The JAMA Network, published by the Journal of the American Medical Association, posted an insightful article this week by a UT Southwestern Medical School professor concerning developments in Texas law concerning maintenance of board certification.
What is board certification?
In the medical profession, board certification is not mandatory.
Many people do not realize that any person who successfully completes four years of medical school can be a licensed physician in Texas.
While most physicians will receive additional hands-on, apprentice-style clinical training in residency and fellowship programs, they are not required. Anyone fresh out of medical school can get licensed and then advertise and accept patients in virtually any specialty.
I recently filed a lawsuit against a doctor who was a wound care physician for a man in his 60s, at Mainland Medical Center, who developed bedsores after a total knee replacement surgery. This doctor holds himself out as a wound care physician, but had no board certification and all of his residency training is in pediatrics.
Most doctors, though, complete post-graduate residency programs, and when they have enough experience under their belt take a board certification examination in a particular medical specialty. It is like a professional capstone that most physicians use to demonstrate their competence and clinical skills, and to distinguish themselves from doctors with less training.
There other professional and financial benefits, as well.
Many hospitals use board certification as a factor in deciding whether to give a doctor staff privileges to work in their facilities. Similarly, insurance companies often look to board certification when making decisions about reimbursement rates and whether to add physicians to their networks.
Patients looking for physicians often look at board certification as good indicator that a doctor’s education, training, and competence have passed muster according to the standards set by nationally-recognized board certification bodies in each medical specialty.
Board certification issues
As a Houston, Texas medical malpractice lawyer, I have found that most doctors are board certified. In fact, I cannot remember the last time I filed a medical negligence lawsuit against a doctor who was not board certified.
What I am getting at is that board certification is more than meets the eye. If you are investigating or considering a potential physician, I recommend using board certification as a first step, but certainly not the last one. There are a few reasons why this is the case.
First, in some specialties, board certification is a relatively new development. Some older physicians who practiced in some areas of medicine before board certification was available in those specialties may be grandfathered in, without taking a board certification exam.
Second, doctors who are board certified in one area may practice in another specialization. For example, I filed a lawsuit against the owner of the Neighbors Emergency Center facility in Kingwood, Texas, and a doctor who provided emergency medicine services there to a teenage boy. That doctor was board certified in internal medicine, but not emergency medicine.
Third, just because physicians pass a board certification exam once does not mean that they are automatically competent for the rest of their lives. Medicine is constantly changing and physicians are required by the standard of care to keep up on these advances. This is why the board certification organizations have increasingly moved to requiring recertification at a designated time intervals.
While this requires some additional time, focus, and expense for doctors, I believe it is a great way to promote patient safety. Sadly, the 2017 Texas legislature disagreed, and past Senate Bill 1148, which Governor Greg Abbott signed into law on June 15, 2017.
Senate Bill 1148, entitled “Relating to Maintenance of Certification by a Physician or and Applicant for a License to Practice Medicine in This State,” was introduced by two physician-legislators, with extensive support by the Texas Medical Association.
In my opinion, this legislation is nothing more than another concerted effort to provide governmental favoritism to physicians, at the expense of patient safety.
Specifically, this law restricts hospitals and other programs licensed by the state or any county to differentiate between physicians based solely on a physician’s maintenance of certification. In other words, hospital credentialing decisions can no longer be based on whether a doctor completes the requirements for re-certification set by programs of the American Board of Medical Specialties.
A similar provision in the law prohibits managed-care plans from differentiating based solely on a doctor’s maintenance of certification, regarding paying or reimbursing the doctor, or making in-network contracting decisions with the doctor.
I was relieved that physician-author of The JAMA Network article admitted to the same problem that I see with this law: “lifetime certification could not guarantee competence for the entirety of a physician’s career.” The article explained that specialty certification boards adopted recertification requirements “to improve the quality of patient care, set standards for clinical competence, and foster the continuing scholarship required for professional excellence over a lifetime of practice.”
What you can do
In this era of insurance networks, patients are often provided with lists of in-network physicians in different specializations. Now that the ill-considered Senate Bill 1148 is law, it is a good reminder to do some research before selecting a physician. A good place to start is the American Board of Medical Specialties website, which has a searchable database for verifying physician certification and re-certification.
During your first visit with a new doctor, I think it is a good idea to have a conversation to get acquainted. While you are expected to provide a lot of information about yourself, which is certainly needed in order for a doctor to provide good medical care, it is also reasonable for you to ask him questions about the doctors training and credentials.
We are here to help
If you or someone you care for has been seriously injured by poor care provided by a physician whose competence you question, call the experienced medical negligence attorneys at Painter Law Firm, at 281-580-8800, for a free consultation about your potential case.
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Robert Painter is a former hospital administrator who practices law at Painter Law Firm PLLC, in Houston, Texas. He represents patients and their families in medical malpractice lawsuits against doctors, hospitals, pharmacies, labs, and other healthcare providers.
