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Certification: goals set, goals met.

Certification: Goals Set, Goals Met

When the American Board of Medical Management was founded by the American College of Physician Executives on January 1, 1989, it was understood that the process for formal recognition of medical management as a specialty of medicine would be rigorous. Understandably, particularly at a time when the medical profession and the health care delivery system are under increasing scrutiny by all third-party payers, the decision to expand medical specialization is made with great caution. But the process of recognition for medical management is now well under way. In an interview with Frank A. Riddick Jr., MD, FACPE, Chairman of the Board of Directors of ABMM, Physician Executive learned more about the specific goals of ABMM and about the degree to which those goals have been achieved.

While the American Board of Medical Management is, by intent and necessity, an independent entity, it and its history are inextricably linked with that of the American College of Physician Executives. The first formal recognition of the medical management profession came from the American Medical Association in 1984, when the College (then the American Academy of Medical Directors) was awarded a seat in the AMA House of Delegates. The ultimate recognition for any medical specialty comes with membership in the American Board of Medical Specialties. That recognition cannot come to the College, however. A separate Board, not affiliated with a professional society, is required. And so, to achieve recognition for certification activities, ABMM was formed. In its short history, ABMM has already accomplished much (see box, page 3). Its Board of Directors is fully energized. Standards have been established for elevation of physician executives to Diplomate status, and a certification examination has been fine-tuned. More important for the profession at large, an application for recognition is being reviewed by the Liaison Committee on Specialty Boards and a preliminary reaction is imminent. But much more remains to be accomplished. Dr. Riddick, who is also Medical Director, Ochsner Clinic, New Orleans, La., and a past President of the American College of Physician Executives, says that ABMM has essentially four goals: * To organize itself as a separate

organization with a separate board. * To improve the statistical validity of

the certification examination. * To establish clear and measurable

standards for certification and to make the

Board of Directors a certifying board

rather than a board of regents. * To gain recognition of ABMM by the

American Board of Medical


An Independent Entity

It has to be remembered that much of what the American Board of Medical Management has undertaken was once the province of the American College of Physician Executives. The members and officers of ABMM previously served on the boards of the College and of the American Academy of Medical Directors. Some of them also served on the examination committee that was responsible for the process by which physician executives were accepted as members of the College and were elevated to fellowship. With the creation of ABMM, members of its Board were charged with organizing an independent certifying entity to serve the medical management profession. "It has been necessary to develop some comfort in working together as a new Board with new responsibilities, rather than as members of the Board of the College or the Academy or as members of the exam committee," Dr. Riddick says. "I think that we have achieved that comfort level in the creation of our new organization. There were no new faces in that creation. Everyone on the Board had participated at some level in the Academy or the College. I think that the familiarity of Board members with the existing processes of the College was of great assistance in the transition." Dr. Riddick believes that the goal of independence has been successfully achieved.

Examination Validity

The success of the examination process must be judged on at least two levels. One of those, Dr. Riddick says, is numbers. "We wanted to increase the number of candidates for the examination. Larger numbers improve the quality of the statistical base for the examination and provide further evidence of the desirability of certification in the medical management profession," he says. And the numbers are impressive. As shown in the table on page 4, the numbers of both eligible candidates for the examination and those successful in taking the exam leaped for the February 1989 examination, and the preliminary numbers for the November 1989 examination are even larger. Dr. Riddick says that the Board is pleased with the growth in the examination numbers and has a high degree of comfort with the content of the examination itself. "The current examination is the result of a learning process that began with the old College," he says. "We have built on our past efforts. Several members of the ABMM Board are veterans of the earlier examination process. Materials from previous examinations are represented in the current examination only if they have proven validity. As a participant and an observer, I believe that our degree of sophistication and comfort with the examination process has increased significantly with each successive examination." Important to the continued validity of the examination is psychometric evaluation of examination results. The precise measures are too technical for this report, but Dr. Riddick says that the validity and internal consistency of the examination have steadily improved. He says that the National Board of Medical Examiners and its staff have been of inestimable assistance in working on the exam. "It is a much more sophisticated product," he says. "Our challenge now is to work with the psychometricians of the National Board of Medical Examiners to set the pass/fail criteria for the examination. Our level of comfort with those criteria will depend greatly on further reducing the number of ambiguous questions on the exam and gaining a larger base of those who have taken the examination."

Eligibility Standards

A process that is still occurring, Dr. Riddick says, involves subtle changes in the mindsets of Board members on their new responsibilities. "The Board of Regents of the College, when it was responsible for administering the examination and setting standards for membership in the College, concentrated on how to recognize achievement in the profession of medical management. Our responsibility as members of the Board of Directors of ABMM is to ensure that eligibility standards and the certification examination accurately measure competence in and knowledge of medical management. That is a very subtle distinction, but it is critical to the success of the certification process." Dr. Riddick says that the Board is still working to refine its judgment on these elements of the certification process. "We've left ourselves a little room for improvement on our mindset. There will be a bit more discussion among Board members before all these issues are resolved."

ABMS Recognition

A longer term goal for ABMM is to gain formal recognition as a specialty of medicine. The Liaison Committee on Specialty Boards, a joint effort of the American Board of Medical Specialties and the American Medical Association, now has the ABMM application for membership in ABMS. The staff of the Committee is analyzing the application and will make recommendations to the Liaison Committee. As mentioned earlier, the decision-making process will probably require two or three years for completion. "We realize that recognition would be a highly ambitious goal for year one of ABMM," Dr. Riddick says. "And certainly it does not appear that we will achieve recognition in 1989. But we have negotiated the first significant hurdle--creating all of the documentation that is necessary to make application and start the process of recognition. A committee did yeoman's work in filling out all the documents and creating our petition for recognition." There is as yet no official word from the Liaison Committee or its staff on the analysis. Unofficially, we have been told that we are in substantial compliance with most of the requirements for recognition. But it is more than just likely that some alterations in the standards and process for certification will be required. What is not certain is what those changes will be and how difficult they will be to achieve. "We would like, of course, for recognition to occur on the current application," Dr. Riddick says. "More realistically, however, we expect the Liaison Committee to offer a critique and point out areas for improvement. We hope that these alterations will be minimal. We anticipate a requirement that we develop a definite plan for an element analogous to the residency requirements in the clinical specialties, perhaps at the preceptor level."

The Year Ahead

The past, then, short as it has been for ABMM, gives promise of a bright future. While 1989 will probably pass without formal recognition of medical management as a medical specialty, 1990 appears more hopeful. The ABMM Board will undoubtedly make recognition a key element of its deliberations and activities. "I hope that we are in the final phases of recognition during 1990," Dr. Riddick says. "And we will continue our work on the criteria for pass/fail on the certifying examination, as well as the eligibility standards. We will have to wrestle with the philosophical question of whether Diplomate status is for entry-level standards in medical management or recognizes some level of achievement in the field."

PHOTO : Wesley Curry is Editorial Director of the American College of Physician Executives. [Tabular data omitted]
COPYRIGHT 1989 American College of Physician Executives
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1989, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:American Board of Medical Management
Author:Curry, Wesley
Publication:Physician Executive
Date:Nov 1, 1989
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