JAOA • Vol 106 • No 2 • February 2006 • 77-84
Board Certification of Osteopathic Physicians
Armando F. Ramirez, BS, CAE
From the Division of Certification, Department of Education, American
Osteopathic Association, Chicago, Ill.
Address correspondence to Armando F. Ramirez, Department of Education,
American Osteopathic Association, 142 E. Ontario St, Chicago, IL 60611-2864.
E-mail:
aramirez{at}osteopathic.org
As managed care's role in the healthcare industry has grown in recent
years, the importance of board certification in the professional lives of
physicians has also grown. Most managed care organizations require board
certification for physicians participating in their plans. Increasingly,
hospitals are also making board certification a prerequisite to obtain staff
privileges. Many physicians, of course, continue to become certified 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 propelling more and more
physicians to begin the process of certification.
The public's perspective of board certification continues to play a role in
certification's importance. As patients become more knowledgeable and
sophisticated about their treatment options, they increasingly view board
certification as a sign of physician quality and competence. The educated
consumer of healthcare prefers to be treated by board-certified physicians.
Thus, board certification, though a voluntary process, has become an
indispensable designation for many physicians.
 |
The AOA Certification Program
|
|---|
The American Osteopathic Association's (AOA) board certification program
began in 1939. The official AOA 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 28,100 General, Special Qualifications, and Added Qualifications
certifications (Figure
1).
As of the end of December 2005, a total of 19,837 osteopathic physicians
were actively certified by the AOA, holding a combined total of 23,016 active
certificates. In 2005, a total of 1002 certificates were awarded in specialty
and subspecialty areas (Table
1). Also in 2005, 35 certificates of added
qualifications were awarded
(Table
2).
View this table:
[in this window]
[in a new window]
|
Table 2 American Osteopathic Association Certification of Added Qualifications
2001 Through 2005 by Specialty
Board*
|
|
|
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, which
may differ from board to board, may include the completion of a specific
amount and type of continuing medical education (CME) credit before physicians
are allowed to sit for certification examination. This process does not
re-establish board eligibility status, but it does allow physicians to meet
the requirements for sitting for certification examinations.
|
Conjoint Examinations
|
|---|
In July 1993, the AOA Board of Trustees directed the AOA executive
director, in conjunction with the BOS, 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 BOS 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, the BOS recommended that a mechanism be
formed for creating conjoint examinations that would allow all appropriate
specialty boards to participate. 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
examinations. Currently, three conjoint examinations are offered (sports
medicine, addiction medicine, and dermatopathology).
|
Recertification Gains Momentum
|
|---|
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.) By January 1, 2004, those 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 time-limit requirement are
valid for life. All diplomates are eligible to sit for recertification
examinations, even if they hold a lifetime certificate.
Figure 2 summarizes
the current status of time limits on the certificates issued by AOA certifying
boards.
View larger version (62K):
[in this window]
[in a new window]
|
Figure 2. Current time limits on certificates issued by American Osteopathic
Association certifying boards.
|
|
American Osteopathic Association recertification rates continue to rise as
many of the initial time-dated certifications expire
(Table
3). In 2005, there was a 72% increase in the
recertification rate compared with 2004. This increase was driven primarily by
family practitioners recertifying through the American Osteopathic Board of
Family Physicians, as well as by internal medicine specialists and
subspecialists taking the various recertification examinations provided by the
American Osteopathic Board of Internal Medicine. Certain other specialties,
including orthopedic surgery, are also beginning to see rising recertification
rates. It is expected that recertification activity through the certifying
boards of the AOA will continue to increase as more of the time-dated
certificates expire and as recertification becomes a more widespread
requirement for managed care participation/credentialing and obtaining
hospital privileges.
|
Psychometric Assistance
|
|---|
Because certification is so consequential, the certification process must
be legally justifiable and valid for credentialers to accept it. 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 all
steps of the examination process, including written, oral, and practical
examinations.
|
Standards Review Committee
|
|---|
From the 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 use. In 1995, the
Board of Trustees resolved that the BOS provide for rigorous statistical
validation of the examinations of all AOA certifying boards. In 1997, formal
approval was granted to the Guidelines for AOA Certification Examination
Standards, which describe 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 review process brings value to osteopathic
certification and to those holding it. The process is in essence a continuous
improvement mechanism that 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 
years. After the
second review, the time interval between reviews is 5 years. At each BOS
meeting, three certifying boards are reviewed. Conjoint examinations are
reviewed at the last meeting of the evaluation cycle.
After review of the certifying board's self-study report, the Standards
Review Committee may make recommendation of compliance to the BOS, or the
committee 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 certifying board was not approved by the BOS as compliant, the
board has 120 days from the date of the written evaluation to respond in
writing with its action plan, specifying how the activities not in compliance
will be addressed. For the second and later review cycles, the submission of
an action plan is not required.
For the first review cycle, at the next meeting of the Standards Review
Committee, the certifying board's action plan is studied, and any comments are
forwarded to the board. In most cases, the board's action plan is formally
accepted at this time, but in some cases, further information from the board
may be requested. Within 1 year of the Standards Review Committee's appraisal
of the action plan, the certifying board must submit an updated report to the
committee with evidence that the board is in compliance with the
standards.
For the second and later review cycles, if any examination activities are
found not in compliance with the standards, the certifying board must submit
an updated report within 1 year of the review date, along with acceptable
evidence showing 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 in which the Standards Review Committee will study
it.
The Standards Review Committee will review the updated report and make a
recommendation to the BOS for action. If the BOS finds the certifying 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. The
failure of the certifying board 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 that certification activities may be
suspended until the board demonstrates compliance with the standards. At the
end of the probation period, the board must demonstrate compliance with the
standards.
The Standards Review Committee began meeting in conjunction with the BOS
meetings (held in January and June) in June 2000. The second review cycle
began in January 2004. Subsequent review cycles start in January 2009 and will
occur every 5 years after that. The schedule for the first and second review
cycles is shown in Figure
3.
|
Evolution of the Osteopathic Recertification Process
|
|---|
Ensuring the validity of the BOS board examinations through its standards
review process is only one initiative that the BOS has taken to better assess
the competence of board-certified physicians. In January 2005, the BOS adopted
a resolution mandating that each specialty include the seven core competencies
(interpersonal and communication skills; medical knowledge; osteopathic
philosophy and osteopathic manipulative medicine; patient care; practice-based
learning and improvement; professionalism; and system-based practice) in its
board examination process. These are the same competencies that have
previously been adopted at the training level in osteopathic residency
programs. The process to test core competencies, under the guidance and
support of the BOS, will vary according to the specific needs of each
specialty board.
In addition to testing core competencies, the BOS continues to evaluate the
concept of continuous assessment of physician competence. The BOS has reviewed
the allopathic model of maintenance of certification (MOC) and considers it to
be one of several possible models to maintain the high competency levels of
osteopathic physicians. The BOS is also considering its own continuous
assessment model as a way to better fit the needs of the osteopathic medical
profession and as a response to public and government calls for improved
patient care. It should be noted that many of the elements of MOC, including
professional standing, required CME, and cognitive examination, are part of
the osteopathic recertification process currently in place. The method by
which continuous assessments will be made will be decided in the near
future.
The commitment of the BOS to assess continued competence of board-certified
physicians is clear. It is this commitment that is guiding the BOS to create
an assessment process that fulfills its function to protect the public and
promote the continued competence of board-certified osteopathic physicians to
deliver quality care.
|
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 worked
closely with the BOS on determining future steps to safeguard and promote AOA
certification. The task force transferred 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 medical
profession.
|
New Certification Pathway for ACGME-Trained/ABMS 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
osteopathic physicians trained by the Accreditation Council for Graduate
Medical Education (ACGME) and certified by the American Board of Medical
Specialties (ABMS) to enter into the AOA certification process. To be
eligible, candidates must have completed an ACGME-accredited 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 the 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 healthcare environment continue to change rapidly, the
AOA and its specialty boards will keep adapting to meet the needs of
osteopathic physicians and 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.
This article has been cited by other articles:
|
|
|
|
 
S. C. Shannon
Osteopathic Medical Education in 2006: Charting a Course for the Future
J Am Osteopath Assoc,
February 1, 2006;
106(2):
48 - 49.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. J. Rodgers
Osteopathic Continuing Medical Education
J Am Osteopath Assoc,
February 1, 2006;
106(2):
85 - 95.
[Full Text]
[PDF]
|
|
|
Top
The AOA Certification Program
Reentry Into the Certification...
