New research shows that many hospitals and health plans do not require pediatricians to be board-certified, a finding that may have implications for patient safety and quality of care.
"You don't have to be board-certified to practice in most hospitals in America, and only around 40% of health plans require a general pediatrician to be certified at any time of association with the health plan," says study author Dr. Gary L. Freed, director of the Child Health Evaluation and Research Unit at the University of Michigan in Ann Arbor.
In this study, 78% of 200 hospitals surveyed nationwide did not require general pediatricians to be board-certified when they first received hospital privileges. However, 70% did require pediatricians become board-certified at some point. Almost half (48%) of those that required board certification had a time frame within which certification was needed, but 42% did not initially credentialed by the plan. Although 41% of the health plans required the pediatricians be certified at some point, the majority (61%) had no time frame in which this should happen. Only 40% of health plans require subspecialists to become board-certified.
"It appears that marry hospitals and many health plans are not using the tools that are available to them to help ensure that the public has the highest quality of care that can be provided," says Freed.
The study raises the question of whether certification translates into better patient care. "There have been few studies that have looked at differences in quality of care," Freed says. "It's an important area for future research. Just as there are no randomized trials of airline pilots who get recertified in the simulator and those who don't, it's likely that the public would want their pilots to have regular certification processes to make sure they stay sharp. One should expect nothing less from physicians."
Dr. Christine K. Cassel, president of the American Board of Internal Medicine, says, "This is a time of tremendous change in health care. There's a whole lot going on around quality assessment, and making it more visible to the public. This is important. The public needs to understand how hospitals and health plans assure that physicians have met certain standards.
Until 1987 certification from the American Board of Pediatrics (ABP) was valid for the entire career of the doctor. Now, the ABP requires renewal of certification, through a stringent review process, every seven years. "Starting in 1987 for pediatrics, they began limited certificates, to be able to say that, in fact, medicine does change, and it's not a static endeavor, and you need to be sure that people keep up to date," Freed explains.
"The only national standard that reflects specialty training is board certification," Cassel says. "My presumption is that you're going to see hospitals and health plans looking much more carefully at board certification going forward. It's a strong indicator, and it's getting stronger."