The American Board of Dermatology's proposal to establish subspecialty certification for procedural dermatology is on hold while board leaders seek to address concerns raised by dermatology societies and individual physicians that certification could divide the specialty and lead to economic credentialing.
The board of directors of the American Board of Dermatology (ABD) will meet in December to discuss the status of the proposal.
“This process will not be completed in haste,” said Dr. Randall K. Roenigk, president of the ABD.
ABD leaders have heard the concerns of the dermatology community and are in deliberations to modify the proposal accordingly, but much of the controversy is the result of “mischaracterizations” about the impact that subspecialty certification would have for dermatologists without it, said Dr. Roenigk, chairman of the department of dermatology at the Mayo Clinic in Rochester, Minn.
The controversy began last year, when the ABD submitted an application to the American Board of Medical Specialties (ABMS) to create certification for the subspecialty of procedural dermatology. The American Society for Mohs Surgery took an early stand against the proposal and others followed.
Last month, the ABD was scheduled to submit a revised application to the ABMS Committee on Certification and Recertification but postponed on the advice of ABMS officials. In the meantime, the ABD has formed its own task force to review areas of concern raised by critics and to report back to the group's board of directors in December with specific recommendations.
Around the time that the ABD announced it was postponing its application, the American Academy of Dermatology also came out against the proposal. During an Aug. 1 meeting, the AAD board of directors approved a resolution opposing the ABD's proposal.
The American Society for Mohs Surgery, which has been critical of the move toward certification, is taking a wait-and-see attitude. Dr. Stephen Spencer, president of the society, said it will monitor the situation and evaluate a new proposal if and when it comes forward.
Despite the criticism, the ABD continues to argue that subspecialty certification in procedural dermatology is important both for patient care and for the specialty of dermatology.
There is a body of knowledge related to surgical and procedural dermatology that is not taught in dermatology residency programs and subspecialty certification would offer assurance to patients that the physician is qualified and possesses the necessary knowledge, experience, and skills. The specialty would also gain under the proposal because certification would establish surgery as an integral part of dermatology, according to ABD.
The ABD's board rebuts charges that subspecialty certification will lead to economic credentialing. Since certification would be voluntary, the lack of a subspecialty certificate would not indicate that a physician is unqualified to practice in the specialty, the ABD said.
Some critics, however, aren't satisfied with the ABD's assurances. Dr. Daniel E. Gormley, a dermatologist in Glendora, Calif., said that, as currently written, the ABD's proposal would only grant certification to dermatologists who have completed fellowship training in procedural dermatology, outside of those who would be grandfathered in. Eventually, only a small group of dermatologists would be certified to perform a wide range of procedures, he said.
Dr. Gormley said the main issue with the ABD proposal is that it will restrict the number of dermatologists who can performs Mohs surgery and related procedures. Instead of creating a small cadre of specially trained dermatologists, he said that all dermatology trainees should have the opportunity to learn these procedures during their residency.
“We want to share this knowledge and spread it around,” Dr. Gormley said.