The future of certification is exciting, according to Robert L. Muelleman, MD, FACEP, new President of the American Board of Emergency Medicine (ABEM), who was elected in July and will serve for the 2018–2019 term.

Dr. Muelleman is professor and past chair of the department of emergency medicine at the University of Nebraska Medical Center in Omaha. He has been a member of the ABEM Board of Directors since July 2011 and was elected to the Executive Committee in 2015.

Dr. Robert Muelleman
Credit: ABEM

Dr. Muelleman recently responded in writing to ACEP Now’s questions about his goals as ABEM President and the future of certification.

Given your long involvement in academic emergency medicine, what would you like ACEP members to know about you?

Until two years ago, I was an academic department chair at the University of Nebraska Medical Center. My practice and teaching focus is in the heartland of America. Much of my academic interest revolves around the challenges of providing emergency care in rural America. That brings a unique, somewhat nontraditional focus within academic emergency medicine.

While I was the chair of the Residency Review Committee for Emergency Medicine, I tried to find practical approaches to residency training that would serve physicians who ultimately went to work in community settings. Because most ABEM-certified physicians are community physicians, I want them to know that I am committed to having ABEM serve their needs.

Finally, I’m an avid wine grape grower in Nebraska. Because ACEP Immediate Past President Paul Kivela is a wine maker, I think we will have some fun, non-emergency medicine–related conversations during the upcoming year.

As the President of ABEM, what do you see as the biggest challenges for the specialty?

Emergency medicine has been described as the hub of the U.S. health care system, and I think the wheel is starting to squeak. Although we have high self-expectations and need to keep up with medical advances, we are being pummeled from every side with additional rules and requirements. We want to take some of the pressure away from emergency physicians. We want ABEM certification to be the only credential that an emergency physician will need beyond a medical license. It’s a delicate balance to increase the value of ABEM certification, with its rigorous standards, without burdening physicians with unnecessary work. We know that certification is valuable and is associated with greater levels of income, more career opportunities, and a lower risk of state medical board disciplinary actions. We are constantly seeking ways to make it even more valuable.

How will the “Vision Commission” that the American Board of Medical Specialties (ABMS) is conducting affect ABEM and our specialty?

The Vision Commission was established by ABMS to suggest ways to redesign continuing certification (Maintenance of Certification [MOC]). What’s important for emergency medicine is that we have had a voice on the commission. ABEM Executive Director Earl J. Reisdorff, MD, FACEP, serves on the commission. The commission heard testimony from John C. Moorhead, MD, FACEP, the Chair of ABMS, but, importantly, a past President of both ACEP and ABEM. Testimony from other emergency physicians, including Janet G. H. Eng, DO, FACEP, and Kim M. Feldhaus, MD, FACEP, provided perspectives on the day-to-day realities of emergency physicians; they really portrayed our specialty favorably.

The Vision Commission will soon submit a report to ABMS with recommendations to improve the continuing certification process. I’ll be surprised if ABEM will need to make many adjustments to our planned modifications.

What can you share from your survey to all ABEM-certified physicians about continuing certification?

We conducted the survey because we felt it was extremely important to hear the voice of all ABEM-certified physicians as we developed modifications to the continuing certification process. I was pleased by the high response rate. We received almost 13,000 responses (36 percent) on a survey that was open for only two weeks. More than 70 percent of respondents thought that some assessment of medical knowledge should be part of continuing certification, and more than 90 percent prefer the general idea of shorter, more frequent open-book assessments. This information will help guide our path. For me, the biggest takeaway is a sense of gratitude to everyone who took the time to share their ideas so that together we can change the future of our specialty.

Tell us about the future of ABEM’s Continuing Certification Program.

In short, it’s really exciting. Our biggest challenges are defining the content and detailed design of the new testing format, MyEMCert, and meeting our self-imposed 2020 deadline for the pilot. We’re also exploring the best parts of our current program, such as the Lifelong Learning and Self-Assessment, to see if we can leverage that learning experience within MyEMCert. With O. John Ma, MD, leading a taskforce of very talented and creative individuals, I’m confident it will be a high quality product.

We are also trying to find ways to identify new developments within the specialty and incorporate them into the new testing format in a timely manner. One of the criticisms we received is that we don’t focus on the most recent and relevant advances in the specialty. I think that will change.

The flip side of this effort is to not lose the validity of the current ConCert Exam. Research shows that the ConCert is a valid assessment of cognitive skill.

What’s been happening with the anti-MOC legislation?

Most anti-MOC legislation has failed. Among the bills that passed, most prohibit using MOC or certification as a requirement for medical licensure. I find that ironic since no ABMS Board has ever suggested that certification should be a requirement for a medical license. There are states, such as Texas, Georgia, and Tennessee, where the legislation has been more substantial.

Much anti-MOC activity has been born out of a hostility within other specialties. We are fortunate that, within emergency medicine, there has been open communication, even when there is not always agreement about the best approach. We think there is a growing awareness that anti-MOC legislation would injure professional self-regulation, which is the publicly stated opinion from our colleagues at the American College of Surgeons. We would welcome ACEP joining us with a similar position. The medical profession has already lost a lot of ground on cost control, access to care, and quality improvement, and now some physicians are trying to legislate away our ability to regulate ourselves. We believe that emergency medicine has an opportunity to be a leader in revising continuing certification and helping emergency physicians become even better doctors while showing a united front in preserving professional self-regulation.