The American Board of Surgery and the ABMS: The role of boards

AT THE BEGINNING of the 20th century, medicine had entered a period of rapid growth and scientific development. Physicians were developing practices devoted to a special area of expertise, but there was no system for establishing and assessing training programs. There was also no system for assessing whether a physician practicing in a specialty area was qualified to do so. In his presidential address to the American Academy of Ophthalmology and Otolaryngology in 1908, Derrick T. Vail called for the establishment of a specialty board in ophthalmology, whose functions were to "arrange, control, and supervise examinations, to test the preparation of those who design to enter on the special or exclusive practice of ophthalmology.'" The American Board for Ophthalmic Examinations first met in 1916 and was officially incorporated in 1917. The second Board, the American Board of Otolaryngology was incorporated in 1924. As more Boards began to form, it was recognized that there needed to be some coordination of the activities of the Boards. The Advisory Board for Medical Specialties, the predecessor of the American Board of Medical Specialties (ABMS), was formed in 1933. The Advisory Board would act in an advisory and coordinating capacity, but agreed that it would not interfere with the autonomy of any of the participating examining Boards. It would function essentially as a federation of Boards and would cooperate with the Council on Medical Education of the American Medical Association to approve the establishment of new specialty boards. This process is still intact and is implemented through a joint ABMS/AMA committee called the Liaison Committee for Specialty Boards (LCSB). The American Board of Surgery was founded in 1937, and the Advisory Board became incorporated as the ABMS in 1970. There are now 24 member boards of the ABMS, representing the major medical specialties. The specialty boards are all separately incorporated, independent entities that are responsible for setting the requirements for admission to their examinations, conducting those examinations, and issuing certificates to those individuals who have successfully passed the examinations. In doing so, the Boards "act in the public interest by contributing to the improvement of medical care by establishing the qualifications for candidates and by evaluating individuals who apply for certification. The intent of the certification of physicians is to provide assurance to the public that a physician specialist certified by a Member Board of the American Board of Medical Specialties (ABMS) has successfully completed an approved educational program and an evaluation process which includes an examination designed to assess the knowledge, skills, and experience to provide quality patient care in that specialty."] The organization responsible for setting the educational standards for each specialty is the Accreditation Council for Graduate Medical Education (ACGME), which works through the Residency Review Committee (RRC) for each specialty. Each ABMS Board has a corresponding RRC, and there is a general correlation between the certification and accreditation processes for each specialty and for most sub-specialties. The structure of the examination system, therefore, is one in which there is a specific attestation that a physician has met the standards of the Board and has passed an examination in the field developed by the Board. There is no specific attestation about competence, although perhaps this can be inferred. There also was, initially, no mechanism to assess the continuing knowledge and ability of the physician over time. The ABMS began to discuss the possibility of issuing time-limited certificates and to institute a system of recertification examinations in 1936. By 1973, all of the ABMS member boards had adopted the principle of recertification, and some of them implemented a system of recertification examinations. By 2000, the majority, but not all of the Boards had actually implemented a recertification system, and most of them