At the turn of the century specialism in medicine became regarded as a public trust and its devoted participants advocated a system of certification by individuals of special training inside the framework of a national specialty medicine organization.

A 1916 photo of the 21st Annual Meeting of the American Academy of Ophthalmology and Otolaryngology in Memphis, Tennessee

The advancements of medical science at the time produced more precise instrumentation which vastly improved the delivery of medical care. Consequently, it generated great interest in the study of specific areas of medicine and patient care. During this period of growth numerous practitioners made false claims of their knowledge in a particular area of medicine. With no system in place to validate these claims, neither the public nor the medical profession could be assured that the so-called specialist had the appropriate education and training. Until the development of the “specialty board movement,” each physician had been the sole assessor of his/her own qualifications to practice a given specialty.

The concept of a specialty board, for the purpose of establishing qualifications for specialists, was first proposed in 1908 by Derrick T. Vail Sr., MD in his presidential address to the American Academy of Ophthalmology and Otolaryngology. He stated:

“I hope to see the time when ophthalmology will be taught in this country as it should be taught, that the day will come when we as oculists demand that a certain amount of preliminary education and training be enforced before a man may be licensed to practice ophthalmology. It should no longer be possible for a man to be called an oculist, by himself or by the laity, after he has spent a month or six weeks in some postgraduate school or after serving as assistant for six months or a year in some oculist’s office. After a sufficiently long time of service in an ophthalmic institution in America or abroad, he should be permitted to appear before a proper examining board …and if he is found competent let him then be permitted and licensed to practice ophthalmology.”

While the prevailing minds of the time agreed that the technical qualification of a specialist may be determined by examinations, ability tests, experience and training reviewed by those already in specialty practice, where and how the physician receives his or her general and graduate training was equally important. The larger problem then became finding opportunities to adequately train specialists in the United States which, in the early years of the twentieth century, were scarce and unorganized.  

Laying the Foundation

Organizational meetings were held, committees were activated, investigations were undertaken and reports were made by the Council on Medical Education and Hospitals of the American Medical Association (AMA/CME), the National Board of Medical Examiners (NBME), the American College of Surgeons and other invested societies and academies to study and bring to order the related issues of graduate medical school education and the recognition of physician specialists.

• In 1914 the American Medical Association (AMA) produced the first list of hospitals with approved internships. Professional field staff were employed in 1928 to collect data and review educational standards in hospitals.
• A 1920 report by the Committee on Graduate Medical Degrees appointed by the Council on Medical Education and Hospitals of the AMA reported on the state of graduate medical opportunities in the United States. That same year, the Council organized 15 different committees in 11 clinical and four basic science areas to recommend what preparation was deemed essential to secure expertness in each of the specialties.
• Also in the early 1920s a subcommittee of the NBME made a detailed study of the methods of medical examination and licensure in Great Britain and France. The report included an analysis of the Conjoint Examining Board of England, comprising the Royal College of Physicians of London and the Royal College of Surgeons of England. (This, and the independent research conducted by some of the ABMS forefathers of the system in Denmark, revealed the underlying pattern for the specialty boards.)
• In 1928, the Council on Medical Education and Hospitals published the “Essentials of Approved Residencies and Fellowships” for the specialties then existing which included approval of residencies.

Example of a 1922 certificate from the American Board for Opthalmic Examinations which later became the American Board of Opthalmology (Click on image for larger version)

While some workable plan was being looked for, there had been examining boards quietly and efficiently working in certain specialties whose efforts had gone far to improve matters in the specialties which they represent. These include the American Board of Ophthalmology (1917), the American Board of Otolaryngology (1924), the American Board of Obstetrics and Gynecology (1930) and the American Board of Dermatology and Syphiology (1932).

During the 1930s sporadic and unsuccessful attempts were made to further the specialty movement through various established national organizations. Many specialty societies, medical education institutions and physicians continued to research and make presentations on the topic of creating specialty qualifications standards and issuing credentials to assure everyone of a physician’s competence and experience. Among the handful of physicians actively involved in the specialty board movement were:

• Louis B. Wilson, MD – Association of American Medical Colleges and later the first President of the Advisory Board of Medical Specialties
• J. S. Rodman, MD – National Board of Medical Examiners and later first Vice-President
• Paul Titus, MD – American Board of Obstetrics and Gynecology and later first SecretaryTtreasurer
• W. P. Wherry, MD – American Board of Otolaryngology and later first Executive Committee Member
• W.B. Lancaster, MD – American Board of Ophthalmology and later first Executive Committee Member
• Robin C. Buerki, MD – American Hospital Association
• C. Guy Lane, MD– American Board of Dermatology and Syphilology
• Willard C. Rappelye, MD – Association of American Medical Colleges
• Harold L. Rypins, MD – Federation of State Medical Boards of the U.S.A.
• W. H. Wilder, MD– American Board of Ophthalmology

These men presented the case for the certification of specialists and mapped out roles for medical schools, specialty boards and states in the process.

Establishing a National System of Specialty Boards

A pivotal point in the crusade was the May 1932 creation of the Committee on Specialists by the NBME. This committee, chaired by Louis B. Wilson, MD included: Hugh S. Cumming, MD, Surgeon General, United States Public Health Services; Robert U. Patterson, MD, Surgeon General, United States Army; Everett D. Plass, MD; Head of the Department of Obstetrics-Gynecology, Iowa University; and J.S. Rodman, MD, Secretary, National Board of Medical Examiners. Dr. Wilson presented the committee’s report in June which included “Suggestions Concerning National Qualifying Boards in Clinical Specialties”. These suggestions were presented to various interested organizations throughout the year and received overwhelming support. In part, these suggestions included:

1. The purpose of a national qualifying board in a clinical specialty is to furnish to the entire medical profession, including state boards who are charged with local regulation of the practice of medicine, accurate and reliable information as to who is competent to practice that specialty.
2. One nationwide qualifying board in a specialty is more desirable than multiple boards which might be set up in several states.
3. A national qualifying board in a clinical specialty should be organized by representatives from each of the several national societies in that specialty.
4. New national specialty qualifying boards should study the organization of national and specialty qualifying boards already in existence.
5. Each national specialty qualifying board should be entirely autonomous both professionally and financially. It should, however, have conference relationships with other national specialty qualifying boards.
6. Each national specialty qualifying board should seek to make available to the entire medical profession detailed information concerning all specialists qualified by the said board.

It soon became very apparent that development of a national system of specialty boards was fully underway.

The development of the specialty board system during the 1920s and 1930s influenced and improved graduate medical education and the competence of physicians. The most notable impact being their requirement of additional education obtained in institutions approved by the AMA or the boards and the residency review committees’ accreditation of specific programs. The boards designated certain types of clinical and practical experiences as well as formal graduate courses required for admission to the examinations. A specific number of years embodying such experiences was mandated and, as time went on, these details have been modified accordingly to better suit the current state of medicine.

Consensus was reached in establishing a uniform system whereby specialty boards administer examinations conducted by a group of peers selected by the specialists themselves. The rapid acceptance of specialty boards by the medical profession and its national organizations also began to restrain physicians with little or no formal education in the specialty from designating themselves as specialists.

Created from strong incentives within the medical profession to improve the capability of physicians to care for patients, the specialty boards have accomplished a great deal in more than 75 years of existence. This success is almost exclusively the result of the vision, dedication, and comparably selfless effort of a relatively small number of physicians who devoted their efforts and talents into establishing specialty boards and creating the Advisory Board for Medical Specialties, now the American Board of Medical Specialties (ABMS). Today’s ABMS Member Boards are made up of dedicated persons who contribute their time and effort to advance the standards of their specialty. Like those before them, they are filled with a sense of responsibility to the medical consumers of our nation to determine the competence of candidates who appear voluntarily before them for certification.

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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.