HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ramirez, A. F. Articles by Bell, E. C. Search for Related Content PubMed PubMed Citation Articles by Ramirez, A. F. Articles by Bell, E. C.

From the Division of Certification and Trainee Services, Department of Education, American Osteopathic Association, Chicago, Ill.

Address correspondence to Armando F. Ramirez, BS, CAE, Department of Education, American Osteopathic Association, 142 E Ontario St, Chicago, IL 60611-2864 E-mail: aramirez{at}osteopathic.org

Specialty board certification, though voluntary, has become an indispensable designation for many osteopathic physicians. The authors report rates of osteopathic specialty board certification and recertification for osteopathic physicians. In the past year, osteopathic specialty boards have proposed conjoint examinations in hospice and palliative medicine as well as in sleep medicine. Plans for the addition of a new conjoint examination for undersea and hyperbaric medicine are also described. As the healthcare environment continues to evolve, the American Osteopathic Association, the Bureau of Osteopathic Specialists, and the 18 osteopathic specialty boards continue to adapt to meet the professional needs of osteopathic physicians.

The public's perspective of specialty board certification also plays a role in physicians' perceptions of the importance of this credentialing opportunity. As patients become more knowledgeable and sophisticated about their treatment options, they increasingly view board certification as a sign of physician quality and competence.⁸ The educated healthcare consumer often prefers to be treated by board-certified physicians.¹ Thus, board certification, though a voluntary process, may be perceived by many physicians as an indispensable designation.

	Osteopathic Specialty Board Certification

Top Osteopathic Specialty Board... Conjoint Examinations Conclusion Appendix References

 
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).⁹

View larger version (70K): [in this window] [in a new window]   Figure. American Osteopathic Association (AOA) terminology for osteopathic specialty board certification (Resolution 58 [M/1994]—Clarification of Terminology for AOA Specialty Certification).9 *General certification was formerly called primary certification. Certification of special qualifications was formerly called secondary certification. Certification of added qualifications (CAQ) was formerly called a certificate of added qualifications.

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:

• uniform standards for all osteopathic specialty boards for test construction, evaluation, and use (Resolution 284 [A/1992]—American Osteopathic Association Certifying Boards–Uniform Standards, and Resolution 19 [A/1995]—Bureau of Osteopathic Specialists)
  
• psychometric services to assist member boards in the creation, validation, scoring, and analysis of their certification examinations whether those examinations are written, oral, or practical (Resolution 37 [A/1995]—Components of Bureau of Osteopathic Specialists Plan)
  
• rigorous statistical validation must be provided by the BOS for all examinations administered by each of its member boards (Resolution 37 [A/1995]—Components of Bureau of Osteopathic Specialists Plan)
  
• continuous improvement mechanism built into the program with the formal approval of "Guidelines for AOA Certification Exam Standards,"¹⁰ which describes the psychometric standards (ie, validity and reliability) that all osteopathic specialty board examinations must meet (Resolution 284 [A/1992]—American Osteopathic Association Certifying Boards–Uniform Standards, and Resolution 19 [A/1995]—Bureau of Osteopathic Specialists)
  
• an established osteopathic certification pathway for osteopathic physicians who meet one of the following three conditions: (1) have received training at institutions accredited by the Accreditation Council for Graduate Medical Education (ACGME), (2) were awarded specialty board certification from a member board of the American Board of Medical Specialties (ABMS), or (3) both (Resolution 56 [A/2004]—Proposed Amendments to the Handbook of the Bureau of Osteopathic Specialists)¹¹
  
• official reviews of osteopathic specialty boards were launched in June 2000 using a self-study model that culminates in a report designed for review by the BOS' Standards Review Committee (Appendix, page 125)
  
• inclusion of the seven core competencies in board examination processes (interpersonal and communication skills, medical knowledge, osteopathic philosophy and osteopathic manipulative medicine, patient care, practice-based learning and improvement, professionalism, and system-based practice)¹²
  
• ongoing evaluation of various models for continuous assessment of physician competence^12-14
  

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 2006.¹²

Osteopathic physicians whose certification eligibility has expired¹⁸ 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:

• re-entry does not re-establish board eligibility status once lost
  
• re-entry may include specific continuing medical education credit requirements,¹⁹
  
• re-entry allows osteopathic physicians who are AOA members and who have met any continuing medical education requirements to sit for certification examinations
  

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.⁷

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.

	Conjoint Examinations

Top Osteopathic Specialty Board... Conjoint Examinations Conclusion Appendix References

 
As a result of a 1993 application from the American Osteopathic Academy of Sports Medicine to form a board of sports medicine, the AOA executive director, in conjunction with the BOS, was instead directed to promote the formation of conjoint examinations in areas of overlapping specialties (Resolution 56 [M/1994]—Proposed Mechanism for Creation of a Conjoint Examination in Sports Medicine). These examinations allow for the cooperation of all appropriate specialty boards, the general adaptability of the profession, and the ongoing relevance of the certification process to osteopathic physicians.

Member boards participating in a conjoint committee are required to meet the same rigorous standards for their examination processes as all other certification examinations administered under BOS review. The Standards Review Committee reviews conjoint examinations at the last meeting of each evaluation cycle (Appendix, page 125). Diplomates from participating member boards are eligible to sit for conjoint examinations. Three conjoint examinations are currently offered: addiction medicine, dermatopathology, and sports medicine.

In the past year, two new conjoint examinations have been proposed. The first of these was in response to the American Board of Hospice and Palliative Medicine and the American Board of Sleep Medicine standalone certification examination programs being absorbed by member boards of the ABMS.^20,21 As a result of this change, only physicians holding one of the following credentials would be eligible to take the examination in hospice and palliative medicine or in sleep medicine through ABMS member boards: (1) allopathic specialty board certification through an ABMS member board, (2) ACGME training, or (3) both. Osteopathic leadership²¹ quickly responded to this change by proposing the creation of conjoint osteopathic examinations in these two specialty areas (Resolution 43 [M/2007]—Approval of CAQ Jurisdiction in Hospice and Palliative Medicine/Conjoint Exam Process, and Resolution 44 [M/2007]—Approval of CAQ Jurisdiction in Sleep Medicine/Conjoint Exam Process). In February 2007, the AOA Board of Trustees subsequently approved CAQ in hospice and palliative medicine as well as CAQ in sleep medicine with conjoint committees comprised of the following three osteopathic specialty boards:

• American Osteopathic Board of Family Physicians
  
• American Osteopathic Board of Internal Medicine
  
• American Osteopathic Board of Neurology and Psychiatry
  

Conjoint examinations through these AOA member boards will provide an avenue to osteopathic physicians that meet AOA certification requirements for those two specialties.

In addition, a conjoint examination in undersea and hyperbaric medicine is also under development by the following member boards (Resolution 46 [M/2007]—Approval of CAQ Jurisdiction in Undersea and Hyperbaric Medicine/Conjoint Exam Process):

• American Osteopathic Board of Emergency Medicine
  
• American Osteopathic Board of Family Physicians
  
• American Osteopathic Board of Internal Medicine
  
• American Osteopathic Board of Preventive Medicine
  

Once this conjoint committee has finalized its examination, the new test will be evaluated by the Standards Review Committee.

	Conclusion

Top Osteopathic Specialty Board... Conjoint Examinations Conclusion Appendix References

 
The healthcare environment and the regulatory landscape continue to evolve, further sharpening the focus of the medical profession on the provision of quality care and patient safety. The AOA and its osteopathic specialty boards continue to adapt to meet the professional needs of all osteopathic physicians, whether they serve in areas that are traditional strongholds for osteopathic medicine, such as family practice and internal medicine,²² or in emerging medical specialties, such as hospice and palliative medicine or sleep medicine.

	Appendix

Top Osteopathic Specialty Board... Conjoint Examinations Conclusion Appendix References

 
The schedule for the first three Standards Review Committee (SRC) evaluation cycles is shown below. The SRC includes six elected members and a BOS public member as well as two alternate members. In addition there is a nonvoting position for the AOA's psychometrician. In conjunction with the Bureau of Osteopathic Specialists, which meets each January and June, the SRC began meeting in June 2000. Three specialty boards are reviewed at each SRC meeting. Conjoint examinations are reviewed at the last meeting of the evaluation cycle. After the first cycle review, each board is reviewed again in 3.5 years. The second evaluation cycle began in January 2004. Subsequent evaluation cycles start in January 2009 and will occur every 5 years thereafter.

After review of the specialty board's self-study report, the Standards Review Committee may make a recommendation of compliance to the BOS—or the Committee may defer making any recommendation at that time. Within 30 days of the SRC's evaluation, the specialty board will receive a written evaluation. Examination activities found not in compliance with BOS standards will be clearly described to the board by the SRC.

During the first evaluation cycle, if the specialty board was not approved by the BOS as compliant, the board had 120 days from the date of the written evaluation to respond in writing with its action plan, specifying how the activities not in compliance would be addressed. (For the subsequent evaluation cycles, the resubmission of that action plan was not required.) The specialty board's action plan was studied at the next SRC meeting, and any comments were returned to the board. In most cases, the board's action plan was formally accepted by the SRC. However, in some cases, further information was requested from the specialty board. Within 1 year of SRC action plan appraisal, the specialty board must submit an updated report to the Committee with evidence of standards compliance.

For subsequent evaluation cycles, specialty boards with noncompliant examination activities must submit an updated report within 1 year of noncompliance review notice, along with acceptable evidence showing that all the examination activities have been corrected for standards compliance. This updated report must be submitted at least 45 days in advance of SRC review.

When the SRC reviews the updated report and makes a recommendation to the BOS for action, it may recommend the imposition of a 1-year probation period with the corresponding specialty college to be notified of the board's probationary status if the specialty board is not in compliance. The failure of the specialty board to comply with the standards results in a BOS recommendation to the AOA's BOT that the specialty board's directors and/or members be replaced and that certification activities 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.

Submitted February 1, 2007; accepted February 1, 2007.

	References

Top Osteopathic Specialty Board... Conjoint Examinations Conclusion Appendix References

 
1. Brennan TA, Horwitz RI, Duffy FD, Cassel CK, Goode LD, Lipner RS. The role of physician specialty board certification status in the quality movement. JAMA.2004; 292:1038 -1043.[Abstract/Free Full Text]

2. The importance of board certification: higher standards lead to better care page. American Board of Medical Specialties Web site. Available at: http://www.abms.org/Who_We_Help/Consumers/importance.aspx. Accessed March 2, 2007.

3. Kinchen KS, Cooper LA, Levine D, Wang NY, Powe NR. Referral of patients to specialists: factors affecting choice of specialist by primary care physicians. Ann Fam Med. May-Jun 2004;2:245-252. Available at: http://www.annfammed.org/cgi/content/full/2/3/245. Accessed March 2, 2007.

4. Levin JL, Pizzino JL. What is a specialist? The role of board certification in occupational medicine [review]. Environ Res. October 1992;59:132-138. Available at: http://www.sciencedirect.com/. Accessed March 2, 2007.

5. Freed GL, Singer D, Lakhani I, Wheeler JR, Stockman JA III; Research Advisory Committee of the American Board of Pediatrics. Use of board certification and recertification of pediatricians in health plan credentialing policies. JAMA. 2006;295:913-918. Available at: http://jama.ama-assn.org/cgi/content/full/295/8/913. Accessed March 2, 2007.

6. American College of Obstetricians and Gynecologists, for the American Medical Association. Resolution 708 [A/2001]—Physician Privileges Application – Timely Review by Managed Care [AMA House of Delegates resolution]. Available at: http://www.ama-assn.org/ama/upload/mm/hod_g708_doc.doc. Accessed March 2, 2007.

7. Freed GL, Uren RL, Hudson EJ, Lakhani I, Wheeler JR, Stockman JA III; Research Advisory Committee of the American Board of Pediatrics. Policies and practices related to the role of board certification and recertification of pediatricians in hospital privileging. JAMA. 2006;295:905-912. Available at: http://jama.ama-assn.org/cgi/content/full/295/8/905. Accessed March 2, 2007.

8. Specialty board certification. August 10, 2005. eMedicineHealth [serial online]. Available at: http://www.emedicinehealth.com/doctors_specialties_and_training/page6_em.htm. Accessed March 2, 2007.

9. Division of Postdoctoral Training. Osteopathic graduate medical education. J Am Osteopath Assoc.1994; 94:938 -948.[Medline]

10. Bureau of Osteopathic Specialists Standards Review Committee. Guidelines for AOA Certification Exam Standards [appendix]. July 1997. In: Wickless L, Field B, McDevitt F, Thomas G; Certification Task Force. Final Certification Task Force Report. American Osteopathic Association: Chicago, Ill; 2003:42 -51.

11. Division of Certification. Resolution 56: Certification Eligibility for ABMS-Certified DOs. American Osteopathic Association; Chicago, Ill; Available at: https://www.do-online.org/pdf/crt_res56abmscert.pdf. Accessed April 17, 2007.

12. Ramirez AF. Board certification of osteopathic physicians. J Am Osteopath Assoc. 2006;106:77-84. Available at: http://www.jaoa.org/cgi/content/full/106/2/77. Accessed February 27, 2007.

13. Maintenance of Certification (MOC) page. American Board of Medical Specialties Web site. Available at: http://www.abms.org/About_Board_Certification/MOC.aspx. Accessed March 2, 2007.

14. Continuous Certification in Emergency Medicine page. American Osteopathic Board of Emergency Medicine Web site. Available at: http://www.aobem.org/continuous.htm. Accessed April 17, 2007.

15. Ramirez AF, Dolan S. Certification of osteopathic physicians. J Am Osteopath Assoc. 2003;103:523-530. Available at: http://www.jaoa.org/cgi/reprint/103/11/523. Accessed March 2, 2007.

16. Ramirez AF. Board certification of osteopathic physicians [published correction appears in J Am Osteopath Assoc. 2006;106:46]. J Am Osteopath Assoc. 2004;104:485-492. Available at: http://www.jaoa.org/cgi/content/full/104/11/485. Accessed March 2, 2007.

17. Ramirez AF, Dolan S. Certification of osteopathic physicians. J Am Osteopath Assoc. 2000;100:691-695. Available at: http://www.jaoa.org/cgi/reprint/100/11/691. Accessed March 14, 2007.

18. Board Eligibility Status page. DO-Online.org Web site. Available at: https://www.do-online.org/index.cfm?PageID=crt_brdeligible. Accessed April 19, 2007.

19. Rodgers DJ. Osteopathic continuing medical education. J Am Osteopath Assoc. 2007;107:67-81. Available at: http://www.jaoa.org/cgi/content/full/107/2/67. Accessed April 19, 2007.

20. American Board of Hospice and Palliative Medicine. The transition to an ABMS subspecialty: subspecialty of hospice and palliative medicine now recognized by ABMS and ACGME. Available at: http://www.abhpm.org/gfxc_100.aspx. Accessed March 2, 2007.

21. Nichols KJ. Plans for new conjoint certificate of added qualifications in hospice and palliative medicine [letter]. J Am Osteopath Assoc. 2006;106:5. Available at: http://www.jaoa.org/cgi/content/full/106/1/5-a. Accessed March 2, 2007.

22. Allen TW, ed. Statistical tables on the osteopathic profession: distribution of DOs by specialty and age—excluding interns and residents. 1988-1989 Yearbook and Directory of Osteopathic Physicians. 80th ed. American Osteopathic Association: Chicago, Ill: 1988: 508-509.

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ramirez, A. F. Articles by Bell, E. C. Search for Related Content PubMed PubMed Citation Articles by Ramirez, A. F. Articles by Bell, E. C.