If you’ve ever been on the hunt for a new doctor, you may have come across a checklist you should use to interview candidates. So you dutifully make your way down the list (“Sorry, I just wrote down a few questions…”), ask the white coat before you, “Are you board-certified?”, check that box, and move on to the next question.
But wait… What exactly does “board-certified” mean?
Before we address that specifically, a whirlwind tour of how your doctor earned that long white coat and the privilege of standing (or sitting) before you:
- Elementary/Middle/High school
- College, during which you take the MCAT (Medical College Admission Test), and hopefully get a high enough score to get you into
- Medical school, during which you take the USMLE Steps 1 and 2 (United States Medical Licensing Examination), and hopefully get a high enough score to get you into
- Internship, also known as PGY-1 (Postgraduate year 1 in which you are learning/working/training on the job in the hospital), during which you take Step 3 of the USMLE before moving on to
- Residency (an additional 2-6 postgraduate years), and sometimes even
- Fellowship (optional - even more postgraduate training in an even more narrow, specialized field).
Once your doctor has completed all of that education and training, then she may be eligible to apply for the board examination, and then maybe - maybe - she will pass the exam(s) and be deemed “board-certified”.
But wait… What exactly does “board-certified” mean? Right, right, we’re getting there.
So just to become a physician licensed to practice medicine in the United States, you’re looking at a minimum of 9 years of higher education and training (4 years college + 4 years medical school + 1 year of internship). Surgical training takes even longer, generally a minimum of 13 years (by adding on at least 4 years of residency, sometimes more).
But even then, you’re getting a fairly generic license from the state. Technically, if I completed college, medical school, then trained for 3 years in pediatrics, I could hang up my shingle as “Joe Schmoe, M.D., Specializing in Adult Brain Surgery.” But that might raise the hairs on the backs of the necks of my exceedingly well-trained neurosurgical colleagues in town, and much worse, it would be a terrible disservice to patients needing an exceedingly well-trained brain surgeon.
Enter the American Board of Medical Specialties.
There are a number of organizations out there claiming to be an official board of something, but unless it is one of the 24 certified ABMS specialties, it may lack legitimacy. Sort of like the difference between mailing in a check and receiving a certificate in the mail 6-8 weeks later vs. documenting all of the education/training listed above, obtaining letters of recommendation from mentors, passing an additional specialty-specific written examination, and particularly in the case of the surgical subspecialties, standing up to an oral vetting of your skill and knowledge, as judged by your more experienced peers.
For the American Board of Plastic Surgery, physicians must complete at least six years of plastic surgery-specific training before they can even apply for the first part of the certification process, the written examination. The computer-based exam takes about 7 hours and covers general principles of plastic surgery (wound healing, microsurgery), plastic surgical aspects of related disciplines (anesthesia, immunology/transplant medicine, pharmacology), and plastic surgery from literally head to toe.
If you pass the written examination, you submit every surgical procedure you perform over a specific nine-month period. The Board determines if this list passes muster in terms of sufficient diversity, complexity, and volume of plastic surgery. If so, The Board then chooses five of your cases, and you prepare detailed reports that serve as the basis of part of your oral examination. The oral examination takes place over two and a half days, including a mix of “unknown” cases (photos of surgical dilemmas you have never seen before but are expected to solve on the spot) as well as an inquisition into your own selected cases. Some would describe the oral examination as collegial, others would choose the word adversarial, but everyone agrees it is the most stressful examination of their professional lives. Not everyone passes.
So yes, “board-certified” by one of the ABMS specialties is quite a legitimate credential.
If your physician has been certified by one of the 24 ABMS boards, she has the chops and her colleagues approve. But does it matter?
According to several studies looking at patient outcomes for board-certified vs. non-board-certified physicians, it does matter (1-3), and this makes sense. With so much information out there (and sometimes an astounding lack of data) about doctors, it can be difficult to decide who to choose to take care of one of our most precious things: our health. Board-certification can serve as a simple metric for identifying physicians who have made a commitment to professionalism, patient care, and lifelong learning.
So go ahead and ask us, “Are you board-certified?” and know what it means to check that box.
1. Prystowsky JB, Bordage G, Feinglass JM. Patient outcomes for segmental colon resection according to surgeon's training, certification, and experience. Surgery. 2002 Oct;132(4):663-70; discussion 670-2.
2. Chen J, Rathore SS, Wang Y, Radford MJ, Krumholz HM. Physician board certification and the care and outcomes of elderly patients with acute myocardial infarction. J Gen Intern Med. 2006 Mar;21(3):238-44.
3. Silber JH, Kennedy SK, Even-Shoshan O, Chen W, Mosher RE, Showan AM, Longnecker DE. Anesthesiologist board certification and patient outcomes. Anesthesiology. 2002 May;96(5):1044-52.
By Dr. Angeline Lim of Duet Plastic Surgery - Expert Plastic Surgeons
Angeline Lim, M.D. and Jennifer Weintraub, M.D. are the board-certified plastic surgeons of Duet Plastic Surgery, a boutique-style practice in Palo Alto, California. When not taking the time to answer really good questions brought up by her intelligent and thoughtful patients, Dr. Lim may be found pounding the pavement in preparation for her first half-marathon or eating donuts (extra sprinkles, please) with her kids.