Changes to Osteopathic Specialty Board Certification
-
Ronald E. Ayres
Abstract
The American Osteopathic Association (AOA) Board of Trustees has mandated that all osteopathic specialty certifying boards implement Osteopathic Continuous Certification by January 1, 2013. This mandate has caused a number of changes to be made to the AOA specialty board certification processes. The authors provide an overview of changes that will affect AOA board–certified osteopathic physicians, including recertification processes, procedures for nonclinical physicians, requirements for non–time-dated and dual certification, and continuing medical education rules. Rates of osteopathic specialty board certification and recertification for 2011 are also reported.
The American Osteopathic Association (AOA) Board of Trustees has mandated that all specialty certifying boards, under the direction and oversight of the Bureau of Osteopathic Specialists (BOS), fully implement Osteopathic Continuous Certification (OCC) no later than January 1, 2013. The BOS is the authoritative body that develops, reviews, and enforces all policies and requirements for osteopathic certification as approved by the AOA.
In the present article, we provide an overview of changes related to OCC, including recertification processes, procedures for nonclinical physicians, and requirements for non–time-dated and dual certification. We also review continuing medical education (CME) rules and provide the number of osteopathic specialty board certifications and recertifications in 2011.
OCC
What is it and how will it affect AOA–board-certified osteopathic physicians?
Osteopathic Continuous Certification replaces the former recertification process for all AOA diplomates with time-dated certifications. Currently, all osteopathic physicians have either a time-dated certificate or a non–time-dated certificate. The OCC process is mandatory for all physicians holding a time-dated certificate and optional but strongly encouraged for physicians holding a non–time-dated certificate.
The current recertification process takes a “snapshot” of a physician's certification at the expiration of the diplomate's certification period. Continuous certification will offer ongoing input to the specialty certifying board and to the osteopathic physician based on actual clinical practice compared with national benchmarks.
As reported in previous articles in JAOA—The Journal of the American Osteopathic Association,1-4 the OCC process consists of the following 5 components:
Component 1—Unrestricted Licensure
Component 2—Lifelong Learning/Continuing Medical Education
Component 3—Cognitive Assessment
Component 4—Practice Performance Assessment and Improvement
Component 5—Continuous AOA Membership
Component 4—Practice Performance Assessment and Improvement is the only new requirement that has been added by the BOS to the AOA's current recertification requirements. In accordance with this component, physicians' clinical performance is compared with national standards for their associated medical specialties. The input osteopathic physicians receive from participation in Component 4 aids them in continuous quality improvement by ensuring that they meet or exceed nationally established standards.
Although OCC is mandatory for physicians holding time-dated certificates, osteopathic physicians holding non–time-dated certificates are encouraged by the BOS to voluntarily participate in OCC. Voluntary participation in the OCC process will not change the non–time-dated certificate but will demonstrate continuing commitment to practice excellence through the receipt of an additional certificate.
Physicians with non–time-dated certifications should consider participating in OCC as the Federation of State Medical Boards has recommended that states accept the requirements of OCC in lieu of their requirements for maintenance of licensure.5 Those diplomates not participating in OCC may have additional requirements for maintenance of licensure as prescribed by the state(s) where they are licensed.
How will it affect osteopathic physicians with non–time-dated certifications?
Just under half of certifications held by osteopathic physicians are not time-dated (formerly referred to as “lifetime certification”). Those certifications without expiration dates are not maintained indefinitely; rather, diplomates must maintain active state licensure, adhere to the CME requirements set forth by the AOA Council on CME,6 and maintain active membership in the AOA.
A number of certified osteopathic physicians have allowed their certification to lapse for a variety of reasons such as nonpayment of AOA membership dues, nonfulfillment of CME requirements, or other circumstances. Prior to July 2009, when membership requirements were fulfilled, a physician's certificate was immediately restored to its prior status (ie, time-dated or non–time-dated). However, with the advent of OCC, any restoration of a certificate will be in the form of a time-dated certificate. As a result, these physicians who previously held non–time-dated certifications will be required to participate in OCC when their certification is restored.
How will dually certified physicians be affected?
The recertification process requires osteopathic physicians to fully participate in the OCC processes of all AOA specialty boards from which they hold certification. Osteopathic physicians who hold certification from both an AOA-recognized board and an American Board of Medical Specialties–recognized board may demonstrate adherence to the American Board of Medical Specialties' Maintenance of Certification process to satisfy the requirements of OCC Component 4. However, boards will also have an osteopathic component in which diplomates will need to participate to satisfy the requirements for Component 4.
Are nonclinical physicians affected?
The AOA recognizes that not all physicians are currently practicing medicine as clinical physicians. Certified osteopathic physicians work in a variety of nonclinical settings, such as academia, research, health care administration, writing and medical communication, technology, and informatics. Although these physicians are still working in and influencing health care, they do not have patient contact. Physicians who fall into this category may apply for an exemption from Component 4—Practice Performance Assessment and Improvement after they validate that they have no patient contact.
Similarly, in May 2011, the Federation of State Medical Boards assembled a task force to address nonclinical physicians' adherence to maintenance of licensure.6
Regardless of clinical or nonclinical status, all osteopathic physicians must demonstrate the following 7 core competencies in their work:
Osteopathic Philosophy and Osteopathic Manipulative Medicine
Medical Knowledge
Patient Care
Interpersonal and Communication Skills
Professionalism
Practice-Based Learning and Improvement
Systems-Based Practice
What happens if the OCC requirements are not met?
Osteopathic physicians who do not meet the requirements set forth by their specialty certifying board for OCC may be called to complete remedial requirements in order to restore their certification to an active status. This re-entry process will be discussed by the BOS at its meeting in April 2012 and will be published on the AOA Web site once approved.
Continuing Medical Education Changes
Currently, for maintenance of board certification, diplomates must obtain 50 Category 1 or Category 2 specialty CME credits during each 3-year CME cycle. The current policy for acceptable specialty CME credit is available at http://www.osteopathic.org/inside-aoa/development/continuing-medical-education/Documents/specialty-cme-policy.pdf.
At its meeting in January 2011, the AOA Board of Trustees approved new initiatives relating to the recommendations of the Education Policy and Procedures Review Committee III, which will apply to OCC Component 2—Lifelong Learning/ Continuing Medical Education. Effective January 1, 2013, no less than 25%, or 13, of the required 50 credits of specialty CME must be obtained at the subspecialty (ie, Certification of Added Qualifications) level and no less than 30%, or 15, of the 50 credits be obtained in the individual's primary certification. For diplomates holding more than 1 Certification of Added Qualifications, this initiative will require them to obtain more than 50 credits of specialty CME during each 3-year CME cycle.
The BOS and the Growth of Certification
The BOS (known as the Advisory Board of Osteopathic Specialists until 1993) was established in 1939 by the AOA Board of Trustees to assess the skills of osteopathic physician specialists in response to the growth of specialization in the osteopathic profession.7 The BOS views the certification process both as an assessment tool to enhance the quality of health care and also as a means to protect the public. Since 1939, the BOS has issued 36,087 certifications in primary specialties, subspecialties, and added qualifications.
As of the end of December 2011, a total of 23,819 osteopathic physicians were certified by the AOA and held a combined total of 27,519 active certificates. In 2011, 1112 certificates were awarded in primary specialty and subspecialty areas. Additionally, 148 certificates of added qualifications were granted, and 867 recertifications were issued. A listing of the total number of active certifications by specialty is found in the Table.
Certification Statistics, 2011a
| American Osteopathic Association Board of … | Certification Type | Specialty | New Certifications | Recertifications | Total Active Certifications |
|---|---|---|---|---|---|
| Anesthesiology | Primary | Anesthesiology | 29 (1) | 13 (2) | 605 (2) |
| CAQ | Pain management | 1 (<1) | 2 (<1) | 68 (<1) | |
| CAQ | Critical care medicine | NA | NA | 5 (<1) | |
| Dermatology | Primary | Dermatology | 28 (1) | NA | 396 (1) |
| CAQ | Dermatopathology | NA | NA | 6 (<1) | |
| CAQ | Mohs micrographic surgery | NA | NA | 18 (<1) | |
| Emergency Medicine | Primary | Emergency medicine | 174 (5) | NA | 2152 (8) |
| CAQ | Emergency medical services | NA | NA | 10 (<1) | |
| CAQ | Medical toxicology | 1 (<1) | 1 (<1) | 9 (<1) | |
| CAQ | Sports medicine | 2 (<1) | 9 (1) | 7 (<1) | |
| CAQ | Undersea hyperbaric medicine | NA | NA | 4 (<1) | |
| Family Physicians | CAQ | Addiction medicine | NA | NA | 4 (<1) |
| CAQ | Adolescent and young adult medicine | NA | NA | 9 (<1) | |
| Primary | Family practiceb | NA | NA | 4901 (18) | |
| Primary | Family practice and OMT | 390 (12) | 453 (52) | 6344 (23) | |
| CAQ | Geriatric medicine | 5 (<1) | 11 (1) | 324 (1) | |
| CAQ | Hospice and palliative medicine | 63 (2) | NA | 118 (<1) | |
| CAQ | Sleep medicine | 3 (<1) | NA | 5 (<1) | |
| CAQ | Sports medicine | 17 (1) | NA | 152 (<1) | |
| CAQ | Undersea and hyperbaric medicine | 1 (<1) | NA | 8 (<1) | |
| Internal Medicine | CSQ | Allergy/immunology | NA | 1 (<1) | 9 (<1) |
| CAQ | Cardiac electrophysiology | 1 (<1) | NA | 23 (<1) | |
| CSQ | Cardiology | 33 (1) | 9 (1) | 449 (2) | |
| CAQ | Critical care medicine | 5 (<1) | 3 (<1) | 134 (<1) | |
| CSQ | Endocrinology | 1 (<1) | NA | 37 (<1) | |
| CSQ | Gastroenterology | 10 (<1) | 8 (1) | 204 (1) | |
| CAQ | Geriatric medicine | 3 (2) | 3 (<1) | 58 (<1) | |
| CSQ | Hematology | 2 (<1) | NA | 45 (<1) | |
| CAQ | Hospice and palliative medicine | 1 (<1) | NA | 14 (<1) | |
| CSQ | Infectious diseases | 5 (<1) | 3 (<1) | 64 (<1) | |
| Primary | Internal medicine | 58 (2) | 2 (<1) | 3072 (11) | |
| CAQ | Interventional cardiology | 3 (<1) | 6 (1) | 94 (<1) | |
| CSQ | Nephrology | 6 (<1) | NA | 129 (<1) | |
| CSQ | Oncology | 4 (<1) | 2 (<1) | 95 (<1) | |
| CSQ | Pulmonary diseases | 8 (<1) | 3 (<1) | 184 (1) | |
| CSQ | Rheumatology | 4 (<1) | 1 (<1) | 63 (<1) | |
| CAQ | Sleep medicine | NA | NA | 34 (<1) | |
| CAQ | Sports medicine | NA | NA | 7 (<1) | |
| CAQ | Undersea hyperbaric medicine | NA | NA | 1 (<1) | |
| Neuromusculoskeletal Medicine | Primary | Neuromusculoskeletal medicine/OMM | 5 (<1) | 14 (2) | 482 (2) |
| Primary | Special proficiency in OMMb | NA | NA | 127 (<1) | |
| CAQ | Sports medicine | 2 (<1) | 0 | 6 (<1) | |
| Neurology and Psychiatry | CAQ | Addiction medicine | NA | 1 (<1) | 3 (<1) |
| CSQ | Child neurology | NA | NA | 3 (<1) | |
| CSQ | Child pyschiatry | 1 (<1) | 1 (<1) | 38 (<1) | |
| CAQ | Geriatric psychiatry | 2 (1) | NA | 7 (<1) | |
| CAQ | Hospice and palliative medicine | NA | NA | 2 (<1) | |
| Primary | Neurology | 6 (<1) | 11 (1) | 202 (1) | |
| Primary | Neurology and psychiatryb | NA | NA | 1 (<1) | |
| CAQ | Neurophysiology | 17 (1) | NA | 23 (<1) | |
| Primary | Psychiatry | 5 (<1) | 16 (2) | 283 (1) | |
| CAQ | Sleep medicine | NA | NA | 6 (<1) | |
| Nuclear Medicine | Primary | Nuclear medicine | NA | NA | 32 (<1) |
| Obstetrics and Gynecology | CSQ | Gynecologic oncology | 1 (<1) | 2 (<1) | 6 (<1) |
| CSQ | Maternal and fetal medicine | 1 (<1) | NA | 21 (<1) | |
| Primary | Obstetrics and gynecologic surgeryb | NA | NA | 57 (<1) | |
| Primary | Obstetrics/gynecology | 57 (2) | 108 (12) | 1025 (4) | |
| CSQ | Reproductive endocrinology | NA | 2 (<1) | 12 (<1) | |
| Ophthalmology and Otolaryngology | Primary | Facial plastic surgery | NA | NA | 5 (<1) |
| Primary | Ophthalmology | 12 (<1) | 13 (2) | 328 (1) | |
| CAQ | Otolaryngic allergy | NA | NA | 18 (<1) | |
| Primary | Otolaryngology | NA | 2 (<1) | 11 (<1) | |
| Primary | Otolaryngology and facial plastic surgery | 18 (1) | 15 (2) | 367 (1) | |
| Primary | Otorhinolaryngologyb | NA | NA | 30 (<1) | |
| CAQ | Sleep medicine | 2 (<1) | NA | 6 (<1) | |
| Orthopedic Surgery | CAQ | Hand surgery | 2 (<1) | 3 (<1) | 30 (<1) |
| Primary | Orthopedic surgery | 60 (2) | 42 (5) | 1082 (4) | |
| Pathology | Primary | Anatomic pathology | NA | NA | 26 (<1) |
| Primary | Anatomic pathology and laboratory medicine | NA | NA | 16 (<1) | |
| CAQ | Dermatopathology | NA | NA | 2 (<1) | |
| CSQ | Forensic pathology | NA | NA | 3 (<1) | |
| Primary | Laboratory medicine | NA | NA | 13 (<1) | |
| Pediatrics | CSQ | Adolescent medicine | NA | NA | 1 (<1) |
| CSQ | Neonatology | NA | 5 (1) | 31 (<1) | |
| CSQ | Pediatric allergy immunology | 2 (<1) | NA | 5 (<1) | |
| CSQ | Pediatric endocrinology | NA | NA | 2 (<1) | |
| CSQ | Pediatric pulmonology | NA | NA | 2 (<1) | |
| Primary | Pediatrics | 51 (2) | 20 (2) | 477 (2) | |
| Physical Medicine and Rehabilitation | CAQ | Hospice and palliative medicine | NA | NA | 1 (<1) |
| Primary | Physical medicine and rehabilitation | NA | NA | 220 (1) | |
| CAQ | Sports medicine | 1 (<1) | 1 (<1) | 3 (<1) | |
| Preventive Medicine | CAQ | Occupational medicine | 4 (<1) | 3 (<1) | 52 (<1) |
| Primary | Preventive medicine aerospace medicine | NA | 1 (<1) | 41 (<1) | |
| Primary | Preventive medicine occupationalb | NA | NA | 8 (<1) | |
| Primary | Preventive medicine occupational environmental medicine | NA | 3 (<1) | 89 (<1) | |
| Primary | Preventive medicine public health | NA | 1 (<1) | 38 (<1) | |
| CAQ | Undersea and hyperbaric medicine | NA | NA | 5 (<1) | |
| Proctology | Primary | Proctology | NA | NA | 24 (<1) |
| Radiology | CAQ | Angiography and intervention radiologyb | NA | NA | 18 (<1) |
| CAQ | Body imaging | NA | 2 (<1) | 8 (<1) | |
| Primary | Diagnostic radiology | 27 (1) | 14 (2) | 637 (2) | |
| Primary | Diagnostic roentgenology | NA | NA | 2 (<1) | |
| CAQ | Diagnostic ultrasound | NA | NA | 1 (<1) | |
| CAQ | Neuroradiology | 5 (<1) | 5 (1) | 57 (<1) | |
| CAQ | Nuclear radiology | 0 | 1 (<1) | 5 (<1) | |
| CAQ | Pediatric radiology | 1 (<1) | 1 (<1) | 20 (<1) | |
| Primary | Radiation oncology | 2 (<1) | NA | 21 (<1) | |
| CSQ | Radiation therapyb | NA | NA | 1 (<1) | |
| Primary | Radiology | NA | NA | 57 (<1) | |
| Primary | Vascular and interventional | NA | 2 (<1) | 15 (<1) | |
| Surgery | Primary | Cardiothoracic surgery | 2 (<1) | 1 (<1) | 6 (<1) |
| CAQ | Surgical critical care | 5 (<1) | 1 (<1) | 53 (<1) | |
| Primary | General vascular surgery | 13 (<1) | 7 (1) | 118 (<1) | |
| CAQ | Hospice and palliative medicine | 1 (<1) | NA | 2 (<1) | |
| Primary | Neurological surgery | 8 (<1) | NA | 95 (<1) | |
| Primary | Plastic and reconstructive surgery | 11 (<1) | 1 (<1) | 63 (<1) | |
| Primary | Surgery (general) | 67 (2) | 33 (4) | 948 (3) | |
| Primary | Thoracic cardiovascular surgery | NA | NA | 54 (<1) | |
| Primary | Thoracic surgeryb | NA | NA | 5 (<1) | |
| Primary | Urological surgery | 11 (<1) | 6 (1) | 200 (1) | |
| Total | 1260 | 867 | 27,519 |
Conclusion
Osteopathic Continuous Certification introduces many changes to the certification process. Osteopathic physicians who are AOA board certified should remain diligent in reviewing information from the AOA regarding maintenance of their osteopathic board certification.
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Financial Disclosures: None reported.
References
1 Ayres RE Scheinthal S Ramirez A Bell E . Osteopathic certification evolving into a continuous certification model. J Am Osteopath Assoc.2008;108(3):159-165.Search in Google Scholar
2 Ayres RE Scheinthal S Gross C Bell EC . Osteopathic specialty board certification. J Am Osteopath Assoc.2009;109(3):181-190.Search in Google Scholar
3 Ayres RE Scheinthal S Gross C Bell EC . American Osteopathic Association osteopathic specialty board certification. J Am Osteopath Assoc.2010;110(3):183-192.Search in Google Scholar
4 Ayres RE Scheinthal S Gross C Bell EC . Osteopathic specialty board certification. J Am Osteopath Assoc.2011;111(4):280-288.Search in Google Scholar
5 Report to the board of directors from the maintenance of licensure implementation group. Federation of State Medical Boards Web site. http://www.fsmb.org/pdf/BD_RPT_1103_%20MOL.pdf. Accessed March 13, 2012.Search in Google Scholar
6 American Osteopathic Association . Continuing Medical Education 2010-2012 Guide for Osteopathic Physicians. Chicago, IL: American Osteopathic Association; 2009.Search in Google Scholar
7 MOL timeline . Federation of State Medical Boards Web site. http://www.fsmb.org/m_mol_timeline.html. Accessed March 2, 2012.Search in Google Scholar
© 2012 The American Osteopathic Association
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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- Continuous Development and Review of AOA COCA Standards and Procedures
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- Evolving Role of Osteopathic Postdoctoral Training Institutions
- AOA Continuing Medical Education
- Changes to Osteopathic Specialty Board Certification
- Appendix 1. Colleges of Osteopathic Medicine in the United States
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- Appendix 2. Figures from AACOM's Trends in Osteopathic Medical School Applicants, Enrollment and Graduates.
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- CME Quiz Answers
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Articles in the same Issue
- The Somatic Connection
- Intraoral Manipulation and Jaw Exercises Shown to Be of Benefit in Temporomandibular Joint Disorder
- Spinal Manipulation and Home Exercise Improve Neck Pain
- Spinal Manipulation Therapy Effect on Somato-Sympathetic Reflexes
- What Price Glamour? It's All About the Shoes!
- Special Report
- Advisory Committee on Immunization Practices (ACIP) Update, February 2012
- Editorial
- The Problem With Graduate Medical Education
- Medical Education
- Successful Implementation of New Osteopathic Graduate Medical Education Programs in a Community Hospital: Challenges and Lessons Learned
- Prediction of Osteopathic Medical School Performance on the Basis of MCAT Score, GPA, Sex, Undergraduate Major, and Undergraduate Institution
- Trainer-to-Student Ratios for Teaching Psychomotor Skills in Health Care Fields, as Applied to Osteopathic Manipulative Medicine
- AOA Communication
- Continuous Development and Review of AOA COCA Standards and Procedures
- Osteopathic Graduate Medical Education 2012
- Evolving Role of Osteopathic Postdoctoral Training Institutions
- AOA Continuing Medical Education
- Changes to Osteopathic Specialty Board Certification
- Appendix 1. Colleges of Osteopathic Medicine in the United States
- Special Communication
- Appendix 2. Figures from AACOM's Trends in Osteopathic Medical School Applicants, Enrollment and Graduates.
- Clinical Images
- Ecthyma Gangrenosum Caused by Psedumonas aeruginosa
- CME Quiz Answers
- CME Quiz Answers
