21, 2014.

      Perhaps the ABIM would bolster its credibility if it would keep its message straight. If the purpose of the MOC process is to benefit patients, why wasn’t grandfathered status addressed in 2003? If it’s about physician quality, where is the strong evidence to support such a claim?
      Unfortunately, the ABIM diplomates remain caught in the middle of a costly, time-consuming MOC process that fails to pass even the most basic evidenced-based scrutiny. Further, the ABIM leadership team has decided to provide patients with inadequate information about the recertification status of their physicians.

      References

        • Cassel C.K.
        • Holmboe E.S.
        • Slass L.B.
        Professional responsibility and certifying examinations [editorial].
        Mayo Clin Proc. 2013; 88: 425-427
      1. American Board of Internal Medicine website. http://www.abim.org. Accessed January 21, 2014.

      2. Gallup Organization, American Board of Internal Medicine. Awareness of and Attitudes Toward Board-Certification of Physicians. http://www.abim.org/pdf/publications/Gallup_Report.pdf. Accessed January 21, 2014.

        • Hayes J.M.
        Professional responsibility and certifying examinations [letter].
        Mayo Clin Proc. 2013; 88: 1035
      3. Wachter B. Reflections On My Year as Chair of the American Board of Internal Medicine. Wachter’s World website. http://community.the-hospitalist.org/2013/06/30/reflections-on-my-year-as-chair-of-the-american-board-of-internal-medicine/. Published June 30, 2013. Accessed January 21, 2014.

      Linked Article

      • Professional Responsibility and Certifying Examinations
        Mayo Clinic ProceedingsVol. 88Issue 5
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          The Commentary by Ruhnke and Doukas1 in the current issue of Mayo Clinic Proceedings is an important “call to action” for academic medicine to actively, and intentionally, strengthen the culture of medical school and training programs to value integrity and to respect the need for examinations to demonstrate competence throughout a professional career. The article discusses the American Board of Internal Medicine (ABIM) experience with physicians who attended Arora Board Review, a course conducted by a New Jersey–based physician, Rajender K.
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      • In reply—American Board of Internal Medicine and the Maintenance of Transparency
        Mayo Clinic ProceedingsVol. 89Issue 7
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          We thank Dr Hayes for his feedback about the changes to the American Board of Internal Medicine (ABIM) maintenance of certification (MOC) process. Dr Hayes contends that the recent changes to the ABIM’s certification status reporting format “provide patients with inadequate information about the recertification status of their physicians”; however, these changes are intended to do the opposite. By paring down the amount of information publicly reported about ABIM diplomates, we believe the certification status reporting on our website is now clearer and more understandable to the public and other stakeholders.
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