ABMS Policies

SECTION I. DEFINITION OF A MEDICAL SPECIALTY BOARD ELIGIBLE FOR ABMS REVIEW

A medical specialty board must be a separately incorporated and financially independent body which determines its requirements and policies for certification, selects the members of its governing body in accordance with the procedures stipulated in its bylaws, accepts its candidates for certification from persons who fulfill its stated requirements, administers examinations and other program components, and issues certificates to those who submit to and pass its evaluations.

SECTION II. OBJECTIVES OF ABMS MEDICAL SPECIALTY BOARDS

The fundamental objective of all approved ABMS medical specialty boards is to act in the public interest by contributing to the improvement of medical care and the health of patients by establishing qualifications for candidates, evaluating the qualifications of candidates who apply, certifying as Diplomates those candidates who are found to be qualified, and ensuring that certified Diplomates maintain their qualifications. ABMS medical specialty boards also assist in ensuring high standards for graduate medical education (GME) in collaboration with other concerned organizations and agencies.

To accomplish these objectives, ABMS medical specialty boards:

• Identify and define the standards, knowledge, clinical judgment, and skills necessary to demonstrate competencies within a specific scope of practice;
• Determine whether candidates have received adequate training and preparation in accordance with standards established by the medical specialty board;
• Create independent, external assessments and conduct comprehensive evaluations of the knowledge, clinical competence, performance, and experience of such candidates, through initial and continuing certification;
• Issue certificates to those candidates and Diplomates found qualified under the stated requirements of the medical specialty board; and
• Bring value to Diplomates, patients, the public, and the profession through a focus on high standards, professionalism, a culture of lifelong learning, and the delivery of high-quality, safe care delivered according to the established standards of the specialty.

SECTION III. REQUIRED CONTENT FOR APPLICATIONS

In order to be recommended for approval by the ABMS Advisory Body on Specialty Board Development (“Advisory Body” [see Section IV]), a new applicant specialty board must demonstrate that all of the following requirements have been satisfied.

1. The applicant board must demonstrate that it is primarily composed of Diplomates who hold a Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), or foreign equivalent (e.g., Bachelor of Medicine, Bachelor of Surgery [MBBS]) degrees. The ABMS Board of Directors will determine whether this criterion has been satisfied in its sole and absolute discretion based on the unique circumstances of each applicant board.
2. The applicant board must define its objectives and function, including a scientific rationale demonstrating a substantial advancement in medicine or technology, evidence of a distinct and well-defined field of medical practice, and/or confirmation of an interdisciplinary practice field sufficiently distinct from existing fields of practice. The applicant board must present data on the field’s core content/competencies and scope of practice based on a validated blueprint of the professional area, including present and projected future public needs and expected growth.
3. The applicant board must present a rationale for how this field of practice serves the patient/public interest, as well as supports candidates’/Diplomates’ needs.
4. The applicant board must demonstrate how its training and evaluation methods satisfy ABMS’ standards.
5. The applicant board must describe the training needed to meet requirements for certification and delineate how this training is sufficiently distinct from the training required for certification by existing ABMS medical specialty boards.
6. The applicant board must define standards for the requisite knowledge and skills in the field of practice. They must demonstrate that candidates for initial certification acquire and maintain these standards. A specific plan for development and validation of the requirements for initial and continuing certification must be presented, along with an outline of and rationale for the qualifications to be required of candidates for certification. The applicant board also must provide a detailed explanation of how the program will adhere to ABMS’ initial, continuing, and organizational standards and provide a detailed plan for program review and evaluation.
7. Except as provided in this section, the applicant board must require all new Diplomates to successfully complete an ACGME-accredited residency or training program prior to becoming certified. If the applicant board is in the process of obtaining ACGME accreditation for the GME training program(s) for the field of practice at the time of application for admission to the ABMS (and if all other conditions are satisfied), the ABMS Board of Directors may conditionally approve the applicant board contingent upon ACGME accreditation of the program(s). Applicant boards may not issue new certificates under the ABMS imprimatur or use the ABMS seal until final approval as a medical specialty board has been granted by the ABMS.
8. A plan must be presented to accommodate the certification of individuals who complete their GME prior to the establishment of ACGME-accredited or other accredited programs in the specialty. A description of the practice requirements for Diplomates practicing in the field of practice without ACGME-accredited training must be provided. The description should include a summary of the qualifications, the examination(s) required, and the number of physicians or medical specialists to be certified in this manner. Applicant boards with existing certified diplomates at the time of application to membership in the ABMS must present a plan to accommodate the ABMS certification of individuals if such ABMS certification for existing diplomates is desired by the applicant board.
9. The applicant board must demonstrate broad support from the relevant field of medical practice and broad professional support. The applicant board must provide the communications used to notify the field of medical practice of the proposed application.
10. The applicant board must provide the total number, along with the complete list of institutions providing residency or other acceptable training programs in the field of practice; the total number of residency positions available; and the number of residency programs planned for creation within the next five years. This data should demonstrate the growth and sustainability of these training programs.
    
    The applicant board further must provide the following:
11. The official name of the proposed board, including the names and professional qualifications of its officials and the organization that each official represents (if applicable).
12. An operational plan, including sufficient detail for evaluation of the following areas:
    
    MISSION AND OPERATIONS
    The applicant board must have a mission that aligns with the mission of ABMS and articulates the purpose of board certification in the proposed field of medical practice. The applicant board will provide copies of existing policies and procedures that promote professionalism and excellence in operations and that strive to meet the needs of the public and the profession. The applicant board is expected to conduct periodic reviews of its operations as supported by principles of good governance.
    
    GOVERNANCE STRUCTURE
    The applicant board must demonstrate that its Board of Trustees/Directors follows best practices for governance and is able to address the needs and concerns of its stakeholders. Board members should have sufficient professional expertise for effective board operation and management. The applicant board must specifically articulate how the perspectives of active clinician Diplomates, stakeholders in the field of medical practice, patients, and the public inform board governance, and must explain the presence or absence of any structural or process components related to equity.
    
    BUSINESS PLAN
    The financial support for a valid, objective program of candidate and Diplomate assessment must be presented, and the applicant board must attest that adequate resources and revenue are available to support and sustain the applicant board. The data should include the approximate number of physicians or medical specialists currently engaged in the practice of the field of medical practice, as well as projected numbers of examinees for initial and continuing certification and projected certification fees. The applicant board must reflect appropriate, transparent financial stewardship in a manner befitting its non-profit status,
13. A copy of the Constitution (if applicable) and Bylaws;
14. A copy of the Articles of Incorporation;
15. A copy of the application form for candidates for initial and continuing certification; and
16. A non-refundable application fee.

SECTION IV. PROCEDURE FOR THE RECOMMENDATION OF APPROVAL OF NEW SPECIALTY BOARDS

Upon receipt of a completed application addressing required content outlined in Section III, the Advisory Body will be convened. The Advisory Body comprises the following individuals (all with vote unless otherwise indicated):

1. The ABMS President and Chief Executive Officer;
2. The Chair of the ABMS Board of Directors;
3. The Chair of the ABMS Accountability and Resolution Committee;
4. Three non-conflicted (as determined by the ABMS Chief Legal Officer) ABMS Member Board Empowered Representatives, appointed by the Chair of the ABMS Board of Directors;
5. The Chair of the ABMS Public Member Caucus (unless this individual is currently serving as the Chair of the ABMS Accountability and Resolution Committee, in which case another Public Member Director of the ABMS will be selected by the Chair of the ABMS Board of Directors);
6. The Chair of the ABMS Stakeholder Council (without vote);
7. The Chair of the ABMS Committee on Certification (without vote);
8. The Chair of the ABMS Committee on Continuing Certification (without vote);
9. The President and Chief Executive Officer of the Accreditation Council for Continuing Medical Education (without vote); and
10. The Chair of the American Medical Association Council on Medical Education (without vote).

The Chair of the ABMS Committee on Certification will serve as the Chair of the Advisory Body (without vote). A senior staff member of the ABMS will serve as the Secretary of the Advisory Body (without vote) and the administrative liaison between the applicant board and the Advisory Body. A senior physician staff member of the ABMS who is not a member of the Advisory Body will serve as the clinical liaison between the applicant board and the Advisory Body.

The Advisory Body will solicit third-party comments regarding the application from the ABMS’ existing Member Boards; the ABMS’ Associate Members; specialty and state medical societies; patient and consumer advocacy groups; hospitals and health systems; insurers; the public; and any other relevant stakeholders during an open comment period of at least 90 days. Anonymous comments will not be accepted. All comments from third parties will be shared with the applicant board. The applicant board, at its discretion, may submit a written response to the Advisory Body regarding third-party comments.

At any time during its review, the Advisory Body may consult experts to assist in evaluating the applicant board’s submission, and/or request additional information, feedback, or opinions from the applicant and/or third parties, such as major specialty organizations, related to the applicant board’s field of practice. The applicant board will be invited to make an oral presentation to the Advisory Body. At the Advisory Body’s discretion, other parties may be invited to make an oral presentation.

After review of the application, comments, expert testimony, and oral presentation(s), the Advisory Body will submit a written, non-binding recommendation, including the rationale for said recommendation, to the ABMS Board of Directors for approval or disapproval of the applicant board based on an assessment of each of the criteria included in this document. The ABMS Board of Directors will consider the recommendation of the Advisory Body at its next regularly scheduled meeting, provided that at least 60 days have passed since the recommendation has been shared with the Board. The Chair of the ABMS Board of Directors may request that the Chair of the Advisory Body and/or an applicant board representative be available to respond to questions during the Board of Directors’ discussion of the recommendation.

The ABMS Board of Directors may approve the application for an applicant board, deny the application for an applicant board, or recommend that an applicant board consider an alternative such as pursuing conjoint board status. Denial of the application by the ABMS Board of Directors is not subject to appeal. Approval of admission to the ABMS as a medical specialty board does not constitute simultaneous approval of the applicant board’s certificate programs; these will need to be separately reviewed and approved according to existing ABMS policies and procedures, including those established by the ABMS Board of Directors, ABMS Committee on Certification, and ABMS Committee on Continuing Certification.

In the event of a negative outcome, the Board’s communication to the applicant board of same will include an explanation of why the application was not approved.

Please see Appendix A in the PDF for a flowchart of the review process for applicant board applications.

SECTION V. REAPPLICATION TO THE ABMS

In the event an application for an applicant board is denied, the applicant board may file a new application no sooner than twenty-four months following notification, to the applicant board, of the previous denial of the ABMS.

1. Reapplications must clearly address any areas of deficiency identified in the Board’s previous denial and highlight relevant changes.
2. Reapplications will not be given preference over new applications already in the review queue.
3. Reapplications will not be exempted from the application fee.

SECTION VI. PROCESS FOR THE TRANSITION OF AN EXISTING ABMS SUBSPECIALTY TO A DISTINCT PRIMARY BOARD

At certain times and under certain conditions, existing ABMS subspecialties may wish to convert their status to primary specialty boards. Subspecialties wishing to convert their status must demonstrate that they have satisfied Section III of this document, in addition to the following criteria, prior to a convening of the Advisory Body:

1. The subspecialty board(s) must detail any proposed changes to the field’s core content/competencies and scope of practice based on a validated blueprint of the professional area, including present and projected future public needs and the rationale for how any such changes and the evolution to primary board status will impact the specialty and will better serve the patient/public interest than the current board structure.
2. The subspecialty board(s) must detail impacts to Diplomates currently practicing in the affected subspecialty, such as whether maintenance of primary certificates is required and/or whether their current certification cycle will be honored.
3. The subspecialty board(s) must delineate how, based on changes or evolution, the practice of that subspecialty, its foundational science and knowledge base, and training requirements are distinct from the primary specialty from which it emerged.
4. The subspecialty board(s) must demonstrate evidence of dialogue with the parent specialty board(s) and include an official response from the parent specialty board(s) regarding its support/non-support for this evolution.
5. Subspecialties existing under multiple parent boards must detail how different primary boarded Diplomates will be tracked into the new primary specialty board.

Please see Appendix B in the PDF for a flowchart of the review process for existing subspecialties wishing to evolve into a distinct primary specialty board.

SECTION VII. PROCESS FOR TRANSITION OF AN EXISTING ABMS CONJOINT BOARD TO A DISTINCT PRIMARY BOARD

At certain times and under certain conditions, existing ABMS Conjoint Boards may wish to convert their status to primary specialty boards. Conjoint Boards wishing to convert their status must demonstrate that they have satisfied all of Section III of this document, in addition to the following criteria, prior to a convening of the Advisory Body:

1. The Conjoint Board must provide a rationale for transition to a distinct primary board.
2. The Conjoint Board must demonstrate evidence of dialogue with the sponsoring boards and include an official response from the sponsoring boards regarding support/non-support for this evolution.
3. The Conjoint Board must detail any proposed changes to the field’s core content/competencies and scope of practice based on a validated blueprint of the professional area, including present and projected future public needs and the rationale for how any such changes and the evolution to primary board status will better serve the patient/public interest than the status quo.
4. The Conjoint Board must detail any proposed changes to current standards for requisite knowledge, training requirements, certification program, and/or continuing certification program including present and projected future public needs and the rationale for how any such changes and the evolution to primary board status will better serve the patient/public interest than the status quo.
5. The Conjoint Board must detail impacts to Diplomates currently practicing in the affected specialty, such as whether maintenance of primary certificates is required and whether their current certification cycle will be honored.

Please see Appendix C in the PDF for a flowchart of the review process for existing Conjoint Boards wishing to evolve into a distinct primary specialty board.

SECTION VIII. AMENDMENTS OR REVISIONS

Amendments or revisions to the processes outlined in this policy must be approved by the ABMS Board of Directors.

Download a PDF of this Policy on Admission of New Medical Specialty Boards to Membership in ABMS^[PDF]

ENGAGEMENT STRATEGIES:

The following strategies provide opportunities for engagement with Associate Members.

1. Associate Members will be invited to participate in meetings of the ABMS Board of Directors when appropriate. These invitations may be to meetings/strategy discussions of the full Board of Directors; a Board Caucus; and/or other Board Committee(s).
2. Associate Members will be invited to submit reports to the Board of Directors on activities of their organizations or on issues of strategic importance, either at board meetings or at regular intervals during the year.
3. A summary of each Board of Directors meeting will be distributed to Associate Members within 45 days of the meeting.
4. ABMS staff, volunteers, Board Members, or designees from the Board community may participate in Board meetings of Associate Members when invited.
5. ABMS staff will cultivate relationships with Associate Member peers.
6. Nominees from Associate Members may be considered for service on committees of the Board.
7. The ABMS Executive Committee will review the list of ABMS’ Associate Members on an annual basis to determine whether it is appropriate or if modifications should be recommended. A list of Associate Members current with the approval of this policy is included in Appendix A.

APPENDIX A: ASSOCIATE MEMBERS OF THE AMERICAN BOARD OF MEDICAL SPECIALTIES

Accreditation Council for Continuing Medical Education (ACCME)

Accreditation Council for Graduate Medical Education (ACGME)

American Hospital Association (AHA)

American Medical Association (AMA)

Association of American Medical Colleges (AAMC)

Council of Medical Specialty Societies (CMSS)

Educational Commission for Foreign Medical Graduates (ECFMG) / Intealth

Federation of State Medical Boards (FSMB)

National Board of Medical Examiners (NBME)

Download a PDF of this ABMS Policy on Associate Member Engagement^[PDF]

2. “General Certification” is the first certification awarded by a Member Board to approved candidates who meet the requirements for certification in a specified field of medical practice.
3. “Maintenance of Certification/Continuing Certification” is the recognition by a Primary or Conjoint Board, from time to time, of the continuing qualification oaf a diplomate and a diplomate’s satisfaction of the requirements of its Maintenance of Certification or Continuing Certification program.
4. A “Primary Board” is a separately incorporated, financially independent body which determines its own requirements and policies for certification, elects its members in accordance with the procedures stipulated in its own bylaws, accepts its candidates for certification from persons who fulfill its stated requirements, administers examinations, and issues certificates to those who voluntarily satisfy its requirements.
5. “Subspecialty Certification”
   1. Subspecialty Certification is conferred by one or more Member Boards in a component of a Medical Specialty or Medical Subspecialty; and
   2. Subspecialty Certification is authorized to be conferred only to certified physicians or medical specialists who have been certified by one or more Member Board(s) in an area of General Certification.

GENERAL CERTIFICATION AND SUBSPECIALTY CERTIFICATION:

Member Boards may issue general certificates of qualification to physicians and medical specialists in the fields represented by such Member Boards and subspecialty certificates of qualifications to physicians and medical specialists in the fields represented by such Member Boards.

1. When approved by the Corporation in accordance with the provisions of Section 7.2 below, a Member Board may issue, alone or in conjunction with another Member Board, certificates to designate qualifications in one or more subspecialty areas of the specialty field represented by that Member Board. When authorized by the Corporation for subspecialty certification, the Member Board may establish subspecialty committees or sub-boards in the approved subspecialty, without further authorization from the Corporation. Subspecialty certification is conferred by one or more Member Boards in a component of the specialty or subspecialty authorized by the Corporation for certification by one or more Member Boards.
2. While subspecialty certification is intended to apply primarily to diplomates of the sponsoring Member Board(s), a sponsoring Member Board may accept applicants holding certificates from other Member Boards for examination and subspecialty certification authorized by the Corporation on a case by case basis or by establishing additional pathways to encompass more than one individual. The additional pathways to subspecialty certification must be:
   1. endorsed by the Member Board sponsoring the subspecialty certification;  
   2. endorsed by the Member Board whose diplomates are being proposed for certification; and  
   3. approved by the Board of Directors by a Representational Supermajority Vote. 
3. Training programs leading to general certification and subspecialty certification must be associated with a residency accredited by the Accreditation Council for Graduate Medical Education or equivalent Canadian accredited residency.
4. The program for training required for general certification must be a minimum of three (3) years in duration and subspecialty certification must be a minimum of one (1) year in duration. General certification and subspecialty certification incorporate a specific and identifiable body of knowledge that may include certain procedural skills or practice modes, but must not be limited only to training in a technical skill.
5. Approval of any general certification or subspecialty certification must be accomplished by the mechanism and process authorized in Section 7.2. The Member Board(s) seeking authorization to issue general certification or subspecialty certification in a proposed area must provide assurance that the Member Board will conduct an evaluation of the impact and effect of the proposed general certificate or subspecialty certificate on its own general and subspecialty training and practice as well as that of other Member Boards.
6. All future applications from the Member Boards for authorization to issue subspecialty certificates will be approved by the Board of Directors by a Representational Supermajority Vote with the name of the subspecialty designation only.

NEW CERTIFICATION, MODIFICATION OF EXISTING TYPES OF CERTIFICATION, OR CHANGE IN NAME:

1. Prior approval of the Corporation is required if any Member Board proposes creation of a new type of certification, substantive modification of existing requirements for certification, or change in its name. Intent to submit a proposal for an additional or a new form of certification must be announced to all Members at least six (6) months before the meeting at which the formal proposal will be submitted for a vote. A proposal for such action by a Regular Member may be submitted to the President and CEO at any time. The proposal shall be considered by COCERT, which shall prepare and submit recommendations to the Board of Directors for action. The proposal and the recommendations of COCERT shall be submitted to the Board of Directors for decision by a Representational Supermajority Vote provided,
   1. that not less than ninety (90) days prior to the first date of consideration by COCERT or the Board of Directors, whichever date is earliest, each Member shall have been provided with a copy of the proposal and notice that the proposal will be submitted to for decision by the Board of Directors by a Representational Supermajority Vote on a date certain; and
   2. that approval of the proposal shall require Representational Supermajority Vote cast at a regular meeting of the Board of Directors at which a quorum is present.
2. A request from a Member Board for a new or modified general certificate or subspecialty certificate must be forwarded to the President and CEO in the form determined by COCERT, with the approval of the Board of Directors.
3. If a Member Board creates a new certification, modifies an existing certification, or changes its name without prior approval of this Corporation, then a grievance may be brought against the Member Board pursuant to these Bylaws.

CHANGE IN CERTIFICATION REQUIREMENTS:

Except as otherwise set forth in these Bylaws, Primary and Conjoint Boards have the responsibility of establishing their own educational requirements for certification and may change such requirements without being required to submit such change for prior approval of the Corporation; provided that such Primary and Conjoint Boards shall forward to the President and CEO written notice of any change in their certification requirements at least sixty (60) days before the proposed change is to become effective.

CHANGES IN WORDING OF CERTIFICATES:

Any change in the wording on an existing certificate which refers to or names the areas of practice or the areas of training or specialization of the holders of such a certificate shall constitute a substantive modification of an existing type of certificate and shall be subject to the provisions of Section 7.2 of the Bylaws of the Corporation. Any change in an existing certificate shall be submitted to the Membership for information upon approval of such change by the Board of Directors.

CHANGE IN MEMBER STATUS FROM CONJOINT TO PRIMARY BOARD:

A Conjoint Board may submit to the President and Chief Executive Officer an application for a change in membership status to that of Primary Board in a form established by the Board of Directors. The application, when completed, shall be considered by the Board of Directors, together with the summary and recommendations from other appropriate consultant bodies, and submitted to the Board of Directors for approval by a Representational Supermajority Vote. Any such Conjoint Board may seek approval of a change in its membership status to that of Primary Board at any meeting of the Board of Directors at which a quorum is present, provided that not less than one hundred twenty (120) days prior to the meeting each Member and member of the Board of Directors shall have been given a copy of the application together with the written notice of the meeting date. The criteria that will be used in evaluating the application will be determined by the Board of Director, in its discretion.

Download a PDF of this ABMS General Policy on Certification by Medical Specialty Boards^[PDF]

At the heart of these ongoing declarations is a three-part promise to acquire, maintain and advance: (1) an ethical value system grounded in the conviction that the medical profession exists to serve patients’ and the public’s interests, and not merely the self-interests of practitioners; (2) the knowledge and technical skills necessary for good medical practice; and (3) the interpersonal skills necessary to work together with patients, eliciting goals and values to direct the proper use of the profession’s specialized knowledge and skills, sometimes referred to as the “art” of medicine. Medical professionalism, therefore, pledges its members to a dynamic process of personal development, life-long-learning and professional formation, including participation in a social enterprise that continually seeks to express expertise and caring in its work.

From this vantage point, medical professionalism functions as an ideology that declares an important role for its members in organizing and delivering health care in society. The standards governing professional work are articulated in various institutionalized forms, and in varying degrees of specificity, in documents such as codes, charters, competencies, and curriculae – with their content subject both to ongoing review and to improvement by the conjoint effort of members and the public. Core to both the profession’s technical expertise and its promise of service is the view that members, working together, are committed to maintaining the standards and values that govern their practice and to monitoring each others’ adherence to their standards on behalf of the public.

From within this framework, medical professionalism embraces a wide variety of behaviors, which can be articulated as specific competencies. Frequently articulated competencies include a commitment to carrying out professional responsibilities and an adherence to ethical principles; demonstration of compassion, integrity, and respect for others; responsiveness to patient needs that supersedes self-interest; respect for patient privacy and autonomy; accountability to patients, society and the profession; and sensitivity and responsiveness to a diverse patient population.

For medical professionalism to function effectively as a means of organizing and delivering health care, it must be recognized as an active and iterative process involving: (1) defining; (2) debating; (3) declaring; (4) distributing; and (5) enforcing the set of discrete, shared standards and values that medical professionals agree must govern its work. During this process, proposed definitions of competencies (whether technical, interpersonal, or values-based) are vetted through a process of internal debate. They then are declared to the public to open dialogue and to assure that they meet social needs while upholding core professional values. Subsequently, these standards must be distributed to all relevant stakeholders to ensure they are understood as the heart of medicine’s social contract with society, and they must be enforced as such by the profession. This entire process is underscored by a commitment to ongoing engagement with each other and with other stakeholders to develop and maintain consensus and to conjointly promote and enforce the agreed-upon competencies on behalf of patients and the public.

A BRIEF DEFINITION OF MEDICAL PROFESSIONALISM

ABMS recognizes the benefits inherent within a diverse community of volunteers and in all committees promotes inclusion of individuals with varied experiences, perspectives, backgrounds, and career phases.

HOW DOES PROFESSIONALISM WORK?

For medical professionalism to function effectively there must be interactive, iterative and legitimate methods to debate, define, declare, distribute, and enforce the shared standards and ethical values that medical professionals agree must govern medical work. These are publicly professed in oaths, codes, charters, curricula, and perhaps most tangible, the articulation of explicit core competencies for professional practice (see, for example, the ABMS/ACGME Core Competencies). Making standards explicit, sharing them with the public, and enforcing them, is how the profession maintains its standing as being worthy of public trust.

Download a PDF of this ABMS Policy on Medical Professionalism^[PDF]

This policy applies only to Member Boards with training programs of 2 or more years duration.

This policy applies only to Member Board eligibility requirements for Initial Certification and does not supersede institution or program policies and applicable laws.

POLICY:

1. Member Boards must have a written and accessible policy that clearly states the training requirements for candidates to become eligible for Initial Certification. This policy should clearly state how much time in training is required for candidates to become eligible for Initial Certification.
2. Member Board eligibility requirements must incorporate time away from training for purposes of parental, caregiver, and medical leave in addition to allowed time away for vacation.
3. Member Board eligibility requirements must allow for a minimum of 6 weeks of time away from training for purposes of parental, caregiver and medical leave at least once during training, without exhausting all other allowed time away from training and without extending training. Member Boards must allow all new parents, including birthing and non-birthing parents, adoptive/foster parents, and surrogates to take parental leave.
4. Member Boards can accomplish the above-stated goals by adding to existing allowances for time away from training for vacation, allowing accrual or averaging of time over the course of a training program, or other mechanisms.
5. Member Board policies must clearly state when time away from training for purposes of parental, caregiver and medical leave will require an extension of training in order to become eligible for Initial Certification.
6. Member Boards may establish guidelines for candidates requesting accommodation for parental, caregiver or medical leave. Examples include: requiring the candidate’s program director and clinical competency committee to document how the candidate’s clinical experiences and educational objectives will be met, or to attest that competency has been achieved without an extension of training.
7. Member Boards may limit the maximum amount of time away from training a candidate may take in any single year or level of training.
8. Member Boards must make reasonable testing accommodations for candidates who extend training, for example, by allowing candidates to take the relevant examination so long as the candidate completes all training requirements by a clearly specified date.

APPENDIX:

This additional guidance is intended for consideration of ABMS Member Boards and should not be interpreted as requirements:

Member Boards that are exempt from this policy are encouraged to consider accommodations for parental, caregiver and medical leave consistent with the spirit of this policy.

Irrespective of time away from training, training is expected to be extended when the clinical competency committee has determined that competency has not been achieved.

In the interest of trainee well-being, Member Boards are encouraged to establish eligibility requirements that allow for at least 6 weeks away from training for purposes of parental, caregiver and medical leave at least once during training while preserving at least 2 weeks of vacation time. Member Boards with requirements that allow for more than 6 weeks of time away from training for any purpose including parental, caregiver and medical leave are in compliance with the above policy.

Member Boards are encouraged to have examination policies that foster flexible scheduling and exam delivery to reduce disruption or delays in career progression for physicians taking parental, caregiver and medical leave.

Member Boards should encourage subspecialty fellowships to foster start dates after the end of July to accommodate physicians who extend training.

Member Boards are encouraged to work with testing centers and other related organizations to facilitate reasonable accommodations for pregnant, peripartum and breastfeeding candidates to accommodate lactation or breast-feeding during certification examinations, such as lactation rooms, more flexible breaks and longer testing periods.

ABMS and Member Boards should collect data on the use of parental leave policies after implementation to study their effect, including data on the impact of parental, caregiver, and medical leave on certifying exam pass rates.

ABMS supports the GME community in investigating and moving towards competency-based training and integrating competency-based criteria such as milestones achievement, targeted (focused) assessments, learning analytics, etc. prior to the implementation of comprehensive competency-based programs.

Download a PDF of this ABMS Policy on Parental, Caregiver and Medical Leave During Training^[PDF]

This Policy on Professional Conduct (“Policy”) is intended to augment those policies and provide further guidance to preserve the trustworthiness of the credential. Under this Policy, in evaluating professionalism, Member Boards are expected to focus not on the nature of the restriction or limitation imposed by a state licensing board on a medical license, but instead on the underlying act or omission that precipitated the restriction or limitation based on the professional norms expected of diplomates. This Policy thus reaffirms that certification by a Member Board is an independent professional judgment that a diplomate has demonstrated the professionalism required for ABMS board certification.

POLICY:

1. The demonstration of conduct consistent with professional norms by diplomates is a condition for ABMS Member Board certification.
   1. Professionalism is a fundamental expectation of competent specialty practice and a pre-requisite for ABMS Member Board certification.
   2. This Policy applies to all applicants for certification, current physician specialist diplomates and non- physician diplomates and is not exclusive to licensed physicians.
   3. Diplomates are assumed to satisfy professional standards of conduct, unless credible verifiable evidence exists of relevant misconduct. “Relevant misconduct” is any conduct related or unrelated to a diplomate’s practice that represents, in the judgment of the Member Board, the following:
      1. A risk to the safety of patients, members of the diplomate’s health care team or the public; or
      2. A threat to the trustworthiness of the profession or of the certification.
2. Member Boards shall have professional conduct policies.
   1. Each Member Board shall implement the requirements of this Policy by establishing or revising its own policy in accordance with its bylaws and ABMS bylaws and standards.
   2. The Member Board’s policy shall articulate its expectations of diplomates in terms of professional norms and shall require all diplomates to uphold such norms as a condition for certification.
   3. The Member Board shall make its policy publicly available and easily accessible to all diplomates.
   4. The Member Board may require diplomates to report any actions or events that may constitute a breach of professional norms within sixty (60) days of the action or event.
   5. The Member Board may require diplomates who report any actions or events that may constitute a breach of professional norms also to report whether they are certified by any other Member Boards.
3. Member Boards shall verify that diplomates are meeting professional norms.
   1. Member Boards shall annually verify that each diplomate is licensed in good standing by at least one (1) licensing jurisdiction in the United States or its territories or Canada. “In good standing” means that the license has not been subject to any actions arising out of relevant misconduct.
   2. Any and all additional licenses currently held by a diplomate shall be in good standing.
   3. Any and all additional licenses previously held by a diplomate shall have been in good standing at the time of their expiration, provided such information is available to the Member Board.
   4. Member Boards should review information about actions by other regulatory, governing and credentialing bodies received or made available to the Member Board.
      1. ABMS may provide information to Member Boards from state licensing boards, the Centers for Medicare and Medicaid Services, the Drug Enforcement Agency or court filings to support Member Board deliberations.
      2. At their sole discretion, Member Boards may choose to obtain information independently, which may include reports from the National Practitioner Data Bank, medical or professional societies, court filings or actions by other governing authorities.
   5. In cases where a diplomate holds a certificate from more than one Member Board, the Member Board that has received credible evidence of potential professional misconduct should promptly advise the other Member Boards about its receipt of such evidence.
   6. Member Boards may consider available credible evidence of any crime or conduct involving moral turpitude or unethical behavior for which a diplomate is convicted, enters a plea of guilty or nolo contendere or is found liable by a judge or jury (e.g., violent or sexual crimes, medical malpractice or harassment) as evidence of a lack of professionalism.
4. Member Boards shall render an independent judgment about professional misconduct based on the context of each case.
   1. Prior to rendering a decision regarding the diplomate’s certification, the Member Board shall examine all available credible evidence to determine whether or not the alleged conduct breached the professional norms established by the Member Board.
      1. Member Boards may consider the context of actions taken by state licensing boards and may choose not to act if they believe that professional norms have not been breached.
      2. Member Boards may take action on the basis of information from other sources if they believe that the information demonstrates that professional norms have been breached.
   2. The diplomate’s underlying conduct may be unrelated to the practice of medicine yet may nevertheless constitute misconduct that creates a safety risk or undermines the trustworthiness of the profession or of the certification.
   3. Member Boards may obtain supplemental information and may consider any and all relevant evidence outside the scope of any state medical board investigation.
   4. Member Boards retain full discretion over the determination to revoke or impose a limitation on certification based on a diplomate’s breach of professional norms.
   5. A diplomate who has been granted a license with practice limitations may be deemed to be in compliance with this Policy, unless the diplomate breaches professional norms.
   6. A diplomate who is suffering from a mental or substance use disorder may be encouraged to seek care through a physician health program (“PHP”) or similar program providing a safe environment in which to receive treatment and support in recovery. A diplomate who is participating in a PHP may be deemed to be in compliance with this Policy.
5. Member Boards shall provide diplomates with due process.
   1. The Member Board’s policy should provide diplomates with a fair and impartial procedure prior to a certification action based on a breach of professional norms.
   2. At a minimum, these procedural protections should include the following:
      1. Notice to the diplomate of the alleged breach of professional norms;
      2. An opportunity for the diplomate to respond to the allegations, which may include the following at the discretion of the Member Board:
         1. Permitting the diplomate to submit a written response; or
         2. Providing the diplomate with a hearing.
   3. Member Boards should ensure that their decisions are supported by substantial evidence and are not arbitrary or capricious.
   4. Member Boards may grant diplomates a right to have their decisions reconsidered.
6. Member Boards shall communicate certification actions related to professional misconduct.
   1. Member Boards shall publicly display actions against a certificate based on professional misconduct within their public reporting systems.
   2. Member Boards shall share information about revoked certifications with ABMS.

Download a PDF of this ABMS Policy on Professional Conduct^[PDF]