The American Board of Orthopaedic Surgery (ABOS) Credentials Committee is the organization’s largest committee. It is comprised of 13 directors—12 active orthopaedic surgeons and the one public member of the ABOS Board. The committee serves a very important role in the evaluation of orthopaedic surgeons in the initial and continuing ABOS Board Certification processes.
Every Candidate applying for initial ABOS Board Certification and every Diplomate applying for Continuing ABOS Certification (Recertification) goes through the ABOS credentialing process. The committee reviews applications and case lists and conducts peer reviews for all Candidates and Diplomates to determine whether their practices adhere to accepted standards of patient care and professionalism, including integrity in interactions with both patients and other medical professionals.
Submitted case lists are first reviewed by a computer algorithm that seeks outliers in case volume, case mix, and complications. An applicant may be flagged for having too many complications or reporting too few. The process for reporting complications has recently been updated in an attempt to standardize reporting and grading. The ABOS contacts all applicants identified by this review to better understand their practices and to make informed decisions concerning eligibility to become or remain Board certified.
Peer review is the other essential part of certification and Maintenance of Certification (MOC) that the Credentials Committee considers to determine the professional standing of applicants. ABOS Diplomates have an obligation to participate in this process to provide thoughtful, candid, and fair evaluations of applicants in regard to their performance in practice and professional integrity. On the Application, Candidates are required to list practice partners and ABOS Diplomates who practice nearby. If needed, the ABOS can also utilize a Candidate’s zip code to contact additional reviewers. Despite skepticism about the fairness of rival surgeons’ scores, the ABOS experience has been that reviewers are generally respectful of the process and honest and professional in their assessments. If you are contacted as part of the ABOS peer-review process, please respond.
Diplomates also may be subject to a Credentials Committee review prior to the expiration of their 10-year certification. This action is termed a “midcycle” review and may be triggered by circumstances that impact MOC professional standing requirements, such as a lapse or restriction of medical licensure, a loss of hospital privileges, a concerning practice pattern, substance abuse, or criminal activity, among other situations. The Credentials Committee may take action up to and including termination of Board certification prior to the expiration of the 10-year term, based on the results of its review.
When a concern is identified by the ABOS credentialing process, it is communicated to the Candidate or Diplomate to ensure transparency with the process and, more importantly, to verify that all relevant information can be made available to the committee for review. Examples of actions the committee may take under such circumstances include:
- allowing an applicant to sit for the Examination
- deferring admission of the Candidate or Diplomate to sit for the Examination in order to obtain additional information
- requiring a site visit to the Candidate’s or Diplomate’s practice; this action consists of two Diplomates visiting the site of the practice and collecting information through interviews, inspection, and a mock oral examination
- denying admission to sit for the Examination
- requiring the Candidate to participate in a mandatory examination pathway—such as the Oral Recertification Examination, Computer-Based Practice-Profiled Exam, or ABOS Web-Based Longitudinal Assessment
- revoking ABOS Board certification
Fortunately, most Candidates and Diplomates are approved to sit for the assessment pathway of their choosing. Adverse actions taken by the Credentials Committee (denial, mandatory pathway, revocation) can be appealed by a Candidate or Diplomate. Revocation of ABOS Board certification is the most serious course of action, and that decision is not taken lightly but can be invoked if deemed necessary to ensure the safety of patients. The ABOS takes its credentialing process seriously and believes that a proper credentialing program is essential to its core mission: protecting the public.
Gregory Mencio, MD, is chair of the ABOS Credentials Committee.