MONTEREY, Calif. — An American Board of Dermatology retreat on June 12 will attempt to reach peace between conflicting factions within the specialty on the issue of a certifying exam in procedural dermatology.
The gathering in Chicago will bring together leaders of various dermatologic associations who favor or oppose an idea first presented in 2008 by the American Board of Dermatology (ABD) to create a subspecialty certifying exam in procedural dermatology.
The proposal drew fire from the American Society for Mohs Surgery, the American Academy of Dermatology, and others who feared that eventually only fellowship-trained physicians would be eligible to take the exam and that insurers would refuse payments for procedures by noncertified physicians, thus restricting access to patient care.
The controversy prompted the ABD to slow consideration of the exam, and to schedule the upcoming retreat to obtain input from dermatologic organizations, Dr. Lee Portnoff, president of the American Society for Mohs Surgery (ASMS), said in an interview at the Society's annual meeting. The ASMS, which does not require fellowship training for membership, opposes the exam proposal. The American College of Mohs Surgery (ACMS), which requires members to have completed a 1- to 2-year fellowship, favors the proposal.
Under the ABD's original proposal, dermatologists who had completed a procedural dermatology fellowship would have the option of sitting for the certification exam and - for a limited time - physicians who had not completed a fellowship but who had significant surgical experience would be "grandfathered" in.
"I don't know if the current proposal differs significantly enough from last year's proposal that any of the dermatology organizations would support it, and I don't know how seriously the ABD would incorporate any comments at the retreat," Dr. Portnoff said.
"Our [ASMS's] position is that sufficient dermatologic surgery training should be included in all dermatology residencies so that certification by the ABD would assume competence in dermatologic surgery," he added.
"One of the large questions is, who will be deemed qualified to sit for the exam? That very question may be the dividing point, and is part of the main controversy," Dr. Matthew M. Goodman said at the meeting.
"We feel, in this Society [ASMS], that if you're appropriately trained - which can occur in residency or post residency - you can be competent to do Mohs surgery in a quality way for the best care of your patients without having done a fellowship or passed a certifying exam," added Dr. Goodman, the founding president of the Society and a Mohs surgeon in private practice in Santa Ana, Calif. "There's nothing against fellowships or against a certifying exam per se. We just would rather not see those as divisive forces."
Dr. Leonard M. Dzubow, president of the ACMS and a former director of the ABD, noted in an interview that procedural dermatology includes not just Mohs surgery but the entire spectrum of dermatologic surgery, so subspecialty certification in the field should be of interest to all dermatologists with advanced experience.
The ACMS's mission includes fostering excellence in treatment and in patient education about treatment options and different subspecialties. "The concept of certification will include several pathways for qualification, which will make it available to all physicians with sufficient experience and knowledge," said Dr. Dzubow, professor of dermatology at the University of Pennsylvania, Philadelphia.
Dr. Randall K. Roenigk
Dr. Randall K. Roenigk, a past president of the ABD, said in an interview that the impetus for the exam was to give residents and fellows who complete training programs accredited by the Accreditation Council for Graduate Medical Education the option of being board certified.
"Just like all 24 core specialties and 117 subspecialties associated with the American Board of Medical Specialties, the mission of the ABD is to assure the public that physicians who hold themselves out as specialists are competent in a defined body of knowledge," said Dr. Roenigk, chairman of the department of dermatology at the Mayo Clinic in Rochester, Minn.
Dr. Elaine C. Siegfried, current president of the ABD and professor of pediatrics and dermatology at St. Louis University, said the ABD would have no comment on the topic until after the retreat.
If the ABD creates the certifying exam, procedural dermatology would join dermatopathology, pediatric dermatology, and clinical and laboratory dermatologic immunology as board-certified subspecialties.