Dr. Mary Nan S. Mallory tackles critical EM certification issues for ACEP Now

The American Board of Emergency Medicine (ABEM) has been transforming its approach to certification, a process that will culminate with the launch of MyEMCert next year. Mary Nan S. Mallory, MD, MBA, the new ABEM President, who was elected in August and serving for the 2020–2021 term, will be taking this multiyear process across the finish line.

Currently vice dean for clinical affairs and professor of emergency medicine for the department of emergency medicine at University of Louisville School of Medicine as well as an attending physician at the University of Louisville Hospital in Louisville, Kentucky, Dr. Mallory has been a member of the ABEM Board of Directors since July 2012 and was elected to the Executive Committee in 2019.

Mary Nan S. Mallory, MD, MBA

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

What are the priorities for ABEM this year?

Our number-one priority is to help physicians transition to a more continuous and lower-risk certification process. We will be continuing our conversations with physicians about changes to our certification process, such as online ConCert, the implementation of MyEMCert, and a virtual oral exam. We’ve designed these transitions based on what we’ve heard from physicians.

Why did ABEM go to a five-year certification cycle?

A number of factors contributed to the decision to change the certification cycle. It became apparent that smoothing out the costs of certification, launching MyEMCert, and shortening the 10-year certification cycle were all likely to occur very soon. The best way to accommodate these changes was to introduce the five-year certification cycle as soon as possible. Spacing out anticipated changes, such as an annual fee, MyEMCert, and a shorter cycle, would have created even greater complexity, which would have been difficult for physicians to navigate. In addition, if ABEM certification is going to remain a strong credential, we’ve got to reduce the time during which a certified physician could be not completing any certification activities. The five-year certification cycle creates a process that encourages ongoing engagement to keeping up with key advances in the specialty.

By instituting the five-year cycle with the launch of MyEMCert in 2021 and by going to an annual fee, the number of times physicians have to adjust to change will be minimized. It also simplifies the continuing certification process and reduces the total number of requirements. The move from 10-year to five-year certification—while simultaneously moving to an annual fee structure—does not come with any increased activity or additional costs.

Another factor ABEM took into account was the American Board of Medical Specialties Vision Initiative report that recommends certifying boards create a continuing certification process. A five-year cycle promotes more regular engagement in the process.

Finally, changing to a five-year cycle now allows physicians with certifications expiring in 2021 to recertify using MyEMCert. That gives nearly 3,000 physicians an opportunity they would not have had without going to a five-year certification cycle.

Also, why did ABEM choose to change to an annual fee?

The switch will allow physicians to avoid paying a one-time, large lump sum fee for the recertification exam (ConCert), which was $1,950. Instead, physicians will pay an annual fee that will approximate the same amount as physicians are now paying for continuing certification. And any physician who has paid more than $1,400 toward continuing certification activities will receive a check for the difference. (Refunds apply only to fees paid for successful completion of the ConCert Exam and Lifelong Learning and Self-Assessment tests; they will not apply to fees paid for retaking exams or for late fees.) None of these changes will result in increased revenue for ABEM. In fact, the five-year certification cycle will result in considerably less continuing certification revenue over the next decade.

Increasingly, ABEM directors heard from physicians that they wanted an annual fee structure. Physicians are then able to budget a lesser amount on an annual basis in their continuing professional development allocations instead of a large amount at one time when taking the exam.

What is the latest news on MyEMCert?

MyEMCert development continues at a rapid pace. Participants for the pilot have been selected, and the pilot begins this fall.

ABEM recently posted MyEMCert presentation scenarios—the core content for the specialty—on our website. We’ve also been developing key advances, areas in which there has been incomplete adoption of certain practices into emergency care. One example is the selection of acute ischemic stroke patients for potential endovascular reperfusion therapy. Some key advances are fairly recent, some less so, but the unifying theme is that we need to integrate these evolving practices into clinical care.

What new technology or apps are being developed or considered by ABEM to allow continuous interaction with the ABEM certification process from mobile devices?

The ABEM public website was redesigned a couple of years ago and is fully responsive, so it can be viewed on a mobile device. The new ✓ ABEM Reqs tool on the public website has been added so that you can check your requirements based on the year your certification expires. Although several app ideas have been explored, right now our resources are focused on the development of the MyEMCert platform. We hope to look into those ideas again after MyEMCert has launched and been fine-tuned. ABEM is also developing a virtual oral exam to accommodate physicians who were scheduled to take the exam in 2020.

What is ABEM doing to support physicians and destigmatize mental health challenges?

ABEM works with physicians who have had medical license issues as a result of mental health or substance disorders so that they don’t lose their certification. We supported 2019 Council Resolutions that addressed these concerns. We work with physicians in recovery programs to help them maintain their certification. ABEM believes that seeking assistance for mental health challenges is a sign of medical professionalism. Physicians are encouraged to contact ABEM prior to surrendering any state medical license to understand potential implications to their ABEM certification.

What is ABEM doing about the issues of advanced practice providers?

ABEM recently issued a statement and press release stating that the delivery of emergency care is best led by ABEM-certified physicians. While ABEM honors the contributions to emergency care by other providers, the path to become a nurse practitioner or physician assistant is not equivalent to the complex training required to become an ABEM-certified physician. ABEM-certified physicians should be leading team-based care in the emergency department.

Finally, what would you like ACEP members to know about you that they might not know?

While my vitae reads of an academic physician, it’s my early career experiences in military medicine, as well as the years spent practicing emergency medicine in rural and community hospitals, that continue to inform and shape my service commitment to ABEM’s mission of ensuring the highest standards across our specialty. But there’s life and lifelong learning to be had outside of the professional classroom, too. My husband and I enjoy long weekends hiking, wading, and roll-casting in the Great Smoky Mountains, where we are awed by the natural beauty of its streams and continually humbled by the innate brilliance of its wild trout