PracticalDermatology

Many of my colleagues have recently been discussing the dilemma of whether it is worthwhile to recertify when their time-limited certifications for dermatology are “up.” While I understand passions are high on the part of the public, who generally assume recertification is a good thing, many dermatologists feel it is an onerous burden. I see good reason to consider both sides of the argument.

One position concerns fairness—that some dermatologists should be expected to recertify while others, even one year earlier in residency graduation status, are ‘grandfathered’ into lifetime certification. Sadly, I just missed grandfather status by two years in my dermatology residency and one year in my pediatrics residency. My certification by the American Academy of Cosmetic Surgery (AACS), a non-ABMS board, is also time-limited, so I achieved an unhappy trifecta of sorts.

Despite my poor luck, I feel better and more confident in that my skills have been tested recently (I recertified in 2011 with the newer, proctored version in dermatology, and in 2010 with the proctored version of AACS). Having said that, I don’t think I am going to take the time and effort to recertify in pediatrics again when my certification lapses in 2014. I might feel differently if the tests become harder or more onerous, but for now they seem to be reasonable and fair. I have seen some “grandfathered” diplomats who have voluntarily taken the recertification exam, and they have my deepest respect.

Further discussion involves the reason for recertification and the demeaning nature of being asked to prove competence every 10 years. While most of our colleagues remain brilliant and keep up with the field, there are some who are either less able over time or who have not stayed current. These individuals may be “flagged” in this process or gently nudged to take the time to re-educate themselves. I can’t imagine the harm in this and welcome the push if I ever fall in this category.

One flaw that I see is that many dermatologists hire extenders (PAs or NPs) who are not required to test whether they have obtained the manifest skill set that we have been trained for via internship and three year residency. There is no dermatology-specific certification exam for these individuals who are certified instead by the judgment and ethics of their supervising dermatologist. This is one area that desperately needs provision for testing and standards of quality. Many PAs and NPs have expressed the desire to have a true dermatology certification and would welcome this opportunity. Until this is addressed, a dangerous and unfair “loophole” is left unattended in our profession in which it is nearly impossible to gauge the dermatologic ability of a present or future PA or NP.

Another area of concern is the potential that insurance companies or the government might use this recertification process to determine whether dermatologists can be part of panels or governmental insurance programs. The risk for abuse of this “status” is unknown and could be devastating for competent dermatologists who may not elect to take another exam due to time pressures, anxiety, or other reasons. This alone is the strongest reason for civil disobedience by our professionals, yet the likelihood of resistance by the medical profession seems close to nil.

While it is a significant intrusion into busy dermatologists’ lives to require yet one more test, there are clearly reasons—both personal and public relations-wise—to consider recertifying. There are also just as many reasons to be vigilant that this exercise remains reasonable and appropriate in scope. The profession would be well advised to keep a watchful eye on this recertification process.