The development of new medical specialties has been an essential feature of the growth of modern scientific medicine. Each represents a distinct and well-defined field of medicine and reflects advancement in medical knowledge and practice.

The time has long since passed when any individual could master the entire field of medical knowledge and practice. Since the early part of the eighteenth century the course of medical education and practice has been one of progressive specialization. In the early part of the twentieth century, medical specialization was just beginning, and the educational systems to provide proper education and training were racing to catch up.

In the years following World War II, the explosion of new medical knowledge and new technologies resulted in an increasing number of specialties and specialists and caused a rapid decline in the number of developing physicians choosing general practice as a career. Up until that time, general practitioners provided the majority of healthcare in solo practices. During the 1950s requests to the Advisory Board for Medical Specialties by numerous organizations wishing to be recognized as a specialty board significantly increased.

In the mid-1960s there was growing concern on the diminishing supply of general physicians and the growth of multispecialty practices. The public became worried about accessibility to appropriate medical care. In 1966, the notion of the primary physician providing continuing and comprehensive care was introduced in a report by the Millis Commission.

New public policies were aimed at encouraging physicians to pursue practice in primary care through the availability of residency programs in family practice, general internal medicine and general pediatrics. The specialty of family practice also emerged at this time with the American Board of Family Practice being incorporated into the Advisory Board in 1969.

Answering the Concern Over Excessive Specialization

Excessive specialization was one of the side effects to specialization of which Advisory Board was keenly aware. While it was clearly understood that there is a core of basic knowledge central to each specialty, it was also recognized that specialty areas would expand their focus on different areas within a specialty. Official recognition of those physicians practicing in the new areas would be necessary. This led to a rise in the development of subspecialty certificates granted by the Member Boards.

The history and development of the subspecialty process began in 1972 when the ABMS Committee on Certification, Subcertification and Recertification (COCERT) discovered there were no generally accepted definitions for a wide variety of terms related to the field of certification. Furthermore, COCERT found that the definitions for primary, subsidiary (boards for subspecialty certification formed under the aegis of existing specialty boards) and conjoint boards as then contained in the “Essentials for Approval of Examining Boards in Medical Specialties” were in need of revision. As a result, the committee concluded that the term “General Certification” was preferable to the terms “Initial” or “Primary” and “Special Certification” was a more suitable term to use for those types of certification identifying specific areas of special competence within the purview of Member Boards.

In March of 1973, the ABMS Assembly decided that the related primary boards should continue to have authority for certification for special competence in the areas formerly represented by the subsidiary boards. In 1981 COCERT was requested to consider the need for additional methods of recognizing qualified practitioners because there was a belief there might not be enough flexibility in existing routes to either general or special certification to accommodate emerging fields of practice, especially those that might cross a number of existing specialties. As a result, COCERT formed a subcommittee to address the question of possible alternative mechanisms for the recognition of practitioners from other fields in medicine than those that currently exist within the structure of ABMS.

In 1985 the COCERT subcommittee presented its final proposal which was passed by the ABMS Assembly that same year. The proposal included the term “Added Qualifications” and was meant to recognize the practitioner’s identification with the primary discipline from which he or she comes as well as the added preparation. This term and that of “Special Qualification” were originally designed to curtail fragmentation of the primary specialty.

By the early 1990s, many ABMS members and COCERT believed that these terms further confused the subspecialty designations. COCERT met in 1994 to review the issue of the Certificates of Added Qualifications (CAQ) and Certificates of Special Qualifications (CSQ), their relationship to each other and the development of pathways of recognition in subspecialty areas which overlap each other.

COCERT made a number of recommendations which were thoroughly reviewed by the ABMS Assembly. Upon the 1995 adoption of these recommendations and the enabling changes in the ABMS Bylaws, the use of these terms to describe subspecialty certificates issued by ABMS Member Boards was discontinued. However, Member Boards, at their option, may continue to designate existing subspecialty certificates as “Added Qualifications” and “Special Qualifications” and use the terms freely for internal purposes.

Member Boards may issue, alone or in conjunction with another Member Board, certificates to designate qualifications in one or more subspecialty areas. Currently, ten subspecialty certificates are issued by multiple boards including one that is co-sponsored by ten ABMS Member Boards.

To ensure that commonly shared goals and standards of ABMS are maintained and that the original purposes of certification continue to exist and continue to be met, Member Boards conduct an evaluation of the impact and effect of the subspecialty at five- and ten-year intervals.

Number of Subspecialty Certificates Issued by ABMS Member Boards

And the numbers kept growing, today, the Member Boards can certify in more than 145 specialties and subspecialties

The information for this history has been compiled by ABMS staff through an examination of ABMS' records and documents. As with all historical reporting, the information we've provided is based on our understanding and interpretation of these records. If you find any factual inaccuracies, please advise us by contacting the Director of Marketing and Communications at (847) 563-4531.