As a recently “Board-certified” dermatologist, I would like to think that this distinction matters – not only for me but for my patients. I would hope that becoming a Diplomate of the American Board of Dermatology (ABD) is more than a title. But honestly, I’m not sure it is.
Breaking Down the Board’s Purpose
The ABD exists “to serve the public by setting high standards for dermatologists to earn and maintain Board certification.”1 They have been “formed for the primary purpose of protecting the public interest by establishing and maintaining high standards of training, education and qualifications of physicians rendering care in dermatology.”
The overarching theme, it seems, is that the Board serves to protect the public and ensure the quality of dermatologic care provided in this country. Though these intentions are noble, I’m not sure the manner in which they are currently carried out accomplishes these goals.
Historical Context
The ABD was originally established in 1932. It was one of the first four specialty boards alongside ophthalmology, otolaryngology, and obstetrics and gynecology. To put that in perspective, the ABD was formed about a decade before the use penicillin became commonplace in medicine.2 At the time, establishing specialty boards was of the utmost importance in order to develop some standard for medical practice within these specialties.
Needless to say, medicine and medical education have progressed a bit in the last 80 plus years. Most notably, with regards to medical education, the restructuring of the Liaison Committee for Graduate Medical Education to form the current Accreditation Council for Graduate Medical Education (ACGME), which now oversees resident education, occurred over 35 years ago in 1981.
The ACGME works with volunteer specialty experts, such as the ABD, to provide assurance that residency programs meet quality standards for their given specialty. To reiterate, they work with volunteer dermatologists to assure training dermatologists receive quality education. Does that mission sound familiar? It should, because that’s essentially what the ABD strives to do.
Two Groups, One Purpose
The way I see it, the ACGME provides oversight of a three-year, dermatology-specific training program. The ABD, on the other hand, provides four multiple-choice tests over that same three-year period – three in-training exams and one final certification exam. The two groups essentially serve the same function, and if anything, the ACGME provides a more rigorous review of a resident’s progress through the completion of their residency training. The standards set by the ACGME provide the basis by which all dermatologists receive thorough, specialty-specific training. One could argue that the outcome of a one-day, multiple choice test administered by the ABD is not as much a reflection of a dermatologist’s competence as completion of an ACGME-accredited residency training program.
How the Board Could Revise Their Purpose
If the ABD were truly concerned with the protection of the public and setting common standards for dermatologic care, they should strongly consider how they could affect change with those healthcare providers who are not residency-trained dermatologists.
It’s no secret that practicing dermatology is great. Whether it’s for the cosmetic procedures, lifestyle, or interesting mix of medical and procedural practice, everyone in medicine seems to want a piece of the dermatology pie. Midlevel providers, such as physician assistants and nurse practitioners, are desperate to find dermatology jobs. Physicians from other specialties attend weekend “certification” courses in which they are “trained” to practice outside of their scope of practice by performing cosmetic procedures.
Ultimately, if the ABD were truly concerned with the safety of the public, they should focus more on those who have no dermatology-specific training and less on those who are already overseen by the ACGME.
My Hope
“Does Board certification really matter?” Well, I’m not sure that’s the right question. A more appropriate question would be, “Does high-quality patient care matter in dermatology?” The answer to that is, of course, a resounding YES! Has the ABD perhaps lost sight of this goal in lieu of self-indulgent prestige, monetary gain, and perpetuating a system for what it should be rather than what it is? Maybe.
The bottom line is that Board certification does matter. It matters a lot. It speaks to a level of competence only a select few possess in this country. It’s a needed competence for patients and non-dermatologists. Our fund of knowledge matters, and it changes lives.
My hope is that the ABD will recognize its shortcomings. If they want to give a multiple-choice test to residency graduates so that 98%-99% of us who pass annually can feel great about ourselves, post it on our social media, and be able to tell everyone we are officially “Board-certified,” then fine. But if they think that a multiple-choice test is keeping patients safe from non-dermatologist physician who practice outside of their scope or from physicians who throw midlevel providers into clinics without any oversight and allow them to “practice dermatology” without adequate training, then they should strongly reconsider their mission. I doubt the purpose of the ABD was ever to keep fully-trained dermatologists from practicing their craft, but rather, to help ensure patient safety and quality care.
In the end, I really do want it to matter that I’m “Board-certified.” But… I want our patients to matter more.
References:
- abderm.org/public/about-the-american-board-of-dermatology/mission-purposes-and-functions.aspx
- Penicillin in the U.S.A. Br Med J. 1943 Nov 6;2(4322):582.
- http://www.acgme.org/About-Us/Overview/ACGME-History
- Fisher WG, Schloss EJ. Medical specialty certification in the United States – a false idol? J Interv Card Electrophysiol. 2016 Oct;47(1):37-43.
- Smith JJ. Specialty board certification and federal civil rights statues. The Journal of Contemporary Health Law and Policy. 1994;11(1):111–147.
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