Many Hospitals Don't Require Board Certification for Pediatricians

TUESDAY, Feb. 21 (HealthDay News) -- New research shows that many hospitals and health plans do not require pediatricians to be board-certified, a finding that may have implications for patient safety and quality of care.

"You don't have to be board-certified to practice in most hospitals in America, and only around 40 percent of health plans require a general pediatrician to be certified at any time of association with the health plan," said study author Dr. Gary L. Freed, director of the Child Health Evaluation and Research Unit at the University of Michigan in Ann Arbor.

"It appears that many hospitals and many health plans are not using the tools that are available to them to help ensure the public that they have the highest quality of care that can be provided," added Freed, whose report appears in the Feb. 22 issue of the Journal of the American Medical Association.

Until 1987, certification from the American Board of Pediatrics (ABP) was good for the entire career of the doctor. Now, the ABP requires renewal, through a stringent review process, every seven years.

"Starting in 1987 for pediatrics, they began limited certificates, to be able to say that, in fact, medicine does change, and it's not a static endeavor, and you need to be sure that people keep up to date," Freed stated.

While the requirements are clear, there has been little information on how hospitals and health plans dovetail with these requirements.

In this latest study, 78 percent of 200 hospitals surveyed nationwide did not require general pediatricians to be board-certified when they first received hospital privileges.

However, 70 percent did require pediatricians to become board-certified at some point.

Almost half (48 percent) of those that did require board certification had a time frame within which certification was needed. But 42 percent did not have a specific time limit.

The researchers also surveyed credentialing personnel from 193 U.S. health plans.

Ninety percent of the health plans do not require general pediatricians to be board-certified when they are initially credentialed by the plan. The majority (61 percent) have no time frame in which to become certified. And 41 percent required certification at some point in their association with the health plan.

Only 40 percent of health plans require sub-specialists to become board-certified.

Exactly what this means is an area for more research.

"There could be significant implications, but there have been few studies that have looked at differences in quality of care," Freed said. "It's an important area for future research. Just as there are no randomized trials of airline pilots who get recertified in the simulator and those who don't, it's likely that the public would want their pilot to have regular certification processes to make sure they stay sharp. One should expect nothing less from physicians."

"This is a time of tremendous change in health care. There's a whole lot going on around quality assessment, and making it more visible to the public," said Dr. Christine K. Cassel, president of the American Board of Internal Medicine and author of an accompanying editorial. "This is important. The public needs to understand how hospitals and health plans assure that physicians have met certain standards."

Right now, physicians are required to have a state license but that, Cassel said, is a "very low basic level." And requirements differ from state to state.

"The only national standard that reflects specialty training is board certification," she added. "My presumption is that you're going to see hospitals and health plans looking much more carefully at board certification going forward. It's a strong indicator, and it's getting stronger."

The American Board of Internal Medicine recently funded Freed and his group to do a similar study for that specialty.