NEW YORK — The new recertification process developed by the American Board of Family Medicine is not as onerous as some are making it out to be, L. Thomas Wolff, M.D., said at a meeting of the New York County Chapter of the American Academy of Family Physicians.
“We're doing many of the things we were doing in the past, but we're doing them better,” he said. “We're helping ourselves as a discipline.”
Dr. Wolff formerly served on the American Board of Medical Specialties and its Committee on Certification and Recertification. He noted that it was the ABMS that initiated changes to the recertification process, which apply to all ABMS member boards. “It's really an issue that all of medicine is struggling with,” he said.
He also pointed out that the ABFM was the first specialty board ever to require recertification. “Nicholas Pisacano, M.D. [the ABFM's first executive director], said, 'How can we put our imprimatur on someone and know that 7 years later, they've kept up?'” explained Dr. Wolff. “We were also the only board at the time to require continuing medical education.”
The ABFM, formerly known as the American Board of Family Practice, was renamed effective Jan. 1 following the unanimous recommendation by its board of directors. The name change was associated with AAFP's Future of Family Medicine project, which recommended more use of the term “family medicine” to avoid the confusion generated by the term “family practice.”
ABFM also required family physicians to send in charts for chart review. “That really made me look at my practice and change things,” said Dr. Wolff, who still sees patients and is also director emeritus of the Rural Medical Education Program at the State University of New York, Syracuse. He noted that the ABMS is currently working on refining its peer review process for the specialties.
Dr. Wolff gave high praise to the interactive patient simulator, in which physicians get to “examine” and ask questions of a simulated patient on the computer. The program requires the test taker to manage the patient until he or she is stabilized for either three visits or 2 years' time, whichever comes first.
But Wendy Barr, M.D., a family practice resident at Beth Israel Medical Center, New York, who recently used the simulator, said it has kinks that need to be worked out. For example, there were no instructions about how to use a pull-down menu that would “officially” tell the patient to go home. “So if you didn't know you needed to send the patient home, the patient sat in the waiting room all night, and you got dinged for it,” she said.
Another point of contention is the self-assessment modules (SAMs). To recertify, family physicians must complete at least one annually. Critics say the modules take too long and don't have intuitive answers. In fact, the American Academy of Family Physicians House of Delegates voted at their meeting last October to ask the ABFM to delay implementation of the SAMs (FAMILY PRACTICE NEWS, Nov. 1, 2004, p. 1).
But Dr. Wolff said that the SAMs were useful teaching tools; he noted that the plan is to update them with the latest evidence-based medicine every 6 months. And in response to a question from an audience member, he said he would not be surprised to see the SAMs replace recertification exams—another part of the process—altogether.
“It may be that at some point the ongoing [SAM] process will suffice,” he said, adding that such a change would be a long way off. “I don't know that, but it wouldn't surprise me.” Dr. Wolff noted that for all the angst among family physicians about the changes, there is even more consternation among other specialties such as thoracic surgery, in which physicians had been given what they assumed would be a “lifetime” certification, only to find out they now have to recertify.
Neil Calman, M.D., president of the Institute for Urban Family Health, New York, said he thought the reaction of family physicians to the new process has been “absolutely absurd.”
“Physicians in general seem to get so stuck in the way things are,” he said. “It's amazing how disappointing people's response has been.”
One of the little known advantages of the new process, noted Steve Tamarin, M.D., chief of family medicine at St. Luke's-Roosevelt Hospital Center, New York, is that physicians can receive up to 15 hours' CME credit for each SAM they complete.
“One of the problems in medicine is that the quality of CME available really stinks, and much of it is corrupt [because] it's financed by the pharmaceutical companies,” he said. “It's a serious problem, the corruption of medical education by business. This solves that problem.”