Continuous certification: When boards say jump, physicians might not
For the past 20 years, my wife, Karen A. Shaw Sylvara, DO, and I have had the distinct privilege of providing competent and compassionate care to the rural underserved population of northern Missouri. Our life’s work and mission of providing rural primary care have been successful.
However, I have grave concerns about the continued survival and success of our endeavor. Ever-increasing overhead, flat or declining reimbursement, greater and greater intrusions, demands from insurance and governments, and the constant threat of malpractice lawsuits are just a few of my concerns. Dark clouds are lining the horizon. I hope the country doctor can survive.
I certainly hope that the implementation of osteopathic continuous certification (OCC) is not so onerous in terms of lost time, travel, missed work and emotional stress from constant test-taking that I can’t comply and maintain my board certification.
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I cannot speak for my family medicine brothers and sisters across the country. However, my peers and I who take care of patients here in the trenches of “fly-over country” feel pretty squeezed, pressured and stressed. We are growing weary of complying with mandate after mandate—seemingly great ideas from people who, actually for the most part, have no idea what we do.
I consistently strive to stay up-to-date with continuing medical education requirements, Audio-Digest Foundation programs, journals and board recertification. I feel these activities have been sufficient to ensure that I remain competent in practicing family medicine.
I have serious concerns about the primary care workforce, especially in rural areas. At 50 years old, I am a typical age for a family physician. Would you like to venture a guess at what my elders think about of a bunch of new mandates to maintain board certification? More and more demands are being placed on an undermanned and aging family medicine workforce.
Has board certification been beneficial to me up to this point?
- I have not had a patient ask me if I was board-certified.
- I have not received higher reimbursement from private third-party payers or the government because of my board certification.
- Board certification has not been required to man the various rural emergency departments and clinics I have worked in or to run my private practice.
- Thankfully, I’ve never been sued for malpractice. However, in that unfortunate event, being board-certified would provide little to no protection.
The primary care physician shortage takes into account the many licensed practicing physicians who are not board-certified or board-eligible. In this context, would states further worsen the shortage by tying board certification to state licensure?
Removing thousands of practicing non-board-certified family physicians from inner-city and rural communities that desperately need their services would be tragic.
To the American Osteopathic Board of Family Physicians, I give some friendly, collegial and unsolicited advice: When formulating new required hoops for the rest of us to jump through to maintain board certification, please do not overestimate the perceived value of board certification to the primary care workforce, especially in the light of even greater costs, time and stress.
J. Tod Sylvara, DO
Dr. Sylvara practices family medicine in La Plata, Mo.
The opinions expressed in “Letters to the Editor” are those of the authors and do not reflect the viewpoints of the editors or the official policy of the AOA.