By Ruth SoRelle, MPH
The New York and Oklahoma medical boards have thrown roadblocks in front of the American Association of Physician Specialists’ (AAPS) quest for recognition of board certification in recent months, slowing its campaign to allow physicians certified through the American Board of Physicians Specialties (ABPS) to advertise themselves to the public as board certified.
Earlier this year, AAPS revealed its plan to aggressively pursue recognition by state medical boards in several states. (http://bit.ly/AAPSRamping
.) Although AAPS’ director of governmental affairs told EMN in March that it planned to approach medical boards in Alaska, Montana, Idaho, Utah, and North and South Dakota, the organization had already set its sights on states with larger numbers of physicians such as New York, Oklahoma, Texas (see EMN article from August, “ABPS Pressures Texas to Endorse Its EM Board Certification;” http://bit.ly/ABPSTexas
), and Louisiana.
Although ABPS offers board certification in 16 specialties, it is emergency medicine that proves contentious because ABPS’ Board of Certification in Emergency Medicine offers a practice pathway for physicians who did not complete residencies in emergency medicine. The American Board of Emergency Medicine (ABEM), part of the American Board of Medical Specialties (ABMS), closed its practice track in 1988, now requiring applicants to complete a residency in emergency medicine. (BCEM requirements can be found at http://bit.ly/BCEMeligibility
; ABEM requirements at http://bit.ly/ABEMeligibility
John McCabe, MD, the chair of the ABMS board of directors and an emergency physician, said the issue is not that board certification should be limited to one group, but that certain criteria for certification must be met. “I think ABMS views itself as a 76-year-old organization in the business of providing board certification. We are the gold standard. We will continue to defend that, but not because ABMS is the only entity doing that. There is a link between trained in the specialty in which you are certified. Those are the basic elements. It is what board certification is based on.”
AAPS seems committed to pursuing recognition for its members, despite recent setbacks. William G. Young, the United States District Judge in the Southern District of New York, last September granted a request for summary judgment by Robert W. Barnett, the director of the New York State Department of Health’s Office of Healthcare Quality and Safety, in a case filed in 2006. AAPS had claimed the state health department violated the 14th amendment by refusing to allow APBS-certified physicians to identify themselves as board certified in public physician profiles on the Internet.
“Because there is no genuine issue of material fact surrounding the rationality of the Department’s conduct, Barnett’s Motion of Summary Judgment is hereby granted, and the Association’s cross-motion is denied,” Judge Young wrote in his ruling. He also ruled that even though some physicians listed as board certified through the American Board of Medical Specialties were “grandfathered” into their board certification, “the existence of some practice-track physicians listed as board certified in emergency medicine does not undercut the rationality of the classification.”
AAPS filed an appeal to the United States Court of Appeals for the Second Circuit, and is awaiting oral arguments, said James Marzano, the director of public relations and marketing for AAPS. He said in an email that the group was disappointed with the judge’s decision, but that they would eventually prevail in higher court. “We are at a complete loss to explain why the judge in this case would allow the State of New York to continue to perpetuate erroneous information through its medical profession website,” he wrote.
AAPS encountered a similar obstacle in Oklahoma, where the Oklahoma State Board of Medical Licensure and Supervision had at first agreed to recognize ABPS certification following several presentations, said Lyle Kelsey, the executive director of the Oklahoma board. “The Oklahoma Medical Board decided, at the November 18th public hearing on the subject of a rewrite of the Board's rule on Board Certification, to recognize the ABPS as another pathway to ‘Board Certification’ for the purpose of physicians advertising their credentials to the public,” he said.
The change required approval by the state legislature and the governor, however, and the board elected to withdraw the change because the amendment was going to fail in the legislature, Mr. Kelsey wrote in an email. “The board was given the option to either pull it back or have it defeated by vote. The board chose to pull the rule back. They did not change their mind.” He said the board will consider recognizing board certification on a physician-by-physician basis, and has given such approval 17 times since 1995.
Mr. Marzano of AAPS said the group was disappointed to have been approved by the medical board only to be derailed in the legislature. “But what is more disappointing is seeing how our opponents will take such a drastic step as sending a misleading letter to the Senate Pro Tem to persuade him to force the withdrawal of the resolution.”
In an April 2 letter to Oklahoma State Sen. Glenn Coffee, Kevin B. Weiss, MD, MPH, the president and CEO of ABMS, asked the state legislature to reconsider the change in the rules. “Oklahoma citizens deserve to have the assurance that physicians who advertise themselves as ‘board certified’ have in fact been certified in their area of expertise by specialty boards that use procedures and standards sufficient to ensure that the certified physician has the training, knowledge, and skills necessary to assure the public that he or she is a qualified medical specialist,” Dr. Weiss wrote.
Senator Coffee did not respond to a request for an interview, but Dr. McCabe said ABMS would not consciously send a misleading letter. “It depends on what side of the fence you are on,” he said.
Angela Gardner, MD, the president of the American College of Emergency Physicians (ACEP), said she does not believe that ABPS is slackening its attempts to have its board certification accepted in various states. She said ACEP recently asked the Federation of State Medical Boards to develop a template of language regarding board certification. The testimony in the issue found ACEP and ABPS on the same side, each wanting a national approach, she said, but the federation refused to accept the resolution because it felt it did not fall under its purview.
While Dr. Gardner said she is aware of the Oklahoma and New York situations, she has been concentrating on her home state of Texas, where the matter was to be considered again in an August hearing. She said she fears that the matter will become an issue in the November state elections. “I have tried to be clear that ACEP is not commenting on whether someone should be working in an emergency department. We are only commenting on telling the truth about your training and certification. What holds true for pediatrics and internal medicine should hold true for emergency medicine.” In an email, Mr. Marzano wrote that the Texas situation “is a major focus of ours at this time.”
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