After serving on the board of the American Board of Internal Medicine for the past few years, I’ve come to truly appreciate the value of board certification in demonstrating – and enhancing – our competence and commitment to professionalism. But not all boards are created equal: the ABIM, like all the members of the American Board of Medical Specialties (ABMS), is frequently challenged by organizations that call themselves boards and offer “certification” but whose rigor is questionable. This is a big deal, since patients need to know what it means when they hear that their doctor is board certified.
You might say that competition is good, and it generally is, but there is a fundamental problem in the worlds of certification and accreditation: the free market just doesn’t work very well. Just envision two boards – one like the ABIM, with rigorous exams and high standards. (Just one small window into this: the ABIM employs several amazingly talented psychometricians whose sole job is to ensure that its tests produce fair and accurate results.) Now pretend there’s another board with very low standards – just pay your money, answer a few simple questions, and voila, you’re certified. While most physicians are ethical folks who would gravitate to the former, clearly some would find the latter deal quite appealing… particularly if patients, hospital credentials committees, and payers failed to differentiate between the two paths to “certification.”
Enter into this arcane but important debate one Dr. Rand Paul, libertarian, Tea Party heartthrob, son of presidential candidate Ron Paul, and (gulp) perhaps the future U.S. Senator from Kentucky. Paul, an ophthalmologist, has long claimed that he is board certified.
But it turns out that the American Board of Ophthalmology (ABO), the official ABMS board for the field, hasn’t heard from Dr. Paul since 2005, which was when his initial certification lapsed. As the Louisville Courier-Journal reported this week, Dr. Paul is now certified by an organization called the National Board of Ophthalmology (NBO).
Which is convenient, since when the NBO incorporated in 1999, the documents list one Rand Paul as both its founding president and director. The NBO went out of business in 2000, but Paul resurrected it in 2005, just in time to revive his lapsed board certification. In contrast to the ABO, which has a staff of 11 in its Philadelphia office, the NBO’s address is a UPS box in Bowling Green. Rented by, well, you know.
In a letter to a Washington Post blogger after the story broke, Paul claimed that he let his ABO certification lapse and founded an alternative organization “to protest the American Board of Ophthalmology’s decision to grandfather in the older ophthalmologists and not require them to recertify.”
I can appreciate a good protest (and the grandfather issue bugs quite a few younger docs), but this is a bit much: Paul ditches the ABO on principle but holds himself out to be board certified via an organization he invented; one that, as far as anyone can tell, has precisely no requirements or public footprint.
While this concerns me (perhaps not as much as Paul’s stated preference to allow restaurants to re-segregate or his heartfelt support of British Petroleum post-spill), I probably wouldn’t have brought it up if Stephen Colbert hadn’t done a hilarious send-up on Paul and board certification a few days ago. “He has inspired me to exercise my constitutional right to call myself an ophthalmologist,” Colbert quips, and then proceeds to diagnose glaucoma in one of his show’s interns. Luckily, “Dr.” Colbert has a prescription: “You are going to want to smoke a lot of weed.” He then sends in a “board-certified” cat, Professor Buttons, to perform nightmarish Lasik surgery on the hapless intern. If you can spare 5 minutes, the video clip is well worth watching.
The bright side of all this bad news about board certification – last week’s cheating scandal and Rand Paul’s present predicament – is that it demonstrates that physicians really seem to value being certified. Good. We just need to ensure that they are doing it the right way.