Comparing “Board Certification” to Eggs

The topic of “Board Certification” in pain management can seem to be about as confusing as trying to understand the label on a carton of eggs.  Your local grocery store has them all:  cage free, free range, vegetarian fed, no hormones, antibiotic free, and organic.  There are certainly differences in price for these types of eggs.  Are there health benefits to choosing one type of egg versus another?  If so, is it worth the price of the more expensive egg?

Should your physician be board-certified?

Perhaps the same questions should be applied to the field of medicine, and pain management in particular.  What does board certified mean?  Who is granting this title to physicians?  Is seeing a board certified physician better for your health?  Should physicians who are not board certified be paid less by insurers like Medicare and Blue Cross?

A few weeks ago, our local newspaper reported on a physician who let his board certification lapse, and it has brought this topic up for discussion.  The physician in question had advertised being board certified when, in fact, that certification had expired.  Why the fuss?  Should we be alarmed when a physician is not board certified?

The South Carolina Board of Medical Examiners states that physicians can only report being board certified if the agency granting that board certification is recognized by either the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA).  In most medical specialties, there is only one board from which a medical doctor can obtain certification.  But it’s different with pain management.  It may come as a surprise to you that a pain management physician can declare board certification without any formal training in pain management.

The American Board of Anesthesiology

Since the American Board of Anesthesiology (ABA) is the only pain management credentialing organization currently recognized by the ABMS, it would follow that only physicians certified by the ABA can state they are board certified.  Well, it’s not that simple.  In 1992, the ABA developed a separate certification called a pain fellowship in order to provide physicians a specialized one-year program focusing on pain management.  This fellowship program was originally offered to any physician who had completed a 4 year residency in Anesthesiology, but was later amended to include physicians with residency training in Psychiatry, Neurology and Physical Medicine and Rehabilitation.  In an effort to offer a path for physicians to “grandfather” into pain management, the ABA gave anesthesiologists until 1999 to take a test and be certified, whether or not he or she had any training in pain medicine.

Boards not sanctioned by the ABMS

There are two pain management boards that are not recognized by the ABMS, the American Board of Pain Management (ABPM) and the American Academy of Pain Management (AAPM).  Neither one requires fellowship training, and the AAPM, allows homeopathic doctors and nurses to become board certified.

It seems healthcare is changing every day.  The Affordable Care Act not only imposed financial penalties on physicians for not adopting electronic medical records, but also on the public for not having health insurance.  Has the time also come to impose financial penalties on physicians who don’t have the most advanced training possible?  The regulators are controlling everything else.  Could it happen?  I don’t know but understanding eggs is probably easier.