Does it matter if your doctor is board certified or board eligible?

Does your doctor have something on the wall that starts with “American Board of … “?

The terms “board certified” and “board eligible” are confusing to people not in the medical profession. It doesn’t help that more than a few doctors blur the distinctions to their own benefit. This post gives you a brief rundown on what’s at stake in the distinctions.

The first thing to understand is that anybody who has graduated from medical school is a physician. They can put those letters M.D. (or D.O.) after their name. But they can’t practice medicine yet on their own. To do that they need a medical license. The granting of medical licenses is one of the powers of each individual state. They all have their own rules, although they are all broadly the same.

For example, I have medical licenses in several states, and they are all pretty much the same in how I got them. All states require some additional training time beyond medical school before you can get a license. This is called residency. The older term, intern, which used to apply to the first year of post-medical training, doesn’t mean much anymore — except in one respect. All states I’m aware of let you get a medical license after only one year of postgraduate training. The key point is that the states, through their licensing system, have virtually nothing to do with regulating how a doctor gets to say he has the advanced training that lets him call himself a specialist.

Residency, which is training in one of the many medical specialities (e.g. pediatrics, internal medicine, surgery, obstetrics and gynecology, family practice, etc.), lasts anywhere from three to five years after medical school. Training time is longer if you want to be a subsupecialist (e.g. critical care, cardiology, gastroenterology, heart surgery, etc.). At the end of training you take a test: if you pass, you are “board certified” in the specialty or subspecialty. You can have several of these. For example, I am board certified in pediatrics and in pediatric critical (intensive) care medicine.

So what is “board eligible”? That means a physician who has completed the residency in a specialty or subspecialty but has not passed the test, either because he hasn’t taken it yet or he failed it. You can see the problem here, where patients can get confused. “Board eligible” sounds pretty fancy, not much different from “board certified.” But some physicians have been calling themselves “board eligible” for years and years without ever passing the test. Doing that will restrict what you can do in a hospital, but there is nothing to prevent somebody practicing a specialty outside the hospital, say allergy, from advertising to the public as “board eligible in allergy” for many years. It’s not false, but it can be misleading.

The American Board of Medical Specialties, the organization that oversees all this, has just put in place a rule forbidding people from claiming to be “board eligible” for their entire careers. After finishing an approved residency they’ve got several years to pass the board examination; if they can’t, they can’t use the term anymore or will face sanctions. I think it’s a good thing.

All of the specialty and subspecialty boards have websites where you can check if a physician really is certified or not. The ABMS site above has links to all of the member boards for your convenience. For example, you can go to the American Board of Pediatrics site and easily verify if your child’s doctor is certified (and when).

Christopher Johnson is a pediatric intensive care physician and author of Your Critically Ill Child: Life and Death Choices Parents Must Face, How to Talk to Your Child’s Doctor: A Handbook for Parents, and How Your Child Heals: An Inside Look At Common Childhood Ailments.  He blogs at his self-titled site, Christopher Johnson, MD.

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  • http://twitter.com/jeffdavismd Jeffrey Paul Davis

    What about physicians that pass their boards but then elect not to pay the thousands of dollars needed to “re-certify” 10 years later? Should they still be considered board certified?

    • Frank Lehman

      I would appreciate a little more a;bout this issue of re-certification. Why does it cost thousands of dollars? Must the physician pass the same test that is being given to those who complete their program now? Is there any way the patient can know whether their board certified physician meets current standards?

      • http://www.facebook.com/people/Alieta-Malwitz-Eck/565880983 Alieta Malwitz Eck

        Dr. Johnson has done a good job of defining the terms. But he does not touch on the issue of re-certification. That is where the Boards are reaping $billions and cannot demonstrate improvement in patient care. Doing a residency to become board-eligible and taking the test to become board-certified are fine– but the ongoing arduous exercises in re-taking the tests and doing “practice assessments” are becoming so burdensome that physicians would rather quit than continue the process.
        Experience is important. Continuing medical education in the fields that are relevant to the individual practice is important. But the re-certification process needs to end. Go to http://www.changeboardrecert.com to see the ongoing efforts to slay this beast.
        Alieta Eck, MD
        President, AAPS

  • Harsh aasiwal

    hmmmm nice work

  • MarcGarfield_DPM

    First off, the answer to Dr Davis’s question is no– both legally and ethically, If you opt to not complete the terms of your board certification you opt to not claim board certified status. However, the public should be better informed as to the fact that board certified does not mean competence, superiority or peer recognition. Both the license and the board means that a doctor paid his fee and passed a test of mixed relevance and arguably minimal or moderate basic knowledge of one’s specialty and possibly a few case submissions. Moreover, the relatively recent surge on board certification requirements, has served to exclude perfectly good physicians that do not incorporate the required case types into their practice. I am board certified and have passed my recertification exam. So this is not a sour grapes post. But I have met older doctors that I respect, that get pushed aside because they do not do certain types of cases required for board certification. I have also met surgeons that are board certified that will do any procedure to on any patient, with little regard as to the impact of that procedure on any given patient. In fact board certification seems to tacitly encourage such an approach to surgery.
    On the other hand, those that cannot pass such a test, concern me. They are generally hard to ace but easy to pass. The scores are generally pass/fail. Licensing and boarding needs to be streamlined and we should simply decide minimal competence to practice and apply that standard to everyone in that specialty. Let the public sort out who does the best job taking care of patients.

    • EmilyAnon

      “Let the public sort out who does the best job taking care of patients.”
      How can the patient tell, for example, that a successful surgery was due to the doctor being certified, or a good result would have been possible no matter who did it. How does a patient make a judgment call on a doctor’s surgical competence? Either you’re healed, harmed, or you die. This is scary stuff for us. So we latch on to board certification hoping it “indicates” the doctor is better than average.

    • FlynnMD

      The specialty boards that use oral exams are entirely subjective and the results arbitrary. To elevate their importance above the “evidence-based medicine” of a physician’s qualified experience, is simply ludicrous.

  • Molly_Rn

    And making up your own board like Senator Rand Paul doesn’t count either. Faker.

  • MarcGarfield_DPM

    Most doctors in the US have gone through enough high water to be
    competent. My assertion is that, you still do not know if a board
    certified doc is any better than another that bucks the trend or does
    not have a practice that adheres to requirements of a recognized
    certifying board. A better question is:” did you pass and did you pass
    the first time?” But you may continue to perpetuate the board
    certification myths for doctors, phlebotomist and plumbers if you like.
    Doing so increases the cost and minimizes access and options for
    patients. But that is exactly how the board certified world wants it.

    State licensing associations should be responsible for ensuring minimal
    competence, and should not be deferring that role to certifying boards
    paid for solely by the recipients of such certification. We are getting
    certifiably crazy in this country and like the 47 warning labels on a
    step ladder, the one that matters is ignored after reading through the
    other legally mandated 46 labels. If a doc is not minimally competent,
    he/she should not practice. Do not be thrown off by the term minimally
    competent. If managed properly it should mean capable of providing
    honest and appropriate care according to patients’ needs.

    Lastly, no one sees the results of a specialist as much as the PCP’s.
    We perpetually want to bypass them to get the care we need. But often,
    they are better able to guide patients to appropriate specialist and
    retain a loop of feedback that cannot be sifted through by certifying
    boards, google reviews or a neighbor that liked or disliked a doctor.

  • EmilyAnon

    I’m just wondering, if a person has a graduate degree, and they wanted to sweeten their resume when applying for some job, could they legally add ‘medical school eligible’?

  • FlynnMD

    Successfully completing a residency is already deemed by the ACGME to signify that the individual physician is now fully trained and capable of practicing independently in their specialty.
    But the ABMS and their member societies have methodically asserted that only their “board certification” provides a true index of a specialist’s qualifications. And just who made them the deciders? Why, they did, in their self-selective glory.
    Part of the physician shortage is due to highly-qualified non-boarded physicians being unable to find work, all to maintain an air of exclusivity and to provide a healthy stream of income for these secretive socities that adjudicate on fear rather than learning. In short, board certification is yet another albatross for the physician, one that does nothing for quality but raises overall medical costs to the public. More distrurbing is that those physicians with malpractice and felonies against them really have no fear of losing their BC status and may continue calling themselves “the best and the brightest”.
    The ABMS et.al. will hold an illegitimate place of authority in medicine until their actions, methods, and decisions are made open and transparent.