Speaking One-on-One with the Vision Commission Co-Chairs
Following the presentation of the final report of the Continuing Board Certification: Vision for the Future Commission (Commission) to the American Board of Medical Specialties (ABMS) Board of Directors (BOD), the Commission has completed its charge. Co-Chairs Christopher Colenda, MD, MPH, and William Scanlon, PhD, reflect on the past year and the work of the Commission in this Q&A. They discuss why they wanted to serve on the Commission, the impact the more than 21 hours of testimony and 36,000-plus responses from the open stakeholders’ survey had on the Commission’s recommendations, findings that surprised them, what they hope will be the next step for the Vision Initiative, and more.
Q: Why did you want to serve on the Vision Commission?
A (Dr. Colenda): I’ve had a wonderful career and I deeply believe it is important for physicians to give back to the profession. Board Certification has had professional meaning to me since I was initially certified in Psychiatry by the American Board of Psychiatry and Neurology (ABPN). I was actively involved in helping Geriatric Psychiatry become recognized as a subspecialty in Psychiatry, and was in the initial group of ABPN diplomates who took the first added qualifications exam in Geriatric Psychiatry in 1991. I served on the ABPN Board from 2006 to 2013 and served on ABPN’s geriatric subspecialty test writing committee for nearly 20 years, eight of which I served as chair. I was on the ABPN Board when Maintenance of Certification (MOC) rolled out, and thus I have been acutely aware of how MOC has impacted Psychiatry and Neurology. When Drs. Lois Nora (former ABMS President and CEO) and Norman Kahn (former Executive Vice President and CEO of the Council of Medical Specialty Societies) asked me to co-chair the Commission, it was a privilege for me to do so. Because of the importance of this work to physicians and the public, as a condition to co-chair the Commission, I was assured that the Commission would be independent; be composed of public members; and have physician representatives from across different specialties, practice settings, career stages, and diverse backgrounds.
A (Dr. Scanlon): Serving on the Commission is very consistent with what I’ve spent my career doing. In health policy, the two things we care about are what we can do to promote and ensure access to health care and how we can assure that the services are of high quality. In the public sector, there are a lot of policies, efforts, and resources in place to address the assurance of quality for hospitals, nursing homes, home health services, etc. For physicians, it’s all about self-regulation, which has been efficient and effective. Having served on the American Board of Surgery’s (ABS’) BOD as a public member for seven years, I was able to see up close how the MOC process works. From that experience, I learned the following: (1) Maintaining one’s certification is essential, but it is not feasible to expect all individuals who become certified, having mastered knowledge and skills in a specialty, to maintain that level of expertise in such a rapidly changing field on his or her own; (2) MOC has been under attack for years; and (3) We know that there is room for improvement. All of those notions played into the Commission’s work.
Q: What impact did the more than 21 hours of testimony and 36,000-plus responses from the open stakeholders’ survey have on the Commission members when it came to making the recommendations?
A (Dr. Colenda): Open testimony and results of surveys were very informative in making judgments about how and where continuing certification should evolve. The Commission’s process required considerable deliberation, but differences of opinion were handled with respect. Trust and transparency among the Commissioners emerged, and our consensus report reflects that trust and our best judgments and recommendations about the future of continuing certification. It was work,however.
A (Dr. Scanlon): In some ways, they reinforced some prior notions people had. A lot of input was similar to what I had heard serving on ABS’ Board. The physician community had concerns about MOC; you heard that loud and clear. But we also realized that there are things that are both desirable and feasible that could be done to modify continuing certification for the future. I now have a lot more respect for continuing medical education (CME) and its potential. The Commission members thought a lot about how to take advantage of CME to provide diplomates a much easier route to staying current. Having a 10-year exam as the only option is a concept whose time has passed. It is also important to keep in mind that the input, particularly on the complaint side, is not representative of the physician community. That’s not to minimize those concerns, which will hopefully be addressed through the Commission recommendations, but out of the more than 950,000 physicians in the United States, only 36,000 submitted comments.
Q: What, if any, findings were surprising?
A (Dr. Scanlon): It was a little surprising how much activity around longitudinal assessment the Member Boards were already engaged in. Also, how the variation among the Member Boards contributed to the varying levels of concern. For me, it was very enlightening to discover the concept of adult learning. A lot has changed in education and there are some options that could really be taken advantage of with regard to physician assessment.
Q: How did the more than 1,800 comments received about the draft report impact the development of the final report?
A (Dr. Colenda): It continued to refine the Commission’s judgment and decisions about the final set of recommendations. The Commission was quite deliberate about weighing preliminary testimony, written comments, background data, and feedback from the draft report in forming the final set of recommendations.
A (Dr. Scanlon): The additional comments were taken very seriously. Upon reflection and seeing the additional comments, we presented the recommendations a little differently in the final report.
Q: Now that the Commission has submitted the final report to the ABMS BOD, what do you hope will be the next step for the Vision Initiative?
A (Dr. Colenda): Commission members hope that the ABMS BOD consider the recommendations for the purposes of creating an implementation plan that will create a continuing certification process that meets the expectations of diplomates, the public, and those health care stakeholders who rely upon Board Certification as a mark of distinction and assurance that diplomates are keeping up in their specialty.
A (Dr. Scanlon): The next step should be the development of a plan to address the recommendations in the report. The different recommendations require different responses. Some will have to come from ABMS and some from the Member Boards collectively. The responsibilities need to be divided and delegated to different stakeholders who can accomplish the tasks. Because of the variation across the Boards, they are starting from different points. We wanted to make sure that those Boards that have already made positive changes won’t have to undo them, such as their efforts to develop longitudinal assessments.
Q: Do you believe the Commission accomplished what it set out to do?
A (Dr. Scanlon): I think it did. If you go back and look at our charge, my sense is that we dealt with the concerns expressed and identified new opportunities for a reformed continuing certification process. In the process of doing that, we made recommendations that, if fulfilled, will enable continuing certification to be significantly more beneficial to diplomates. It will no longer just be about passing a test. It will be about helping diplomates stay current, which is a significant contribution and fully faithful to our obligation to the public because we’re doing the best we possibly can to make sure doctors are current in their specialty when they are designated as board certified.
Drs. Colenda and Scanlon Bios
Dr. Colenda is President Emeritus of West Virginia University Health System (WVUHS), having also served as Chancellor for Health Sciences at WVU. Prior to his leadership positions at WVU, Dr. Colenda was the Jean and Thomas McMullin Dean of the College of Medicine at Texas A&M University Health Sciences Center. He served as Chairman of Psychiatry at Michigan State University’s College of Human Medicine. Prior to his Michigan State University appointment, he held leadership positions in Geriatric Psychiatry at the Wake Forest University School of Medicine and Medical College of Virginia/Virginia Commonwealth University. Dr. Colenda has held numerous elected and appointed positions in academic medicine. He served as Treasurer and Vice Chair of ABPN. Dr. Colenda was a member of the Liaison Committee for Medical Education and was its Chair in 2012-13. He has served on the BOD of the Accreditation Council on Graduate Medical Education, Executive Board of the National Board of Medical Examiners, and Administrative Board of the Council of Deans for the American Association of Medical Colleges. In 2016, Dr. Colenda was appointed to the Health Systems Governing Council of the American Hospital Association. He served as Co-Chair of ABMS’ Special Committee on Physician Executives/Administrative Leaders and Continuing Certification. Dr. Colenda was a member of the Psychological Health External Advisory Committee of the Defense Health Board for the U.S. Department of Defense. He is board certified by ABPN in Psychiatry and Geriatric Psychiatry.
Dr. Scanlon is a Consultant to the West Health Institute in La Jolla, Calif. He is also a member of the Medicaid and CHIP Payment and Access Commission. Dr. Scanlon has served as the public member of ABS’ BOD and on the Patient Access Network Foundation Board, Medicare Payment Advisory Commission, National Committee on Vital and Health Statistics, National Commission for Quality Long- Term Care, and the 2005 White House Conference on Aging Advisory Committee. Previously, he was the Managing Director for Health Care at the U.S. General Accounting Office, a Co-Director of the Georgetown University School of Medicine Center for Health Policy Studies, and a Principal Research Associate at the Urban Institute.
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