The move by the American Board of Medical Specialties (ABMS) to stop issuing lifetime board certifications and instead move to certification that is conditional on meeting periodic recertification requirements was controversial from the start. Now the Association of American Physicians & Surgeons (AAPS) says that the ABMS Maintenance of Certification program has more to do with enriching the ABMS than improving patient care. It has filed a federal suit in the district of New Jersey to stop the program.
In radiology, the ABMS Maintenance of Certification program became effective last year when the American Board of Radiology (ABR) instituted its requirements for all new certifications. Radiologists already certified by the ABR would maintain their lifetime certification, but were urged to voluntarily enroll in the Maintenance of Certification program.
According to the ABMS, it began developing the Maintenance of Certification program back in 2000 as part of the quality movement in health care. The goal was to increase the value of a board certification by ensuring that all certified physicians were keeping up with the latest developments in their field and meeting certain quality measures.
However, the assertion that making physicians adhere to the program’s requirements would correlate to improvements in patient care has been questioned by many, including the New England Journal of Medicine, which last year published “Ensuring Physicians’ Competence—Is Maintenance of Certification the Answer?” in its Dec. 27, 2012 issue.
In its suit, the AAPS says that when the ABMS entered into agreements with 24 other allied board organizations, including the American Board of Radiology, to apply the Maintenance of Certification program, it set up an anti-competitive trust system that would effectively bar some physicians from practicing at hospitals and also created an unfair competitive advantage for senior physicians whose lifetime board certifications were grandfathered in.
In its press release announcing the suit, the AAPS says one member — “a first-rate physician in New Jersey” — was barred from seeing his patients at the local hospital when his decision not to participate in the Maintenance of Certification program excluded him from the hospital’s medical staff.
The AAPS also says that information on the ABMS website about the program creates an impression that physicians who do not participate are professionally inferior to physicians who do, without any direct research evidence that this is the case. Therefore, it is misinformation designed to create an unfair competitive advantage for program participants.
“Money-making schemes that reduce access by patients to patients, as ‘maintenance of certification’ does, are against public policy and harmful to the timely delivery of medical care,” the AAPS says in its press release. It also added that the ABMS program “is a moneymaking, self-enrichment scheme that reduces the supply of hospital-based physicians and decreases the time physicians have available for patients, in violation of Section 1 of the Sherman Act."
(The Sherman Antitrust Act was the 1890 landmark federal statute that prohibits certain business activities like monopolies that federal government regulators deem to be anti-competitive.)
The lawsuit asks that a court order the ABMS to stop the violating antitrust law and take down all information that makes misrepresentations about the medical skills of physicians who decline to purchase and spend time on its program. In addition, AAPS wants ABMS and the other boards who participate in the program to refund all fees paid to them by AAPS members.