Exploring Certification: Getting Started

Who’s Who?

American Board of Medical Specialties
Since 1933 the American Board of Medical Specialties (ABMS) has established the professional and educational standards for medical specialty practice and certification in partnership with its 24 certifying Member Boards.

American Board of Internal Medicine
The American Board of Internal Medicine (ABIM) is one of the ABMS certifying Member Boards. ABIM governs internal medicine and its 20 subspecialties. The ABIM was founded in 1936, with certification in the subspecialty of rheumatology first offered in 1971. The ABIM is a non-profit, independent evaluation organization. ABIM is accountable to both the medical profession and the public. ABIM is not a membership society.

American Board of Allergy and Immunology
The American Board of Allergy and Immunology (ABAI) is one of the ABMS certifying Member Boards. The ABAI was founded in 1971 and is a conjoint board with the ABIM and the American Board of Pediatrics. The ABAI provides initial certification and MOC for adult and pediatric allergy and immunology and is a non-profit, independent evaluation organization. ABAI is accountable to both the medical profession and the public. ABAI is not a membership society.

American College of Rheumatology
The American College of Rheumatology (ACR) is not an ABMS certifying Member Board. The ACR was founded in 1934 and is a not-for-profit professional membership organization dedicated to advancing the rheumatology subspecialty. As the majority of ACR members participate in the MOC process, the ACR made a commitment to provide rheumatologists with rheumatology specific educational resources needed to navigate the process, prepare for the assessments, and earn MOC points.

Value of Board Certification

All physicians in the United States must be licensed in order to practice medicine, but they are not required to be board certified. A license is issued by the physician’s state medical board. In contrast, board certification is issued by a member board of the ABMS where the requirements go above and beyond licensing requirements. Board certification is a voluntary process and is not mandated by law. However, in many states physician certification is a requirement by payers, employers, and hospitals.

It has been a long-held view that earning and maintaining certification through an ABMS Member Board, demonstrates a physician’s commitment to achieve expertise in a particular medical specialty or subspecialty and to then continually update his or her knowledge during the course of the career.

The guiding principles of ABMS, ABIM, and ABAI all uphold that the achievement of certification indicates the physician has demonstrated that he/she has the clinical judgment, skills, and attitudes essential for the delivery of excellent patient care and public service.

The ACR believes rheumatologists and the public continue to support and value specialty and subspecialty board certification in rheumatology and the College is committed to ensuring the credential is meaningful and relevant.

Background

ABIM began offering certification in the subspecialty of rheumatology in 1971 for diplomates who had already achieved an ABIM certification in internal medicine. In 1990, all certificates for internal medicine and its subspecialties became time-limited requiring recertification every ten years. Over time this process continued to evolve and became known as maintenance of certification (MOC). In 2014, ABIM introduced its most significant changes to the requirements for MOC.

While there has been longstanding confidence in the value of the ABIM initial certification exam in rheumatology; dissatisfaction with the ABIM MOC program has steadily grown. Following the 2014 revisions to MOC, the ACR has taken a very active stance in advocating for MOC reform based upon feedback received from the membership in response to surveys, educational sessions during the Annual Meeting and one-on-one communications. The steps that have been taken by the ACR include written communications with the development of an MOC position statement and face-to-face meetings with ABIM leadership. We have provided a detailed timeline that reviews the steps taken by the ACR to address membership concerns and encourage you to review this.

In September 2016, the ABIM proposed a new assessment consisting of either a 2-year pathway or a 5-year pathway that would be launched in 2018, alongside the 10-year secure MOC examination. ACR sought the community’s feedback on these options. Of the members who responded to the ACR survey, most were not supportive of either pathway expressing that this represented minimal change that did not reflect the current practice of medicine and offered no opportunities for specific identification of knowledge gaps and learning. During an ABIM’s Liaison Committee on Certification and Recertification meeting, 26 societies presented their preference for the two ABIM proposed models. Consistent with direct feedback obtained from the membership survey, the ACR stated neither model was adequate, which was similarly expressed by a total of 17 societies. This membership feedback was also provided directly to Dr. Richard Baron ABIM President and CEO, who was invited to attend the ACR Board Directors meeting in November 2016.

In December 2016, the ABIM announced their plans to move ahead with the development of the 2-year knowledge check-in option. In response to the ABIM’s decision and concern expressed by ACR members, the ACR Board of Directors established an MOC taskforce to examine options regarding MOC.

In pursuing their directive, the ACR taskforce examined the approach to MOC being taken by other member boards within the ABMS. A shared interest in immunologically mediated disease led the ACR taskforce to contact the ABAI to learn more about their MOC program. Of specific interest to the taskforce was the continuous assessment program (CAP) that was launched by ABAI at the beginning of 2018 that is based on recently published medical articles and general knowledge questions. This program appeared to address many of the learning goals directly expressed by ACR members while also providing a meaningful model for rheumatologists to demonstrate continual professional development with the application of evidence-based standards.

Based on taskforce recommendations and further discussion with ABAI and ABIM, the ACR Board of Directors determined that the next appropriate step was to engage the rheumatology community in a discussion related to the future of rheumatology certification (which would include initial certification and MOC). This information would then be used to decide whether a proposal should be submitted to the ABMS to request that rheumatology certification be moved from ABIM to ABAI with the formation of a new combined board of Allergy, Immunology, and Rheumatology.