The DO | Opinion | Letters to the Editor

Continuous certification: When boards say jump, physicians might not

For the past 20 years, my wife, Karen A. Shaw Sylvara, DO, and I have had the distinct privilege of providing competent and compassionate care to the rural underserved population of northern Missouri. Our life’s work and mission of providing rural primary care have been successful.

However, I have grave concerns about the continued survival and success of our endeavor. Ever-increasing overhead, flat or declining reimbursement, greater and greater intrusions, demands from insurance and governments, and the constant threat of malpractice lawsuits are just a few of my concerns. Dark clouds are lining the horizon. I hope the country doctor can survive.

I certainly hope that the implementation of osteopathic continuous certification (OCC) is not so onerous in terms of lost time, travel, missed work and emotional stress from constant test-taking that I can’t comply and maintain my board certification.

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I cannot speak for my family medicine brothers and sisters across the country. However, my peers and I who take care of patients here in the trenches of “fly-over country” feel pretty squeezed, pressured and stressed. We are growing weary of complying with mandate after mandate—seemingly great ideas from people who, actually for the most part, have no idea what we do.

I consistently strive to stay up-to-date with continuing medical education requirements, Audio-Digest Foundation programs, journals and board recertification. I feel these activities have been sufficient to ensure that I remain competent in practicing family medicine.

I have serious concerns about the primary care workforce, especially in rural areas. At 50 years old, I am a typical age for a family physician. Would you like to venture a guess at what my elders think about of a bunch of new mandates to maintain board certification? More and more demands are being placed on an undermanned and aging family medicine workforce.

Has board certification been beneficial to me up to this point?

  1. I have not had a patient ask me if I was board-certified.
  2. I have not received higher reimbursement from private third-party payers or the government because of my board certification.
  3. Board certification has not been required to man the various rural emergency departments and clinics I have worked in or to run my private practice.
  4. Thankfully, I’ve never been sued for malpractice. However, in that unfortunate event, being board-certified would provide little to no protection.

The primary care physician shortage takes into account the many licensed practicing physicians who are not board-certified or board-eligible. In this context, would states further worsen the shortage by tying board certification to state licensure?

Removing thousands of practicing non-board-certified family physicians from inner-city and rural communities that desperately need their services would be tragic.

To the American Osteopathic Board of Family Physicians, I give some friendly, collegial and unsolicited advice: When formulating new required hoops for the rest of us to jump through to maintain board certification, please do not overestimate the perceived value of board certification to the primary care workforce, especially in the light of even greater costs, time and stress.

J. Tod Sylvara, DO
Dr. Sylvara practices family medicine in La Plata, Mo.

The opinions expressed in “Letters to the Editor” are those of the authors and do not reflect the viewpoints of the editors or the official policy of the AOA.

19 Responses

  1. kevin Mason on June 1, 2012, 9:43 a.m.

    Well stated!

  2. Art Bell, DO on June 1, 2012, 9:58 a.m.

    I couldn’t have stated it better myself. Board certification is a money making racket.

  3. Colin Kavanagh, DO on June 1, 2012, 11:08 a.m.

    I don’t recall the membership being asked to approve this change. I would have at least liked a discussion on how this would make us better physicians. It will certainly keep the pedantic employed while giving the practitioners another reason not to recommend this profession as a career choice to their children.

  4. robert migliorino,d.o. on June 1, 2012, 11:39 a.m.

    How true!Your 4 points cannot be refuted.Add the statement that bc/be would lower the malpractice rate to this{it has increased,rather than decreased}and you are nearly there. Re the physician shortage,that was self imposed,particularly by hospitals & insurance companies requiring bc/be for admission to hospital staffs,etc.My previous writings to these replies cover all this although they are quickly dismissed by the sheep.If you want to have some fun,next time a headhunter calls & extolls you with the wonders of a new job,big salary,etc;tell him you’re not be/bc & count the seconds that it takes for him to terminate the call.

  5. Rich McCaughey, DO on June 1, 2012, 1:40 p.m.

    I couldn’t agree more with the comments above. Following Dr. Sylvara’s letter is the disclaimer “The opinions expressed in Letters to the Editor are those of the authors and do not reflect the viewpoints of the editors or the official policy of the AOA.” Therein lies the problem. I have often felt that there was a disconnect between “leadership” and members.

  6. William E. Franklin, DO on June 1, 2012, 1:59 p.m.

    The same thing has happened in emergency medicine. I believe a door is WIDE open for the formulation of a board composed of our professional peers who studies our knowledge of the core curriculum of our profession. Said board would be purely an attestation from our professional peers that we have achieved the highest level of learning in our profession. A mark of quality that will set us apart from the types of physicians who only jump through hoops. If enough physicians strive for THAT board certification, the old political “good old boys club” board of the past will go away. I’d rather be recognized by me peers as having achieved the highest level of knowledge in my profession that to be recognized by the lay public as a person who jumps through hoops.

  7. Ellie Griffin on June 1, 2012, 3:35 p.m.

    Well written, Dr. Sylvara.
    Your 4 points apply to part time women physicians as well. I live 2 hours from the nearest large airport. Getting out of town CME is not the way for many of us to stay informed. And it is hard on our families. When I was young and foolish I was board certified in 3 fields. I had to drop one area as soon as my daughter was born because there was no way I could afford three certifications on my decreased income and increased demand on my time.
    Ellie Griffin DO

  8. Mark DeMasi, DO on June 1, 2012, 4:15 p.m.

    I am a second generation board certified Osteopathic Ob/Gyn physician. I am also a distinguished fellow in my specialty college. I could not agree more with this board certification issue. I have worked hard to give my patients the finest care possible. I will always strive for this goal. However, becoming re-certified when my certificate orginally had no time limit, is a milestone I will embrace, nor endorse. I guess some people have nothing but time on their hands.

  9. Joe M on June 1, 2012, 8:39 p.m.

    One aspect of this continuous re-certification that should concern all of us is the standard of practice. The material we learn to take the board exam will be the guidelines for our practice. This can lead to a rigid protocol of treatment by the doctor and any deviation will be, well, outside the approved guidelines. This is OK for the by the book doctors, but some of us use alternative therapy which is certainly not approved, and would thus be a deviation from prescribed standard of practice. I am concerned that this continuous certification will lead us into a rigid protocol of practice and new ideas and treatments could not be used until they are officially introduced into the continuous certification material. Many of our medical colleagues in FP are very careful to go by protocol as a defense against malpractice because practice outside guidelines, protocol, or current standard of care is in their mind an invitation to malpractice litigation, since they did not follow the rules close enough. This is a fast track to total control of all treatment by any doctor and leaves little room for variation.

  10. Miles A Brrumberg, DO on June 5, 2012, 12:17 a.m.

    I am a 1976 graduate of PCOM. From 1977 until 1986 I worked as an ER physician. Since 1982 I have also been a solo general practitioner. I no longer do any hospital work. I THEREFORE did not renew my re-application for membership on the active medical staff of 2 local hospitals. I am not board certified in FAMILY MEDICINE. I never completed a residency in Family Medicine as it was not a necessary prerequisite in order to start a medical practice I just received a letter from Horizon Blue Cross Blue Shield of New Jersey stating that UNLESS I AM BOARD CERTIFIED AND HAVE FULL ADMITTING PRIVILEGES IN AN HORIZON PARTICIPATING HOSPITAL I WILL NO LONGER BE ABLE TO PARTICIPATE IN ANY HORIZON BLUE CROSS BLUE SHIELD HEALTH PLAN NOW AND IN THE FUTURE. Some reward for 30 years in general practice. ARE WE GOING TO ALLOW THEM TO DICTATE TO US HOW WE ARE TO PRACTICE WHAT HAS TAKEN US YEARS OF STUDY AND AND CLINICAL EXPERIENCE TO ACHIEVE. WE CAN ONLY STAND OUR GROUND IF

  11. Miles A. Brumberg, DO on June 5, 2012, 9:36 a.m.

    If there are DOs who have received similar ultimatums (sorry about the butchered Latin grammar)this year or in the past I would be interested to know if you did, how it was handled or how it should be handled. Perhaps the State Boards of Medical Examiners. I have my doubts about whether or not they would step in to help from my past experiences with my board.

  12. robert migliorino,d.o. on June 5, 2012, 9:39 a.m.

    Dr.Brrumberg,welcome to the club!You have found out what i have been writing about these past several years.I also note that in the AOA news,the Mississippi board & state are now considering tax breaks to lure physicians to Mississippi.That is NOT the answer…rather change the antiquated & draconian regulatons regarding licensure,staff requirements; & the insurance requirements that each facility received.The AOA can do nothing,the AMA will do nothing.Hospital staff regs are directly tied to insurance edicts as any administrator will tell you.Because it is impossible to obtain a position unless one is residency trained & is BC/BE as an FP,I simply retired & am now residing in Las Vegas & no longer need to put up with the bureaucrats & their effluence.

  13. robert migliorino,d.o. on June 5, 2012, 9:45 a.m.

    I should mention Standards of Practice. This is a myth,there are NO written standards anywhere & re Guidelines are just that. How many times were you told “They’re just guidelines,not edicts written in granite”‘But if one didn’t follow them precisely,then there was hell to pay,LOL.

  14. robert migliorino,d.o. on June 5, 2012, 9:50 a.m.

    Re licensure,many states now require residency training & BC/BE.Many of these states are those with the greatest need.

  15. Thomas Johnson, DO on Sept. 8, 2012, 4:23 a.m.

    MSU-COM 85
    As a board certified ob/gyn I quit ob practice back in 03. It just wasnt worth the cost to my family. I finally retired in 2011 and returned to the Army. When is the AOA going to grow some (g)uts and stand up to all this pretend feel good certification. Being “boarded” never got me anything but into my pocket. Fortuneately I was never suited, settled, or went to court in 20+ years. Being boarded never protected me. It was my own hard work that protected me. (I disengaged early with many a care plan with patients whom had unrealistic expectations.) Now Im back in the Army with the only requirement of a license in one state. I raised my 4 kids to not be afraid and stand up to intimidation. The only reason I pay into the AOA now is because my state license requires it. Now we have Obama care…the doc exodus from medicine continues and the Dr/Phd nurse practitioners are the new answer. The lawyers are just sharpening their knives …just waiting for the “cheaper” care that looms on the horizon. When is the AOA going to return to a physician protection organization and not some advocate for every other special interest?

  16. DS,D.O. on Sept. 14, 2012, 9:59 a.m.

    I’m a board certified family medicine osteopathic physician. I pay enough money with going to osteopathic CMEs and paying the AOFBP funds to stay board certified, paying malpractice, paying for DEA license, paying for medical license. My time is limited due to patient demands in family medicine and my work hours. I understand I have to take the board exam – written & OMT – every 8 years.
    Now, if that was not enough, what is truly really upsetting me now and makes me livid about the AOFBP is the new 2 OCC modules I must start doing every 3 years, which starts in 2013. This will take exhaustive time and less time to spend with patients. The AOFBP better begin to astutely think about this new agenda they are setting here. I am just livid about this.
    DS, D.O.

  17. Chris Laseter, DO on Oct. 5, 2012, 5:51 p.m.

    I was dual-boarded in NMM-OMM and FP through the profession. I understand the mandates of our certifying boards are being strongly encouraged by government types and of course we mimic the MD’s. Of course it is an awful turn of events and a trend further pushing the most seasoned clinicians out of medicine all together. Are they afraid to be perceived as not putting us through the inane hoop jumping that the larger medical profession seems to embrace? Of course they are. We stand little chance of rolling back this tide.
    I gave up my FP certification. I practice OMM as a specialty. I was galled by the move to undermine the OMM Board by the FP’s who tacked on the “OMM certification” to their Board a few years ago. I only have one question. Is there a mechanism for those who wanted to maintain dual certification, after all the work many did with combined or sequential residencies?

  18. Chris Burritt D.O. on June 18, 2013, 11:10 a.m.

    A very well written and sobering article. To any physician who agrees I highly recommend joining the Association of American Physicians and Surgeons an organization dedicated to private practice and quality care of the patients as well as physician and patient autonomy. They are currently suing the ABMS and could use your support!

  19. Mashelle Morris DO on Feb. 26, 2015, 10:47 a.m.

    Well stated and agree with all that was voiced. We are not benefiting from demanding certfication testing on the whole. I vote that this practice changes soon or Iam going to opena spa and follow another dream.

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