Certification from the American Board of Surgery is optional, but surgeons are incentivized to obtain it since many hospitals and insurance reimbursements require certification, making it a de facto requisite for many. Certification is not obtained easily, however: Doctors must pass both written and oral exams to demonstrate a thorough understanding of best practices and agility in various surgical situations.
Now, a new study has shown that doctors who receive ABS certification are less likely to receive severe disciplinary actions against their medical license. The study, conducted by the American Board of Surgery and published in JAMA Surgery (2020 Mar 18:e200093. doi: 10.1001/jamasurg.2020.0093), also found that initial success on the exam was related to lower risk for disciplinary action over time. These results mean surgeons who passed both the written qualifying exam and oral exam the first time had the fewest strikes against their medical license.
“We found the results very encouraging,” said Andrew Jones, PhD, the director of psychometrics and research at the American Board of Surgery, and an author on the paper. “We weren’t sure if we would find a difference between certified surgeons and doctors who tried but failed to obtain certification. Not only did we find a difference, but we showed that each step of our process has utility.”
In fact, surgeons who tried but never passed the multiple-choice qualifying exam were nearly five times as likely to face severe disciplinary action against their medical license as doctors who passed both the qualifying exam and oral test on their first attempt.
“The results show that board certification matters,” Dr. Jones said. “It acts as a marker of quality. While it remains unclear if board certification causes you to be a better surgeon, this study provides further evidence that it is an indicator of quality.”
For the study, Dr. Jones and a team of researchers led by Jason Kopp, PhD, used more than 40 years of test results spanning 1976 to 2017, for surgeons who attempted the qualifying exams. They then compared the results from over 44,000 surgeons with disciplinary data obtained from the Federation of State Medical Boards.
“The ABS has an initiative to provide evidence that our programs matter,” Dr. Jones said. “We’re constantly looking to improve the tests and our processes, but we need data to show that our process is working.”
To obtain the data, the researchers looked at surgeons’ performance on each part of the exam. They compared the likelihood of disciplinary action among three groups: doctors who passed the first time, doctors who failed one section or the other but ultimately received certification, and doctors who never received certification. The trend was consistent, showing that as performance on the exam decreased, and as doctors needed multiple attempts to pass, the likelihood of severe disciplinary action against their medical license increased.
This study shows an association without causal interpretation, so for future research Dr. Jones wants to partner with other groups to link certification with patient outcomes, morbidity and mortality. In addition, he wants to link board certification data to malpractice claims to see if there is a difference between certified and non-certified surgeons.
An invited commentary (doi: 10.1001/jamasurg.2020.0108) agreed that future steps should explore whether ABS certification is a predictive measure of surgeon quality. It also concluded that the study provides a data point to start targeted measures to help doctors avoid future mishaps.
“These findings open up a two-way street for both surgeons and hospitals,” said Rachel Kelz, MD, in the Department of Surgery, Center for Surgery and Health Economics at the Perelman School of Medicine, in Philadelphia, who co-wrote the commentary. “While few candidates will actually experience licensure problems, those who fail the certification exam should recognize they are at an increased risk of ruining their career with egregious, unprofessional behavior. The test result provides a chance to be reflective and seek out resources to fix deficiencies that led to failure.”
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