Medical specialty certification in the United States—a false idol?

PURPOSE: Recent changes to medical specialty certification in the USA have prompted the process to come under intense scrutiny. METHODS: We review the history of board certification and the changes made to the process. As part of this review, we examine both literature and public record to examine the motives behind the changes made. We then review the legal challenges and changes under way to modify the current ABMS board re-certification process. RESULTS: In 1917, the first board certification was a lifetime designation, voluntary, and managed by unpaid board members with a focus to enhance quality for patients. Corresponding to the implementation of time-limited certification, $55 million of physician testing fees were transferred from the American Board of Internal Medicine to its Foundation between 1989 and 1999. From 2000 through 2007, and additional $20.66 million were transferred from the ABIM to its Foundation culminating in the purchase of a $2.3 million luxury condominium in December 2007. CONCLUSIONS: Significant financial conflicts of interest for the implementation of time-limited specialty certification exited and continue to plague the medical profession. The specialty boards and the organizations that created them should remove all requirements for time-limited board certification and resort to conventional self-selected ACGME-approved CME programs for ongoing education.