The American Osteopathic Association's (AOA) specialty board certification program began in 1939. The official AOA certifying body, the Bureau of Osteopathic Specialists (BOS), through its 18 approved specialty boards, has issued almost 30,000 general, special, and added qualifications certificates to osteopathic physicians in the United States (
Figure).
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Specialty board certification must be legally defensible and valid in order for credentialers to accept it. The AOA and the BOS have had an ongoing commitment to ensuring the quality and standards of osteopathic specialty board certifications, establishing policies that will ensure the following:
The AOA has a commitment to assessing the competence of osteopathic specialty-board–certified physicians for the protection of patients. This commitment has lead the BOS to create an assessment process that fulfills its function to promote the continued competence of these physicians in delivering quality patient care.
In January 1993, the American Osteopathic Board of Internal Medicine independently elected to begin issuing time-limited certificates to physicians seeking certification.
12,15 The American Osteopathic Board of Internal Medicine took this step before the BOS mandated this change for all member boards effective January 1, 2004, when the American Osteopathic Board of Obstetrics and Gynecology, the American Osteopathic Board of Physical Medicine and Rehabilitation, and the American Osteopathic Board of Proctology joined the other 15 member boards in time-limiting specialty certificates—and keeping pace with evolving industry standards.
1,12-15 With the exception of the American Osteopathic Board of Family Physicians, the American Osteopathic Board of Obstetrics and Gynecology, and the American Osteopathic Board of Pediatrics, who have set their certification time limits to 8, 6, and 7 years, respectively, all other member boards have a 10-year time limit on specialty certificates issued.
12,16 Certificates issued before the time-limit requirement was instituted, however, are valid for the life of the physician.
As of December 31, 2006, a total of 20,659 practicing osteopathic physicians were board certified by the AOA, an increase of 4% on the previous year's total of 19,837.
12 These physicians hold a combined total of 23,824 active certificates, a 3.5% increase from the 2005 year-end total of 23,016.
12 In 2006, a total of 1308 certificates were awarded in specialty and subspecialty areas (
Table 1), reflecting an increase of 30.4% on the previous year's total of 1003 [corrected from 1002]. The largest area of growth in physician certification was in certifications of added qualifications (CAQs) (
Table 2), where the total number of certifications awarded more than doubled, from 35 CAQs in 2005 to 89 CAQs during 2006.
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Osteopathic physicians whose certification eligibility has expired
18 have a formal mechanism for re-entry into the certification process (Resolution 61 [M/1994]—Deadline for Establishment of Mechanism for Reentry into the Osteopathic Certification Process). Although the re-entry process differs among the 18 member boards, there are a few commonalities:
All diplomates meeting board-specified conditions are eligible to sit for recertification examinations, even if they hold life-time certificates.
In 2006, recertification rates among osteopathic physicians continued to increase as the first round of time-limited certificates reach their expiration dates (
Table 3). In 2006, a total of 823 osteopathic physicians were awarded recertification, a 68% increase on the 491 physicians recertified in 2005.
12 This increase was driven primarily by family physicians who recertified through the American Osteopathic Board of Family Physicians as well as by internal medicine specialists and subspecialists who took the various recertification examinations provided by the American Osteopathic Board of Internal Medicine.
Similarly, the number of osteopathic emergency medicine physicians seeking recertification in 2006 through the American Osteopathic Board of Emergency Medicine more than doubled when compared with data reported for 2005 (63 vs 29).
12 It is expected that recertification activity through AOA member boards will continue to increase as existing certificates expire and as recertification continues to be a requirement for managed care participation
5,6 and physician acquisition of hospital privileges.
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The recertification process in the osteopathic medical profession is also developing in conjunction with evolving industry standards,
1,13 moving toward assessing physician competence on a continuous basis rather than at periodic intervals. Discussions among the AOA's BOS and its 18 member boards are ongoing.