Whom are the certifying organizations really serving?
March 21, 2015
An American doctor summarized some drama surrounding the American Board of Internal Medicine (ABIM) over at BMJ Blogs. Essentially, doctors have been chafing at ABIM's growing requirements for certification (board certification can be a requirement for employment at certain institutions, such as hospitals). Part of the backlash has been about the financial cost, and in one debate, Dr. Charles Cutler highlights a culture of luxury within the leadership of ABIM (as well as detachment from the practicing physician).
It'll be interesting to see how this story plays out, but for our purposes, there is a question of what obligation ABIM -- as a non-profit whose mission is to "enhance the quality of health care by certifying internists and subspecialists" -- owes to the general public. One interesting statistic is that somewhere between 95% and 98% of physicians eventually pass the certification exam. The public is only told who is or is not certified; we are not told, for example, how many times a physician had to take an exam in order to pass, nor are we told how well a physician tested. The theory is that any doctor that becomes certified is qualified to treat patients, and therefore patients do not need any further information -- that theory is not very reassuring for patients who have experienced a seemingly wide range of outcomes when visiting different doctors. Given that ABIM goes through all of this trouble to test doctors, it would be helpful for them to parlay the results into some more meaningful signals for patients. A previous chairman, for example, written about releasing actual percentile scores so that they can be combined with other factors to help patients make decisions; alas, transparency within health care moves slowly.
Another question is whether certifying organizations should view the certification data as mostly a revenue channel, or as a public service. Sure, consumers can look up individual doctors on a related website, but that can be rather tedious (versus, for example, doing a specialty search within a geographic area). It's also nice to be able to compare doctors on other metrics, whether that be the incursion of disciplinary actions, patient ratings, or even something as simple as distance from a specific location. When we've inquired about licensing this data, we were surprised by how expensive the data is (cost-prohibitive given where we are as a company). It seems to us that ABIM (and the related ABMS) would actually further their mission of enhancing the quality of health care by freely and publicly releasing board certification lists so that patients can more easily take advantage of decision support tools. But, as Dr. Cutler pointed out in his video debate, financial compensation to ABIM's leadership is pretty high, and that money has to come from somewhere.