Medicine's Certification Wars

By David Witmer posted 07-15-2015 09:12


As we ponder the future of pharmacy’s framework for Board certification we would do well to study how things work for medicine. A recent survey conducted by the Board of Pharmacy Specialties (BPS) showed the most pharmacists believed that pharmacy would be best served by basing its framework on that of medicine. Comments generally revealed that these pharmacists believed that this model is very credible and that adoption of a similar model by pharmacy would add to the credibility of our profession.  Unfortunately, many pharmacists are unaware of the increasing controversy over the framework for medicine’s certification programs and the growing number of physicians that hate it and are opting out.

I’m not exaggerating when I say they hate it. In recent years there has been a rebellion brewing in medicine and it has gotten downright ugly. In March 10, 2015 an article in Newsweek dubbed the controversy “The Ugly Civil War in American Medicine”. Physicians are in rebellion against high fees, multiple required examinations, and new Maintenance of Certification or MOC requirements. The result has been that in January of 2014, a new group, The National Board of Physicians and Surgeons (NBPS), was formed to compete with the American Board of Internal Medicine (ABIM).

It is very informative to read the recent blog posted by Dr. Bob Watchter, entitled, The ABIM Controversy: Where the Critics are Right, Where They’re Wrong, and Why I Feel the Need to Speak Out. Dr. Watcher just competed 10 years of service on the ABIM Board, including serving as its Chair, and subsequently served on the ABIM Foundation. In his blog he shares his views about the controversy. He summarizes the history of medicine’s certification programs, the growing criticism surrounding recent changes, and politely provides an eloquent defense of ABIM, addressing the various concerns of its critics. But one only needs to read the comments posted to his blog to see how deep the resentment runs in medicine today. This is a must read for those contemplating how to evolve pharmacy’s framework for the future. Assuming that we understand the complexities and politics of medicine’s model would be a mistake. We should look more deeply into this controversy and consider carefully what has worked and just as importantly what have been the fallings of medicine’s model.

Almost exactly a year ago BPS issued a draft discussion paper announcing that it was seeking input on the structure and framework for certification. Since then there has been much discussion, study, debate, and consensus building. BPS’s Specialty Framework Steering Committee (full disclosure, I serve as a member of this committee) has provided its input over the last year, with many thoughtful and at times passionate debates along the way.  BPS has fine-tuned its proposal and in the very near future BPS will be discussing proposed changes to its framework for specialization with the Specialty Framework Advisory Committee and then with the profession as a whole to get broader input on the proposed new framework.  I encourage all pharmacists to carefully study the new proposed framework and engage in the debate. The role of Board certification as well as other credentials looms larger as we near our goal of recognition as providers. This is a time of great change both in our profession and more broadly for health care. It is critical that we not make assumptions but think strategically about how to evolve pharmacist’s credentials to serve the future needs of patients, payers, and pharmacy practitioners.

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