Almost 80% of internists maintain board certification

Many internists who maintain their certification say they do so to uphold a professional image and to update their medical knowledge. Internists who do not participate say the process takes too much time and is too expensive.

These and other findings of a new study tell internal medicine leaders that many internists value recertification, but that more work needs to be done to refine the process and educate physicians about how it works.

"People have come back [to recertify] because it's a valuable thing for them. They don't seem to be doing it because it's required [for employment]," said lead study author Rebecca Lipner, PhD, vice president of psychometrics for the American Board of Internal Medicine. The ABIM and American College of Physicians collaborated on the study that appears in the Jan. 3 Annals of Internal Medicine.

The groups conducted the national survey to find out what motivates internists to take part in maintenance of certification. They also wanted to understand why 23% of general internists and 40% of subspecialists are not renewing their internal medicine certificate, and to determine why 14% of subspecialists are not renewing their subspecialty or an added qualifications certificate. The results were culled from responses of 1,607 internists originally certified in 1990, 1991 or 1992.

The findings: More than half said they participated in maintenance of certification to update their knowledge and maintain their professional image. About one-third recertified for personal preference or interest, or because it is required for employment. More general internists (42%) than subspecialists (20%) participate in maintenance of certification because it is required for work.

Addressing diplomates' concerns

Two-thirds of surveyed doctors said patients and peers value board-certified physicians more than noncertified physicians and that physicians working in direct patient care should be certified. The most common reasons given for not taking part in maintenance of certification is that it takes too much time, is too expensive and is not required for employment.

The ABIM has heard similar concerns before and used that input from internists to help refine the process. This year, the ABIM is enhancing its program by streamlining requirements, providing flexibility to diplomates and reducing redundancy with other programs. Module counts are being replaced by a point system that creates a flexible self-evaluation process and grants credit for self-assessment tools that other groups, such as the ACP, develop.

"Once they have been through the process, many more of them are likely to say it wasn't too bad and it was relevant to their practice," said ABIM President Christine K. Cassel, MD.

Steven E. Weinberger, MD, ACP's senior vice president for medical knowledge and education, said concerns from ACP members about the recertification process have died down in recent years.

"When you do go through [the process], it does help you and it helps your practice," he said.

Researchers were surprised to find that some surveyed internists reported working in a medical field other than internal medicine. The survey did not explore why that was the case, but future research will look at that issue.

Internal medicine leaders are pleased that most internists are getting recertified.

"We really feel the program will help improve the quality of care of patients and the safety of patients," Dr. Lipner said.