Make Bylaws Inclusive of Board Certification Options

A lot of medical staff bylaws restrict board certification to ABMS and its member boards—sometimes unintentionally. Doing so blocks physicians certified by osteopathic boards, non-U.S. boards, and any new boards created not under ABMS.

This is an excerpt from an article that originally appeared on Credentialing Resource Center on September 25, 2017.

Most people don’t realize the true definition of board certification. “It doesn’t mean only being certified by the American Board of Medical Specialties (ABMS),” says Jeff Morris, JD, executive director of the American Board of Physician Specialties (ABPS).

In fact, a few years ago, the United States Department of Labor updated its Occupational Outlook Handbookto include ABPS as an option for board certification for physicians. Previously, the Handbook only listed the American Board of Medical Specialties (ABMS) and the American Osteopathic Association (AOA) as certifying bodies.

ABPS was founded in 1952 and certified its first physician in 1960. What makes ABPS unique is that it certifies both allopathic and osteopathic physicians, something that was unheard of at that time.

The organization was created by a group of osteopathic surgeons who completed allopathic residencies. According to Morris, the surgeons tried to become board certified through the AOA and were denied because they did not complete osteopathic residencies. They then tried to become certified by ABMS and were laughed at because they were doctors of osteopathic medicine (DO).

“At that time, they decided to build a certification that didn’t discriminate on training and actually tested a physician’s knowledge of the specialty,” says Morris. Although ABMS now extends certification to osteopathic physicians, Morris says ABPS is still proud of the fact it has always offered certification to both MDs and DOs. “We still seek that non-discriminatory approach today.”

There has been more acceptance of ABPS in the past few years. One reason, says Morris, is that more of the country’s leadership is seeking ABPS’s guidance on physician care issues. Another reason is that more medical staff services departments are reaching out to ABPS because their physicians are looking for choices in certification/recertification.

In years past, medical staffs might grant exceptions to physicians who didn’t meet the board certification requirements in the organization’s bylaws. Morris says because of primary source verification requirements, negligent credentialing cases, and electronic credentialing programs, exceptions rarely occur now. As a result, hospitals are looking to make changes to their bylaws to include ABPS.

“In seeking qualified physicians, hospitals should not discriminate against physicians who chose to be certified by ABPS instead of the more well-known ABMS boards,” says Morris.

Morris says the easiest way to get medical staffs to change their bylaws is to point out that the definition from the U.S. Department of Labor of board certification has changed to include ABPS.

“What we are asking bylaws to do is get current with the current standard,” says Morris.

He compares it to the issue of DOs in the 70s—most bylaws wouldn’t accept DOs as physicians. As the definition changed, medical staff bylaws changed, and the stigma changed.

“Hospitals weren’t being asked to review whether DOs were as good as MDs, it was simply about having the bylaws incorporate the current definition of what a physician was,” says Morris.

A lot of medical staff bylaws restrict board certification to ABMS and its member boards—sometimes unintentionally. Doing so blocks physicians certified by osteopathic boards, non-U.S. boards, and any new boards created not under ABMS.

"What we really want are well-qualified physicians," says Elizabeth "Libby" Snelson, JD, Legal Counsel for the Medical Staff, PLLC, in St. Paul, Minnesota. "Is there anyone who can sit down and say, well, if you are ABMS certified, you are a better doctor?"

She advises medical staffs to look at their physicians to see who would be affected by tightening requirements for board certification. "If you set a standard for quality reasons and there is someone you have never had a quality issue with who would be axed, you are also denying patients access. What if it is your only pediatric pulmonologist and he or she happens to be 'only' trained in Canada? What are you really accomplishing?"

One way to ensure you are not losing quality physicians who are not board certified according to your bylaws is to include an equivalency clause. Snelson advises writing something like, "The doctor is board certified or standing for certification or otherwise establishes qualification for the privilege."

Quality can be established through other means of credentialing already being performed, such as proctoring, peer review, or peer references.