As managed care's role has grown in recent years, board certification's importance in the professional lives of physicians has grown correspondingly, as most managed care organizations require board certification for physicians participating in their plans. Hospitals increasingly are also making board certification a prerequisite to obtain staff privileges. Many physicians, of course, continue to become certified simply to obtain the professional recognition that accompanies completing the intensive requirements of board certification and to establish and legitimize areas of expertise. These are all compelling factors motivating more and more physicians to begin the process of certification.
The public's perspective of board certification continues to play a significant role in certification's importance. As patients become more knowledgeable about their treatment options, they increasingly view board certification as a sign of quality and competence. The educated healthcare consumer prefers to be treated by board-certified physicians, and board certification, though a voluntary process, is becoming an indispensable designation for physicians.
The American Osteopathic Association's Board Certification Program
The American Osteopathic Association's (AOA) board certification program began in 1939. The official AOA's certifying body, the Bureau of Osteopathic Specialists BOS), through its 18 approved specialty boards, has been the primary certification provider for osteopathic physicians and has issued more than 26,700 General, Special Qualifications, and Added Qualifications certifications. (
Figure 1)
As of the end of August 2004, a total of 18,816 osteopathic physicians are actively certified by the AOA and hold a combined total of 21,883 active certificates. In 2003, a total of 1030 certificates were awarded in specialty and subspecialty areas (
Table 1). In 2003, a total of 34 certificates of added qualifications were awarded (
Table 2).
Table 1
American Osteopathic Association Certification Awarded 1997 Through December 2003 *
| Specialty | 1997 | 1998 | 1999 | 2000 | 2001 | 2002 | 2003 |
|---|
| □ Allergy and Immunology | 0 | 2 | 0 | 0 | 1 | 0 | 1 |
| □ Anatomic Pathology | 1 | 1 | 0 | 2 | 1 | 0 | 0 |
| □ Anatomic Pathology and Laboratory Medicine | 0 | 0 | 0 | 1 | 0 | 1 | 0 |
| □ Anesthesiology | 21 | 43 | 20 | 31 | 18 | 11 | 15 |
| □ Cardiology | 14 | 12 | 11 | 9 | 13 | 9 | 11 |
| □ Child Neurology | 0 | 0 | 0 | 0 | 0 | 1 | 0 |
| □ Child Psychiatry | 0 | 0 | 0 | 0 | 0 | 0 | 3 |
| □ Dermatology | 14 | 14 | 8 | 14 | 8 | 16 | 10 |
| □ Diagnostic Radiology | 28 | 53 | 26 | 29 | 21 | 17 | 17 |
| □ Emergency Medicine | 65 | 45 | 106 | 110 | 87 | 103 | 120 |
| □ Endocrinology | 3 | 0 | 1 | 1 | 2 | 0 | 1 |
| □ Facial Plastic Surgery | 1 | 0 | 0 | 0 | 0 | 0 | 0 |
| □ Family Practice (and OMT)† | 677 | 610 | 934 | 546 | 596 | 686 | 435 |
| □ Forensic Pathology | 0 | 0 | 0 | 0 | 1 | 0 | 0 |
| □ Gastroenterology | 13 | 8 | 7 | 0 | 2 | 8 | 6 |
| □ General Vascular Surgery | 10 | 4 | 12 | 7 | 2 | 7 | 0 |
| □ Gynecologic Oncology | 1 | 1 | 0 | 0 | 0 | 0 | 1 |
| □ Hematology | 1 | 3 | 1 | 0 | 0 | 0 | 0 |
| □ Infectious Diseases | 3 | 3 | 3 | 0 | 4 | 4 | 5 |
| □ Internal Medicine | 92 | 93 | 118 | 145 | 146 | 143 | 157 |
| □ Laboratory Medicine | 0 | 3 | 0 | 1 | 1 | 0 | 0 |
| □ Maternal and Fetal Medicine | 0 | 3 | 1 | 1 | 0 | 1 | 2 |
| □ Neonatology | 2 | 0 | 0 | 0 | 0 | 1 | 1 |
| □ Nephrology | 2 | 4 | 1 | 11 | 4 | 2 | 9 |
| □ Neurological Surgery | 1 | 3 | 4 | 3 | 1 | 6 | 1 |
| □ Neurology | 0 | 15 | 9 | 8 | 11 | 12 | 4 |
| □ Neuromusculoskeletal Medicine and OMM/Special Proficiency in Osteopathic Manipulative Treatment‡ | 10 | 20 | 16 | 20 | 24 | 23 | 35 |
| □ Nuclear Medicine | 0 | 3 | 0 | 0 | 0 | 1 | 0 |
| □ Obstetrics and Gynecology | 28 | 72 | 43 | 80 | 27 | 61 | 53 |
| □ Oncology | 2 | 1 | 2 | 2 | 1 | 1 | 7 |
| □ Ophthalmology | 10 | 23 | 12 | 10 | 8 | 10 | 12 |
| □ Orthopedic Surgery | 35 | 31 | 75 | 14 | 39 | 45 | 44 |
| □ Otolaryngology | 1 | 0 | 0 | 2 | 1 | 2 | 1 |
| □ Otolaryngology and Facial Plastic Surgery | 10 | 34 | 11 | 10 | 13 | 11 | 11 |
| □ Pediatrics | 8 | 4 | 5 | 21 | 17 | 18 | 18 |
| □ Physical Medicine and Rehabilitation§ | 11 | 11 | 10 | 11 | 17 | 0 | 0 |
| □ Plastic and Reconstructive Surgery | 2 | 2 | 6 | 2 | 1 | 3 | 0 |
| □ Preventive Medicine/Aerospace Medicine | 2 | 2 | 2 | 1 | 2 | 2 | 4 |
| □ Preventive Medicine/Public Health | 4 | 1 | 0 | 2 | 3 | 3 | 1 |
| □ Preventive Medicine/Occupational Medicine/Environmental Medicine | 13 | 17 | 5 | 3 | 10 | 4 | 5 |
| □ Proctology | 1 | 1 | 4 | | 0 | | 1 |
| □ Psychiatry | 11 | 17 | 10 | 21 | 16 | 13 | 13 |
| □ Pulmonary Diseases | 7 | 6 | 4 | 10 | 3 | 7 | 4 |
| □ Radiation Oncology | 0 | 0 | 0 | 1 | 1 | 1 | 0 |
| □ Radiology | ... | ... | ... | ... | ... | ... | 0 |
| □ Reproductive Endocrinology | 1 | 1 | 1 | 0 | 0 | 2 | 0 |
| □ Rheumatology | 3 | 3 | 1 | 2 | 1 | 2 | 5 |
| □ Surgery (General) | 21 | 30 | 51 | 46 | 11 | 48 | 14 |
| □ Thoracic/Cardiovascular Surgery | 5 | 3 | 2 | 4 | 1 | 1 | 0 |
| □ Urological Surgery | 6
| 11
| 9
| 4
| 2
| 6
| 3
|
Total Certificates Awarded
| 1140
| 1215
| 1531
| 1187
| 1118
| 1294
| 1030
|
Table 1
American Osteopathic Association Certification Awarded 1997 Through December 2003 *
| Specialty | 1997 | 1998 | 1999 | 2000 | 2001 | 2002 | 2003 |
|---|
| □ Allergy and Immunology | 0 | 2 | 0 | 0 | 1 | 0 | 1 |
| □ Anatomic Pathology | 1 | 1 | 0 | 2 | 1 | 0 | 0 |
| □ Anatomic Pathology and Laboratory Medicine | 0 | 0 | 0 | 1 | 0 | 1 | 0 |
| □ Anesthesiology | 21 | 43 | 20 | 31 | 18 | 11 | 15 |
| □ Cardiology | 14 | 12 | 11 | 9 | 13 | 9 | 11 |
| □ Child Neurology | 0 | 0 | 0 | 0 | 0 | 1 | 0 |
| □ Child Psychiatry | 0 | 0 | 0 | 0 | 0 | 0 | 3 |
| □ Dermatology | 14 | 14 | 8 | 14 | 8 | 16 | 10 |
| □ Diagnostic Radiology | 28 | 53 | 26 | 29 | 21 | 17 | 17 |
| □ Emergency Medicine | 65 | 45 | 106 | 110 | 87 | 103 | 120 |
| □ Endocrinology | 3 | 0 | 1 | 1 | 2 | 0 | 1 |
| □ Facial Plastic Surgery | 1 | 0 | 0 | 0 | 0 | 0 | 0 |
| □ Family Practice (and OMT)† | 677 | 610 | 934 | 546 | 596 | 686 | 435 |
| □ Forensic Pathology | 0 | 0 | 0 | 0 | 1 | 0 | 0 |
| □ Gastroenterology | 13 | 8 | 7 | 0 | 2 | 8 | 6 |
| □ General Vascular Surgery | 10 | 4 | 12 | 7 | 2 | 7 | 0 |
| □ Gynecologic Oncology | 1 | 1 | 0 | 0 | 0 | 0 | 1 |
| □ Hematology | 1 | 3 | 1 | 0 | 0 | 0 | 0 |
| □ Infectious Diseases | 3 | 3 | 3 | 0 | 4 | 4 | 5 |
| □ Internal Medicine | 92 | 93 | 118 | 145 | 146 | 143 | 157 |
| □ Laboratory Medicine | 0 | 3 | 0 | 1 | 1 | 0 | 0 |
| □ Maternal and Fetal Medicine | 0 | 3 | 1 | 1 | 0 | 1 | 2 |
| □ Neonatology | 2 | 0 | 0 | 0 | 0 | 1 | 1 |
| □ Nephrology | 2 | 4 | 1 | 11 | 4 | 2 | 9 |
| □ Neurological Surgery | 1 | 3 | 4 | 3 | 1 | 6 | 1 |
| □ Neurology | 0 | 15 | 9 | 8 | 11 | 12 | 4 |
| □ Neuromusculoskeletal Medicine and OMM/Special Proficiency in Osteopathic Manipulative Treatment‡ | 10 | 20 | 16 | 20 | 24 | 23 | 35 |
| □ Nuclear Medicine | 0 | 3 | 0 | 0 | 0 | 1 | 0 |
| □ Obstetrics and Gynecology | 28 | 72 | 43 | 80 | 27 | 61 | 53 |
| □ Oncology | 2 | 1 | 2 | 2 | 1 | 1 | 7 |
| □ Ophthalmology | 10 | 23 | 12 | 10 | 8 | 10 | 12 |
| □ Orthopedic Surgery | 35 | 31 | 75 | 14 | 39 | 45 | 44 |
| □ Otolaryngology | 1 | 0 | 0 | 2 | 1 | 2 | 1 |
| □ Otolaryngology and Facial Plastic Surgery | 10 | 34 | 11 | 10 | 13 | 11 | 11 |
| □ Pediatrics | 8 | 4 | 5 | 21 | 17 | 18 | 18 |
| □ Physical Medicine and Rehabilitation§ | 11 | 11 | 10 | 11 | 17 | 0 | 0 |
| □ Plastic and Reconstructive Surgery | 2 | 2 | 6 | 2 | 1 | 3 | 0 |
| □ Preventive Medicine/Aerospace Medicine | 2 | 2 | 2 | 1 | 2 | 2 | 4 |
| □ Preventive Medicine/Public Health | 4 | 1 | 0 | 2 | 3 | 3 | 1 |
| □ Preventive Medicine/Occupational Medicine/Environmental Medicine | 13 | 17 | 5 | 3 | 10 | 4 | 5 |
| □ Proctology | 1 | 1 | 4 | | 0 | | 1 |
| □ Psychiatry | 11 | 17 | 10 | 21 | 16 | 13 | 13 |
| □ Pulmonary Diseases | 7 | 6 | 4 | 10 | 3 | 7 | 4 |
| □ Radiation Oncology | 0 | 0 | 0 | 1 | 1 | 1 | 0 |
| □ Radiology | ... | ... | ... | ... | ... | ... | 0 |
| □ Reproductive Endocrinology | 1 | 1 | 1 | 0 | 0 | 2 | 0 |
| □ Rheumatology | 3 | 3 | 1 | 2 | 1 | 2 | 5 |
| □ Surgery (General) | 21 | 30 | 51 | 46 | 11 | 48 | 14 |
| □ Thoracic/Cardiovascular Surgery | 5 | 3 | 2 | 4 | 1 | 1 | 0 |
| □ Urological Surgery | 6
| 11
| 9
| 4
| 2
| 6
| 3
|
Total Certificates Awarded
| 1140
| 1215
| 1531
| 1187
| 1118
| 1294
| 1030
|
×
Table 2
Certificates of Added Qualifications 1999 Through 2003 *
| Certificate of Added Qualification and Specialty Board | 1999 | 2000 | 2001 | 2002 | 2003 |
|---|
| □ Critical Care Medicine-Anesthesiology | 0 | 0 | 0 | 0 | 0 |
| □ Pain Management-Anesthesiology | 8 | 7 | 3 | 1 | 1 |
| □ Dermatopathology-Dermatology | 0 | 0 | 0 | | |
| □ MOHS Micrographic Surgery-Dermatology | 0 | 0 | 0 | 3 | 1 |
| □ Emergency Medical Services-Emergency Medicine | 0 | 3 | 0 | 1 | 0 |
| □ Sports Medicine-Emergency Medicine | 0 | 0 | 0 | 1 | 0 |
| □ Medical Toxicology-Emergency Medicine | 2 | 0 | 2 | 0 | 0 |
| □ Addiction Medicine-Family Physicians | 4 | 0 | 1 | 0 | 0 |
| □ Adolescent and Young Adult Medicine-Family Physicians | 0 | 0 | 0 | 0 | 0 |
| □ Geriatrics-Family Physicians | 14 | 17 | 37 | 61 | 1 |
| □ Sports Medicine-Family Physicians | 8 | 8 | 4 | 17 | 0 |
| □ Addiction Medicine-Internal Medicine | 0 | 0 | 0 | 0 | 0 |
| □ Critical Care Medicine-Internal Medicine | 3 | 0 | 6 | 0 | 5 |
| □ Clinical Cardiac Electrophysiology-Internal Medicine | 0 | 0 | 0 | 0 | 0 |
| □ Geriatric Medicine-Internal Medicine | 0 | 2 | 0 | 6 | 0 |
| □ Interventional Cardiology-Internal Medicine | 0 | 0 | 0 | 0 | 16 |
| □ Sports Medicine-Internal Medicine | 0 | 2 | 0 | 0 | 0 |
| □ Addiction Medicine-Neurology/Psychiatry | 0 | 0 | 2 | 0 | 0 |
| □ Hand Surgery-Orthopedic Surgery | 0 | 0 | 21 | 0 | 6 |
| □ Dermatopathology-Pathology | 0 | 0 | 0 | 0 | 0 |
| □ Vascular and Interventional Radiology-Radiology† | 4 | 0 | 1 | 1 | 0 |
| □ Body Imaging-Radiology | 1 | 0 | 3 | 0 | |
| □ Neuroradiology-Radiology | 1 | 5 | 8 | 3 | 0 |
| □ Nuclear Radiology-Radiology | 0 | 0 | 2 | 0 | 0 |
| □ Pediatric Radiology-Radiology | 1 | 0 | 1 | 0 | 0 |
| □ Sports Medicine-Physical Medicine & Rehabilitation | 0 | 0 | 0 | 0 | ... |
| □ Sports Medicine-Special Proficiency in Osteopathic Manipulative Medicine | 1 | 0 | 0 | 1 | 0 |
| □ Sports Medicine-Preventive Medicine | 0 | 1 | 0 | 0 | 0 |
| □ Surgical Critical Care-Surgery | 3 | 4 | 6 | 1 | 0 |
| □ Occupational Medicine | 11 | 14 | 10 | 3 | 4 |
| □ Otolaryngic Allergy-Ophthalmology/Otolaryngology | 3
| 7
| 0
| 3
| 0
|
Total
| 64
| 70
| 107
| 102
| 34
|
Table 2
Certificates of Added Qualifications 1999 Through 2003 *
| Certificate of Added Qualification and Specialty Board | 1999 | 2000 | 2001 | 2002 | 2003 |
|---|
| □ Critical Care Medicine-Anesthesiology | 0 | 0 | 0 | 0 | 0 |
| □ Pain Management-Anesthesiology | 8 | 7 | 3 | 1 | 1 |
| □ Dermatopathology-Dermatology | 0 | 0 | 0 | | |
| □ MOHS Micrographic Surgery-Dermatology | 0 | 0 | 0 | 3 | 1 |
| □ Emergency Medical Services-Emergency Medicine | 0 | 3 | 0 | 1 | 0 |
| □ Sports Medicine-Emergency Medicine | 0 | 0 | 0 | 1 | 0 |
| □ Medical Toxicology-Emergency Medicine | 2 | 0 | 2 | 0 | 0 |
| □ Addiction Medicine-Family Physicians | 4 | 0 | 1 | 0 | 0 |
| □ Adolescent and Young Adult Medicine-Family Physicians | 0 | 0 | 0 | 0 | 0 |
| □ Geriatrics-Family Physicians | 14 | 17 | 37 | 61 | 1 |
| □ Sports Medicine-Family Physicians | 8 | 8 | 4 | 17 | 0 |
| □ Addiction Medicine-Internal Medicine | 0 | 0 | 0 | 0 | 0 |
| □ Critical Care Medicine-Internal Medicine | 3 | 0 | 6 | 0 | 5 |
| □ Clinical Cardiac Electrophysiology-Internal Medicine | 0 | 0 | 0 | 0 | 0 |
| □ Geriatric Medicine-Internal Medicine | 0 | 2 | 0 | 6 | 0 |
| □ Interventional Cardiology-Internal Medicine | 0 | 0 | 0 | 0 | 16 |
| □ Sports Medicine-Internal Medicine | 0 | 2 | 0 | 0 | 0 |
| □ Addiction Medicine-Neurology/Psychiatry | 0 | 0 | 2 | 0 | 0 |
| □ Hand Surgery-Orthopedic Surgery | 0 | 0 | 21 | 0 | 6 |
| □ Dermatopathology-Pathology | 0 | 0 | 0 | 0 | 0 |
| □ Vascular and Interventional Radiology-Radiology† | 4 | 0 | 1 | 1 | 0 |
| □ Body Imaging-Radiology | 1 | 0 | 3 | 0 | |
| □ Neuroradiology-Radiology | 1 | 5 | 8 | 3 | 0 |
| □ Nuclear Radiology-Radiology | 0 | 0 | 2 | 0 | 0 |
| □ Pediatric Radiology-Radiology | 1 | 0 | 1 | 0 | 0 |
| □ Sports Medicine-Physical Medicine & Rehabilitation | 0 | 0 | 0 | 0 | ... |
| □ Sports Medicine-Special Proficiency in Osteopathic Manipulative Medicine | 1 | 0 | 0 | 1 | 0 |
| □ Sports Medicine-Preventive Medicine | 0 | 1 | 0 | 0 | 0 |
| □ Surgical Critical Care-Surgery | 3 | 4 | 6 | 1 | 0 |
| □ Occupational Medicine | 11 | 14 | 10 | 3 | 4 |
| □ Otolaryngic Allergy-Ophthalmology/Otolaryngology | 3
| 7
| 0
| 3
| 0
|
Total
| 64
| 70
| 107
| 102
| 34
|
×
Reentry Into the Certification Process
In February 1994, the AOA Board of Trustees directed all certifying boards to establish a mechanism for re-entry into the certification process for those physicians whose board eligibility had expired. Such a re-entry process may include, for example, the completion of a specific amount and type of continuing medical education credit before being allowed to sit for certification examination, and may differ by certifying board. This process does not re-establish board eligibility status, but does allow physicians to meet the requirements for sitting for certification examination.
Conjoint Examinations
In July 1993, the AOA Board of Trustees directed the AOA Executive Director, in conjunction with the BOS, in conjunction with the BOS (the Bureau), to study the issue of creating a mechanism for the formation of conjoint boards in areas of overlapping specialties. This action was prompted by an application for the formation of a conjoint board of sports medicine.
In its discussions, the Bureau noted that over time, there likely will emerge new areas of overlapping jurisdiction in osteopathic medicine in addition to sports medicine and that the formation of a new certifying board each time would not be practical. Instead, it was recommended that a mechanism for creating conjoint examinations be formed which would allow all appropriate specialty boards to participate if they desire. The Board of Trustees accepted this recommendation in February 1994 and approved the mechanism for creating conjoint examinations.
The conjoint mechanism allows diplomates (those holding general certification) from participating boards to establish eligibility to sit for examination. To date, three conjoint examinations are offered (sports medicine, addiction medicine, and dermatopathology).
Recertification Gains Momentum in the Osteopathic Medical Profession
Effective January 1, 1995, the AOA certifying boards were directed to offer a recertification mechanism to its diplomates. In conjunction with implementation of the recertification process, numerous boards have instituted time-limited certificates (that is, new certificates are issued with an expiration date). Effective January 1, 2004, AOA certifying boards that had not yet implemented a certificate time-dating policy, were required to make all newly issued certificates time-limited to 10 years or less. Fifteen of the 18 AOA certifying boards had already time-limited their certificates before January 1, 2004. Certificates issued before the requirement to time-limited certificates are valid for life. All diplomates are eligible to sit for recertification examinations, even if they hold a lifetime certificate (
Table 3).
Table 3
Recertification Statistics 1998 Through December 2003 *
| Specialty | 1998 | 1999 | 2000 | 2001 | 2002 | 2003 |
|---|
| □ Anesthesiology | 4 | 6 | 4 | 0 | 0 | 3 |
| □ Cardiology | 0 | 0 | 0 | 0 | 0 | 8 |
| □ Critcal Care Medicine-Internal Medicine | 0 | 0 | 0 | 0 | 0 | 11 |
| □ Dermatology | 0 | 0 | 0 | 0 | 0 | 0 |
| □ Diagnostic Radiology | 0 | 3 | 6 | 4 | 23 | 1 |
| □ Emergency Medicine | 6 | 18 | 10 | 11 | 13 | 20 |
| □ Family Practice and OMT | 12 | 17 | 31 | 17 | 20 | 17 |
| □ Gastroenterology | 0 | 0 | 0 | 0 | 0 | 13 |
| □ Geriatric Medicine-Family Practice | 0 | 0 | 0 | 0 | 1 | 0 |
| □ Geriatric Medicine-Internal Medicine | 0 | 0 | 0 | 0 | 0 | 3 |
| □ Hematology | 0 | 0 | 0 | 0 | 0 | 3 |
| □ Infectious Diseases | 0 | 0 | 0 | 0 | 0 | 2 |
| □ Internal Medicine | 0 | 0 | 0 | 0 | 0 | 61 |
| □ Neonatology | 0 | 0 | 0 | 0 | 0 | 2 |
| □ Nephrology | 0 | 0 | 0 | 0 | 0 | 2 |
| □ Neurology/Psychiatry | 0 | 0 | 0 | 0 | 0 | 0 |
| □ Nuclear Medicine | 0 | 0 | 0 | 0 | 0 | 0 |
| □ Obstetrics/Gynecology | 0 | 0 | 0 | 0 | 0 | 0 |
| □ Oncology | 0 | 0 | 0 | 0 | 0 | 7 |
| □ Ophthalmology/Otolaryngology-Head and Neck Surgery | 0 | 0 | 1 | 0 | 0 | 0 |
| □ Orthopedic Surgery | 0 | 2 | 4 | 0 | 3 | 0 |
| □ Pathology | 0 | 0 | 0 | 0 | 0 | 0 |
| □ Pediatrics | 0 | 0 | 0 | 0 | 0 | 10 |
| □ Physical Medicine & Rehabilitation | 0 | 0 | 0 | 0 | 0 | |
| □ Preventive Medicine | 0 | 0 | 1 | 1† | 1† | 0 |
| 0 | 0 | 0 | 1‡ | 1‡ | 0 |
| 0 | 0 | 0 | 0 | 1§ | 0 |
| □ Preventive Environmental Medicine | 2 | 0 | 0 | 1 | 5 | 1 |
| □ Proctology | 0 | 0 | 0 | 4 | 0 | 0 |
| □ Pulmonary Diseases | 0 | 0 | 0 | 0 | 0 | 9 |
| □ Neuroradiology | 0 | 0 | 1 | 1 | 0 | 0 |
| □ Rheumatology | 0 | 0 | 0 | 0 | 0 | 3 |
| □ Diagnostic Roentgenology | 0 | 0 | 0 | 0 | 1 | 0 |
| □ Osteopathic Manipulative Medicine | 0 | 1 | 0 | 0 | 0 | 0 |
| □ Surgery | 0 | 0 | 0 | 0 | 1 | 0 |
| □ Urological Surgery | 0
| 0
| 0
| 0
| 0
| 0
|
Total
| 24
| 47
| 58
| 40
| 70
| 176
|
Table 3
Recertification Statistics 1998 Through December 2003 *
| Specialty | 1998 | 1999 | 2000 | 2001 | 2002 | 2003 |
|---|
| □ Anesthesiology | 4 | 6 | 4 | 0 | 0 | 3 |
| □ Cardiology | 0 | 0 | 0 | 0 | 0 | 8 |
| □ Critcal Care Medicine-Internal Medicine | 0 | 0 | 0 | 0 | 0 | 11 |
| □ Dermatology | 0 | 0 | 0 | 0 | 0 | 0 |
| □ Diagnostic Radiology | 0 | 3 | 6 | 4 | 23 | 1 |
| □ Emergency Medicine | 6 | 18 | 10 | 11 | 13 | 20 |
| □ Family Practice and OMT | 12 | 17 | 31 | 17 | 20 | 17 |
| □ Gastroenterology | 0 | 0 | 0 | 0 | 0 | 13 |
| □ Geriatric Medicine-Family Practice | 0 | 0 | 0 | 0 | 1 | 0 |
| □ Geriatric Medicine-Internal Medicine | 0 | 0 | 0 | 0 | 0 | 3 |
| □ Hematology | 0 | 0 | 0 | 0 | 0 | 3 |
| □ Infectious Diseases | 0 | 0 | 0 | 0 | 0 | 2 |
| □ Internal Medicine | 0 | 0 | 0 | 0 | 0 | 61 |
| □ Neonatology | 0 | 0 | 0 | 0 | 0 | 2 |
| □ Nephrology | 0 | 0 | 0 | 0 | 0 | 2 |
| □ Neurology/Psychiatry | 0 | 0 | 0 | 0 | 0 | 0 |
| □ Nuclear Medicine | 0 | 0 | 0 | 0 | 0 | 0 |
| □ Obstetrics/Gynecology | 0 | 0 | 0 | 0 | 0 | 0 |
| □ Oncology | 0 | 0 | 0 | 0 | 0 | 7 |
| □ Ophthalmology/Otolaryngology-Head and Neck Surgery | 0 | 0 | 1 | 0 | 0 | 0 |
| □ Orthopedic Surgery | 0 | 2 | 4 | 0 | 3 | 0 |
| □ Pathology | 0 | 0 | 0 | 0 | 0 | 0 |
| □ Pediatrics | 0 | 0 | 0 | 0 | 0 | 10 |
| □ Physical Medicine & Rehabilitation | 0 | 0 | 0 | 0 | 0 | |
| □ Preventive Medicine | 0 | 0 | 1 | 1† | 1† | 0 |
| 0 | 0 | 0 | 1‡ | 1‡ | 0 |
| 0 | 0 | 0 | 0 | 1§ | 0 |
| □ Preventive Environmental Medicine | 2 | 0 | 0 | 1 | 5 | 1 |
| □ Proctology | 0 | 0 | 0 | 4 | 0 | 0 |
| □ Pulmonary Diseases | 0 | 0 | 0 | 0 | 0 | 9 |
| □ Neuroradiology | 0 | 0 | 1 | 1 | 0 | 0 |
| □ Rheumatology | 0 | 0 | 0 | 0 | 0 | 3 |
| □ Diagnostic Roentgenology | 0 | 0 | 0 | 0 | 1 | 0 |
| □ Osteopathic Manipulative Medicine | 0 | 1 | 0 | 0 | 0 | 0 |
| □ Surgery | 0 | 0 | 0 | 0 | 1 | 0 |
| □ Urological Surgery | 0
| 0
| 0
| 0
| 0
| 0
|
Total
| 24
| 47
| 58
| 40
| 70
| 176
|
×
Table 4 summarizes the current status of establishing time limits on the certificates issued by AOA certifying boards.
Table 4
Certificate Time-Limiting by the American Osteopathic Boards
| American Osteopathic Board of | Certificate Time Limit, y | Date Specialty Board Implemented Time Limiting |
|---|
| □ Anesthesiology | 10 | January 1, 2002 |
| □ Dermatology | 10 | January 1, 2004 |
| □ Emergency Medicine | 10 | January 1, 1994 |
| □ Family Practice | 8 | March 1, 1997 |
| □ Internal Medicine | 10 | January 1, 1993 |
| □ Neurology and Psychiatry | 10 | January 1, 1996 |
| □ Nuclear Medicine | 10 | January 1, 1995 |
| □ Obstetrics and Gynecology | 6 | January 1, 2003 |
| □ Orthopedic Surgery | 10 | January 1, 1994 |
| □ Neuromusculoskeletal Medicine* | 10 | January 1, 1995 |
| □ Ophthalmology† | 10 | January 1, 2000 |
| □ Otolaryngology-Head and Neck Surgery† | 10 | January 1, 2002 |
| □ Pathology | 10 | January 1, 1995 |
| □ Pediatrics | 7 | January 1, 1995 |
| □ Physical Medicine & Rehabilitation‡ | 10 | January 1, 2004 |
| □ Preventive Medicine | 10 | January 1, 1994 |
| □ Proctology | 10 | January 1, 2004 |
| □ Radiology | 10 | January 1, 2002 |
□ Surgery
| 10
| January 1, 1997
|
Table 4
Certificate Time-Limiting by the American Osteopathic Boards
| American Osteopathic Board of | Certificate Time Limit, y | Date Specialty Board Implemented Time Limiting |
|---|
| □ Anesthesiology | 10 | January 1, 2002 |
| □ Dermatology | 10 | January 1, 2004 |
| □ Emergency Medicine | 10 | January 1, 1994 |
| □ Family Practice | 8 | March 1, 1997 |
| □ Internal Medicine | 10 | January 1, 1993 |
| □ Neurology and Psychiatry | 10 | January 1, 1996 |
| □ Nuclear Medicine | 10 | January 1, 1995 |
| □ Obstetrics and Gynecology | 6 | January 1, 2003 |
| □ Orthopedic Surgery | 10 | January 1, 1994 |
| □ Neuromusculoskeletal Medicine* | 10 | January 1, 1995 |
| □ Ophthalmology† | 10 | January 1, 2000 |
| □ Otolaryngology-Head and Neck Surgery† | 10 | January 1, 2002 |
| □ Pathology | 10 | January 1, 1995 |
| □ Pediatrics | 7 | January 1, 1995 |
| □ Physical Medicine & Rehabilitation‡ | 10 | January 1, 2004 |
| □ Preventive Medicine | 10 | January 1, 1994 |
| □ Proctology | 10 | January 1, 2004 |
| □ Radiology | 10 | January 1, 2002 |
□ Surgery
| 10
| January 1, 1997
|
×
As many of the early-issued, time-dated certificates are just beginning to expire, in 2003, AOA recertification saw an increase of slightly more than 150% over the number of osteopathic physicians recertified in 2002 (
Table 3). This increase was driven primarily by the first large group of internal medicine specialists and internal medicine subspecialists taking the various recertification examinations provided by the American Osteopathic Board of Internal Medicine. In subsequent years, it is expected that recertification activity through the certifying boards of the AOA will continue to increase as many more of the time-dated certificates continue to expire and as recertification continues to become a requirement for managed care participation/credentialing and obtaining hospital privileges.
Psychometric Assistance
As certification is so consequential, the certification process must be legally justifiable and valid for credentialers to accept it.
Beginning in January 1994, the AOA began providing psychometric services to assist osteopathic medical certifying boards in the validation of their certification examinations. The AOA provides consultation and data analysis services to certifying boards and assists them in creating, scoring, and analyzing their examinations. These services provide psychometric guidance to a board in any step of the examination process, whether for a written, oral, or practical examination.
Standards Review Committee Upholds High Standards of Quality
From the early beginnings of the AOA's certification program, the AOA has been concerned with the quality and standardization of its certifications. In 1992, the AOA Board of Trustees established a policy on uniform standards for all AOA certifying boards for test construction, evaluation, and test use and, in 1995, resolved that the BOS provide for rigorous statistical validation of the examinations of all AOA certifying boards. In 1997, the Guidelines for AOA Certification Examination Standards was formally approved, which describes the psychometric standards that all AOA examinations must meet. From this document, a plan for a formal evaluation process to assess the validity and reliability of each AOA certification examination was devised and, in June 2000, the first official reviews of three AOA certifying boards were conducted. This is an area that certainly brings value to osteopathic certification and those holding it. The review process is in essence a continuous improvement mechanism that in the end benefits not only the certifying board but the current and future diplomates as well.
The format of the certifying board review is a self-study with completion of a report. These reports are then reviewed by the Standards Review Committee, which includes six elected members plus the BOS public member, two alternate members, and the AOA psychometrician (nonvoting). After the first cycle review, each board is reviewed again in 3.5 years. After the second review, the time interval between reviews is 5 years. At each BOS meeting, three certifying boards are reviewed and conjoint examinations are reviewed at the last meeting of the evaluation cycle.
After review of the board's self-study report, the Standards Review Committee may make recommendation of compliance to the BOS, or they may defer making any recommendation at that time. Within 30 days of the Standards Review Committee's evaluation, the certifying board will receive a written evaluation, and examination activities found not in compliance with the standards will be clearly described to the Board. In the first evaluation cycle if the board was not approved by the BOS as compliant, the certifying board has 120 days from the date of the written evaluation to respond in writing with their action plan, specifying how the activities not in compliance will be addressed. For second and later review cycles, the submission of an action plan is not required.
For the first review cycle, at the next committee [D2]meeting, the board's action plan is studied and any comments are forwarded to the certifying board. Usually, the board's action plan is formally accepted at this time or further information from the board may be requested. Within 1 year of the committee's appraisal of the action plan, the board must submit an updated report to the committee with evidence that shows the board is in compliance with the standards.
For second and later review cycles, if any examination activities are found not to be in compliance with the standards, the board must submit an updated report within 1 year of the review date, along with acceptable evidence that shows that all the examination activities are in compliance with the standards. The board must submit its updated report at least 45 days in advance of the meeting when the committee will study it.
The committee will then review the updated report and make a recommendation to the BOS for action. If the BOS action finds the board not in compliance, the BOS may impose a 1-year probation period and the practice affiliate will be notified of the board's probationary status. Certifying board failure to comply with the standards results in a BOS recommendation to the Board of Trustees that the certifying board's directors and/or members may be replaced and certification activities may be suspended until the board demonstrates compliance with the standards. At the end of the probation period, the board must then demonstrate compliance with the standards.
The Committee began meeting in conjunction with the BOS meetings (January and June) starting in June 2000; the second review cycle began in January 2004. Subsequent review cycles start in January 2009 and occur every 5 years after that. At each meeting, three certifying boards will be reviewed. The schedule for the first and second evaluation is shown in
Figure 2.
In addition to ensuring the validity of the AOA certification process, the BOS is also beginning to explore how to enhance the certification process through incorporation of the seven core competencies into the process. The seven core competencies, already espoused by AOA-approved residency programs, are, and will be items of discussion at near future BOS leadership meetings.
AOA Board of Trustees Establishes Task Force on Certification
In October 2002, the AOA Board of Trustees created a Task Force on Certification to review the overall operational structure of the AOA's certification program and to study future trends that may impact or change the certification process and demand. The Task Force on Certification will continue working closely with the AOA BOS on determining future steps to safeguard and promote AOA certification. Additionally, the task force will begin transitioning its functions to the newly created BOS Committee on Financial and Administrative Board Matters, which will monitor existing and upcoming certification trends in the osteopathic profession.
Board of Trustees Approves New Certification Pathway for Accreditation Council for Graduate Medical Education–Trained/American Board of Medical Specialties Board–Certified Osteopathic Physicians
In July 2004, the AOA Board of Trustees approved a new certification pathway that provides a more streamlined and facilitative process for Accreditation Council for Graduate Medical Education (ACGME-) trained/American Board of Medical Specialties (ABMS-) board-certified osteopathic physicians to enter into the AOA certification process. To be eligible, candidates must have completed an ACGME residency program at least 5 years before application and hold ABMS certification in a primary specialty. The pathway is for AOA certification only and does not confer approval of first year of training as equivalent to an osteopathic internship (provided through Resolution 42(A/2000). For complete requirements and eligibility information, and to determine whether a particular specialty participates in this new pathway, inquiries can be referred to the AOA Division of Certification at (800) 621-1773, extension 8266 or 8105.
Board Certification: Dynamic and Ever-Changing
As the needs of the health care environment continue to rapidly change, the AOA and its specialty boards will continue to adapt to meet the needs of the osteopathic physician and to protect the interests of the public. Board certification no doubt will continue to play a key role in the professional lives of osteopathic physicians well into the future.