Board certification in orthopaedic surgery has been a tradition since 1934, when the first certificates were awarded by the American Board of Orthopaedic Surgery (ABOS). The process of certification has changed greatly in the following years but the mission of the ABOS has not changed.

The ABOS certifies surgeons to “serve the best interests of the public and the medical profession.” The original intent of that mission statement was to show the public that a Board-certified orthopaedic surgeon had met the minimum standards of education, training, and competence. This is important to ensuring the quality of medical service—an effort that begins in American medical schools, continues through graduate medical education (residency and fellowship), and flows throughout the independent practice of the surgeon.

Current requirements
Currently, certification by the ABOS requires that the individual achieve passing scores on a computer-based exam that is mostly knowledge-oriented, followed by an oral exam that is practice-based. Candidates who pass the part I (knowledge) exam are considered “Board-eligible”; candidates who pass the part II exam are certified for 10 years.

In the United States, the process requires completion of an orthopaedic residency program accredited by the Accreditation Council for Graduate Medical Education, or completion of an orthopaedic residency in Canada with achievement of certification by the Canadian Royal College. Internationally trained orthopaedists are not eligible for ABOS certification unless they are found to be compliant with the Distinguished Scholars Pathway.

ABOS certification is voluntary and “does not confer any rights on its diplomates, nor does it purport to direct licensed physicians in any way in the conduct of their professional duties or lives.” Despite this disclaimer, certification has taken on a meaningful role in the professional lives and practices of both diplomates (those who are certified) and nondiplomates (those who are not certified).

For example, active membership in the AAOS and many orthopaedic specialty societies is dependent upon the applicant’s achievement of Board certification. Hospital credentials, group or health system hiring, group insurance contracts, and faculty positions at teaching institutions may also require Board certification.

The ABOS has no influence or control over the uses of Board certification in society. The meaning of certification remains very much as it was at its founding in 1934: a means of gaining trust from the public that someone who claimed to be an orthopaedic surgeon had indeed met the requirements of training and education and passed a review process and a thorough examination demonstrating the knowledge and skill expected of an orthopaedic surgeon.

Today, pressure from external sources is being exerted to make certification a mark of quality above and beyond its recognition of achievement for the orthopaedic surgeon. The quality movement is much like the certification movement in the 1930s that created the ABOS and many other specialty boards (24 such boards are partners in the American Board of Medical Specialties).

Evidence indicates that the public (our patients) does not understand the meaning of Board certification and confuses certification with licensure or surgical privileges. Certification is still relevant today and will continue to be important to the safe practice of orthopaedic surgery for the foreseeable future. The process of certification and maintenance of certification may change, but the primary goal is still to assure our patients and fellow physicians that Board-certified means trustworthiness, competence, and skill in treating musculoskeletal injuries, conditions, and developmental disorders.

Part II requirement change
Recently, the ABOS changed the practice requirements for the Part II oral exam. Under the old rules, candidates were required to practice for 22 months prior to taking the exam. The following new requirements begin with the 2012 exam:

1. The applicant must be continuously and actively engaged in the practice of operative orthopaedic surgery, other than as a resident or fellow (or equivalent), for at least 20 full calendar months in one location immediately prior to the Part II examination. An applicant must have started practice and been granted hospital admitting and surgical privileges on or before November 1, 2010, to qualify for the 2012 Part II exam.
2. A change in practice location, hospital surgical staff privileges, and/or practice association during the 20 full calendar months may result in deferral. The practice must be located in the United States or its territories, Canada, or a United States service installation.
3. To satisfy the requirements in Sections 1 and 2 above, the applicant’s practice must include hospital admitting and surgical privileges (temporary privileges acceptable) for the 20 full calendar months immediately prior to the Part II examination and continue through the date of the examination. The practice must allow independent decision-making in matters of patient care.

More information is available at www.abos.org

Shepard R. Hurwitz, MD, is executive director of the ABOS and can be reached at hurwitz@abos.org

Stephen Albanese, MD, is a member of the ABOS board of directors. He can be reached at albaness@upstate.edu