Physician Recertifications Adding to Early Retirement?

Physicians are inching closer to retirement at the same time the country’s aging population greatly needs care, which will likely lead to shortages. But some would argue that the burdens of board recertification are forcing older clinicians to consider leaving their careers early.

“Board recertification is most definitely a disincentive for people to stay in practice,” said Gail Gazelle, M.D., FACP, FAAHPM, a life and career coach for physicians and nurses and assistant clinical professor of medicine at Harvard Medical School in Boston, who likely will leave clinical care at age 62 rather than recertify again. “This is particularly true for the primary care disciplines where we are facing a precipitous shortage of docs in the next decade.”

More than one-third of the 744,000 physicians practicing medicine in the United States are age 55 and older, according to the Association of American Medical Colleges, which anticipates the number of retirees will increase to 23,000 annually by 2025.

“A frightening proportion of our physicians are older than 55, and we cannot afford to lose them,” said internist Jane Orient, M.D., in Tucson, Ariz., executive director of the Association of American Physicians and Surgeons. “We’re having a huge bulge in elderly patients fixing to retire, and due to their age, [they] are going to have more medical needs. Who is going to take care of them?”

Prior to 1990, internal medicine specialists received time-unlimited certification. Now, certification is good for 10 years. The American Board of Internal Medicine (ABIM) indicates that maintenance of certification is needed because knowledge deteriorates, practice habits fail to change, and the public expects physicians to demonstrate continued competence. All of the participating organizations in the American Boards of Medical Societies have since adopted maintenance of certification requirements.

A survey commissioned by the American Board of Medical Specialties found that 95 percent of Americans considered it important that their doctors participate in a program to maintain their board certification, with 45 percent indicating they would look for a new doctor if they learned theirs was not participating in such a program, and 41 percent would stop referring family and friends to that doctor.

In addition to many patients seeking certified providers, some hospitals and health plans require their participating physicians to be board certified.

Gazelle described the internal medicine recertification process as grueling. She studied and prepared for more than a year.

“The exam was about all of the esoteric, what we call ‘zebra diseases,’ which we learn about in medical school and never see,” Gazelle said. “It was like a return to medical school.”

Gazelle agreed that it is important for physicians to keep up with current changes in internal medicine, but she does not feel it’s relevant to require physicians to study rare diseases they do not treat in their practice.

“Most physicians don’t use a huge amount of the information that has to be on the test,” Orient added. “It would serve the patients better by focusing on things they might actually need to know.”

Maintenance of certification requires the physician to pass a certification exam and earn 100 self-evaluation points by taking exams on various topics. Costs run into the thousands of dollars.

A New England Journal of Medicine poll conducted in March 2010 found that 63 percent of the 2,512 respondents recommended not enrolling in the current maintenance of certification programs. Many of the physicians commenting on the study said they felt the cost of recertification outweighed the educational benefit, that the program was a money-making activity for the ABIM, and that the exercise was only marginally relevant to their practice. Others said doctors should be held to the same standard and demonstrate their medical knowledge is up to date.

A random survey of 100 members of the Association of American Physicians and Surgeons in 2009 found that of 37 physicians who had been recertified only 11 thought the process improved his or her performance and only eight said they would voluntarily participate again.

Orient said that she thinks there are financial motives associated with recertification, and control issues about what a physician has to know and what constitutes acceptable practice.

“We have a bunch of self-appointed experts deciding what everyone else is supposed to know, and they have a lot of conflicts of interest and no way of knowing what the doctors they are examining are confronting in their day-to-day practices,” Orient said.

However, many physicians are investing the time and money in recertification activities. Lorie Slass, vice president of communications for the American Board of Internal Medicine, reports that more than 80 percent of physicians recertify in at least one of their certifications. In some, such as cardiology, she explained, the physician need only recertify in the subspecialty, not internal medicine.

The American Board of Family Medicine reported in May/June 2011 that 91 percent of its board-certified physicians are participating in the board’s Maintenance of Certification for Family Physicians program.

Mary Pat Cornett, senior director of education and meetings for the American Academy of Otolaryngology – Head and Neck Surgery, said the academy considers maintenance of certification a formalized process for the lifelong learning education, self-assessment and continuous improvement that otolaryngologists already actively engage in and reported that is consistent with the academy’s mission to empower its surgeons to deliver the best patient care.

Orient does not see a need for certification to expire. She said physicians take courses all of the time to stay current and best serve their patient populations.

“We don’t see that lawyers need to retake the bar exam every 10 years or that engineers need to retake a basic exam every 10 years,” Orient said. “I think doctors should refuse to do it, if they feel it is not worthwhile. If doctors say this is nonsense and I’m not going to do it, what are these folks going to do?”