Between 1969 and 1999, virtually every major specialty switched from lifetime certificates to time-limited certificates, conforming to policy of the American Board of Medical Specialties. The rational for recertification was to reassure the public that the specialist was fully qualified to practice the specialty today, not 10 or 20 years ago. In May 1999, the American Board of Neurological Surgery (ABNS) tested the first cohort of neurosurgeons for time-limited certificates. To maintain Board certification, these and future Board diplomates will be required to pass another examination and meet other as yet incompletely-defined CME and practice outcome criteria.
Transition to Recertification
The transition to time-limited certificates completes a chapter in neurosurgical credentialing in which the specialty clung to rigorous traditional training and knowledge-testing standards. At the same time it opens a new chapter, in which the specialty accepts the responsibility to verify for public benefit, not only initial training and knowledge, but something more important from a public perspective: the continuing competence of the specialists certified by the Board. If certification is to satisfy the public interest, it must certify current competence, which is the public demand.
The transition to recertification, now termed maintenance of certification, has sparked a predictable reaction among those neurosurgeons subject to the new rules. Most worrisome among residents, new graduates and new diplomates is the fear that by failing an exam in the future, they could arbitrarily, and without appeal, lose the ability to practice their chosen profession in the midst of an otherwise entirely successful career. They question the ability of the testing and evaluation format to truly measure their skill and knowledge. They worry about the time and stress necessary to study and prepare for the new examination. They wonder about the availability and effectiveness of continuing education opportunities to prepare for the renewal examination. And they question the fairness of recent graduates being subject to the new rules, while older diplomates, “grandfathered in” under the technicality of a time-unlimited certificate, and perhaps more in need of testing for competence in newer science and techniques, escape the strain, risk and discipline imposed by the new Board policy.
The ABNS has recognized both the need to convert to time-limited certificates, and more recently, the need to communicate with its current and future members about the demands and conflicts it faces, what options it is considering, what decisions it has made and why those actions are justified. Steven Giannotta, MD, Chairman of the ABNS, presented a detailed explanation of recertification to both the CSNS Young Physicians Committee and the AANS Young Neurosurgeons Section at the AANS Annual Meeting in April in Toronto. The cover story of this issue is devoted to the issue of neurosurgical recertification and the ABNS’ ideas and plans. The young neurosurgeons of the Council of State Neurosurgical Societies (CSNS), concerned about recertification, passed a resolution in Toronto requesting the ABNS “consider appointing a liaison to the ABNS who has received board certification subsequent to May 1999.” This openness and opportunity for communication should go a long way to allay fears among members over whether the final decisions about testing include the perspective of those whom the policy affects, satisfying both their needs as well as the profession’s public responsibility.
Benefits of Recertification
Recertification as a policy juxtaposes the interests of patients in contrast with those of neurosurgeons and paradoxically exposes both joint benefit as well as conflicting interests. Neurosurgeons benefit from the exclusive status conferred by the certificate and the access to licensing, contracting, reputation and practice it confers. That benefit comes with the risk,, however, that failing the recertification requirements, their privileges and livelihood may be imperiled or lost.
The public benefits from the assurance that certified neurosurgeons pass minimal professional standards and patients can feel safe in their care. The assurance of competence, however, is not a guarantee of perfect result and cannot imply a warranty either of the performance of the neurosurgeons certified by the Board or against the unpredictability of disease.
So overwhelmingly has specialty recertification been adopted by specialty boards, that it is no longer optional or avoidable. Our professional responsibility to the public is to see that we make the transition in education and testing in a way that most effectively achieves the stated goal of publicly demonstrated maintenance of competence. Our professional obligation to our members is to make the process of recertification fair and relevant to practice. Although late, we are well on our way to achieving the goal.
James R. Bean, MD, is Associate Editor of the AANS Bulletin and a neurosurgeon in private practice in Lexington, Kentucky.