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Invited Critique
August 14, 2009

Use of Board Certification and Recertification in Hospital Privileging—Invited Critique

Arch Surg. 2009;144(8):752. doi:10.1001/archsurg.2009.27

The results of a telephone survey conducted by the authors are quite alarming, particularly the findings that one-third of the hospitals surveyed do not require surgeons and subspecialists ever to be board certified and that 82% of all hospitals and two-thirds of hospitals whose policies require recertification allow surgeons and nonsurgical specialists to retain privileges when board certification expires. The executive officials of some of the specialty boards question these results, highlighting that the percentage (approximately 33%) of hospitals never requiring surgeons and nonsurgical subspecialists to be board certified to receive or to maintain hospital credentials is likely an overestimation. However, with only approximately 400 hospitals (of >6000 nationwide) having more than 500 beds, it is feasible that smaller community hospitals are unable to attract physicians/surgeons who have successfully completed their board certification requirements. Whether the cohort of hospitals in this survey (with an overall response rate of 82%) is an outlier is irrelevant. The fact that any appreciable number of hospitals have chosen not to use board certification as a method of assessing physician competency is problematic. With specialty board certification currently being the most established and widely accepted metric available to assess physician competence, the paramount question that the authors failed to adequately address is what specific surrogates or equivalent assessment tools the hospitals are using to ensure physician competence if the specialty board certification process is not being used for credentialing. Perhaps, with a more comprehensive study design, key comparisons could have been made with appropriate statistical analyses to determine whether there were disparities in outcome measures between the hospitals that based credentialing on specialty board certification and the ones that chose a different method of credentialing eligibility. The growing emphasis on quality care and patient safety, with an overreaching goal to substantially reduce physician errors, is imperative. It is doubtful that the board certification process being conducted under the auspices of the ABMS is “the emperor without clothes” and that there are other, more established assessment tools that are equal or better in their ability to determine competency. However, the authors' findings dictate that a substantial number of hospitals are not relying on the ABMS certification process for competency assessment.

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