The American Board of Emergency Medicine (ABEM) is working to create a new process for continuing certification by offering an alternative to the ConCert Examination. The ConCert will remain an option for physicians who wish to take it, and many likely will. However, there will soon be a way to opt out of taking the 10-year exam.

ABEM just completed a year-long listening program where we sought the opinions of leaders in our specialty. ABEM has had extensive conversations with the ACEP Board of Directors, the leadership of the American Academy of Emergency Medicine, and about half of the state ACEP chapters. We’ve also reviewed thousands of survey responses from last year. One of the most helpful conversations we had was at the ConCert Summit, a national summit we convened last October that included representatives from every major emergency medicine organization. What we heard was a desire to focus on three areas: cost, convenience, and clinical relevance.

The Three Cs

Despite Maintenance of Certification (MOC) fees averaging only $265 per year, those costs are not evenly distributed, and they do not include additional costs that a physician might spend. Discussions about cost are complicated. We know that 32 percent of physicians take an off-site board prep course, which adds an additional expense. However, there is usually a substantial amount of continuing medical education (CME) awarded, and the course’s expense is tax deductible. We also know that being board-certified is associated with higher financial compensation. Still, the costs feel considerable. ABEM also realizes that there is a significant cost in time. We know that 98 percent of physicians study for the ConCert because the consequences of failing are substantial. The amount of preparation by physicians is also why the pass rate is so high, and more than 90 percent of physicians report a learning benefit to preparing for and taking the ConCert.

Convenience is a challenge. When ABEM changed from offering the recertification examination on a single date in only a handful of sites to offering the examination at Pearson VUE testing centers, ABEM-certified physicians were very pleased. Times have changed. We heard a strong request to add flexibility into the process and expand when and where tests can be taken. For the existing ConCert, starting in 2019, ABEM will offer the test twice yearly to provide an extra opportunity to pass the examination so that physicians have greater opportunities to maintain certification. We are looking at additional ways to optimize the convenience of completing the ConCert alternative.

Improving the clinical relevance of the continuing certification process was a key request. A message we received loud and clear was that emergency physicians remain committed to a rigorous program of continuing certification, as long as it helps them become better clinicians. What a remarkable statement! The bottom line for emergency physicians is improved patient care, not self-interest. ABEM is committed to a revised process that helps physicians find learning opportunities and involves assessment that is more clinically focused. This could even involve looking up material much like we do when working in the emergency department.

The bottom line for emergency physicians is improved patient care, not self-interest. ABEM is committed to a revised process that helps physicians find learning opportunities and involves assessment that is more clinically focused.

Communicating

Many of the details of the ConCert alternative are not yet defined, but ABEM wanted to let physicians know the importance of what they told us and how we are responding. We envision that the alternative assessments will be shorter (possibly taking an hour or less to complete) and will target one or more content areas (such as trauma). Because relevance was a key issue for physicians, we will attempt to integrate more recent and timely topics into the alternative more quickly. Another consideration is the ability to use of some form of reference material(s). Finally, the feasibility of remote access to the assessment is being explored. ABEM will begin phasing in the alternative assessment in 2020. Over the next year, more and more details will be forthcoming. We also want to hear from ABEM-certified physicians about their ideas and thoughts on improvements.

Maintaining Credential Strength

ABEM is committed to maintaining the integrity and strength of ABEM certification as a credential. Emergency medicine faces many challenges, and those challenges are best addressed by skilled and talented physicians leveraging the strong credential of ABEM certification. ABEM supports using continuing certification as an indicator of quality and patient safety in our struggles surrounding scope of practice. ABEM strongly believes that continuing certification eliminates the need for medical merit badges and state-based CME requirements. We believe that the alternative assessment to the ConCert must ensure the continuing strength of ABEM certification so that emergency physicians can use the credential to their professional benefit and to optimize patient care. We think the ConCert alternative, as well as administering the ConCert more frequently, can address the issues of cost, convenience, and clinical relevance while maintaining the potency of ABEM certification.

Dr. Kowalenko is President of ABEM.