Three Reasons Why Renewal of Certification is a “Waste of Time”
Recertification is a “waste of time and effort”. Whether you agree or not, there’s a good chance this thought has crossed your mind or you have heard some version of it said. If you know any physicians, you might also know they debate this even more.
Recertification is a “waste of time and effort”.
Whether you agree or not, there’s a good chance this thought has crossed your mind or you have heard some version of it said. If you know any physicians, you might also know they debate this even more than we do in pediatric dentistry. Given the chatter, let’s consider why recertification may be a “waste of time”.
Reason #1—Certification should be one and done
I frequently hear people say that all the effort they spent getting a professional degree and board certification proves their personal commitment to quality. This makes a lot of sense to me. One would think the positive habits established by these pursuits are likely to continue throughout clinical practice.
Furthermore, unlike medicine, dental specialties do not require board certification to practice. A fair conclusion might be that both certification and recertification must not be that important.
Unfortunately for this argument, there are a number of studies (in medicine) that find evidence linking positive clinical outcomes to a required recertification process. Specialty board policies, informed by this, have established mechanisms to help the clinician stay up-to-date. While there is still little information about how much continuing education is optimal, one-time certification is likely insufficient to meet our professional code of practice.
Reason #2—Old “docs” don’t need new tricks
Alright. Just because there’s some benefit to forcing doctors to recertify, isn’t experience really the most important factor? After all, the more experienced the doctor, the better the outcomes, right? Case in point, the stainless-steel crowns I do now are much better than that first one in dental school. “Practice makes perfect” must certainly trump recertification.
Hmm. But what if one repeats outdated treatments? What role does experience play then? Though limited, evidence suggests that there may be an inverse relationship between clinical experience and patient outcomes.[1] If your first reaction is like mine, you’ll find this hard to believe. One likely explanation, however, is that doctors actually have difficulty keeping up with the continual flow of new information. Treatment protocols change and emerging technologies pop up almost every day now. Typically, a new graduate is exposed to these latest developments while a seasoned veteran might have more deeply rooted practice habits and a lessened interest in trying something different.
I’ve been practicing since 1998 and claim a modest amount of experience. While some things are just automatic, intentionally reaching for new information isn’t. I must admit that participating in the ABPD’s Renewal of Certification Process (ROC-P) constantly challenges me to learn something new.
Perhaps experience matters most when it is coupled with new data. Such a marriage tailors the treatment for each patient which is our ultimate goal.
Reason #3—The cost of recertification is too high!
While the previous two reasons seem to have diminishing support, this final reason might seem to be the winner in the argument against recertification. It is also the most common reason I hear. Recertification is certainly a significant investment once all the time and money, review courses, continuing education, and forfeited clinic income are added up. How can we justify this? And we are not alone in this concern--many physicians have banded together for this reason in an attempt to repeal their certification renewal requirements.
How does this argument stack up for me as a pediatric dentist? What are the ABPD costs to remain board certified? Well, let’s look. Continuous Quality Improvement (CQIs) modules, provide free continuing education to Diplomates. These modules also seem to be quite time efficient and cover relevant clinical topics. The comprehensive review course isn’t required anymore. The recertification exam is open book, can be done from home whenever convenient, provide additional continuing education hours and is included in the annual fees. So, what about those annual Diplomate renewal fees? Actually, I have found them to be more reasonable than almost all of my other professional dues/fees, and in fact, the renewal fee for Time Limited Diplomates actually went down two years ago.
As a participating practitioner in the ABPD, I can attest that the ABPD considers how these factors impact Diplomates when making decisions about the renewal process. The Board continuously absorbs new information from practitioners and research as it reshapes recertification.
In short, specialty boards share a mission to encourage quality care through continued learning and measurement. While board recertification is a work in progress, maybe saying it is a waste is a bit excessive--especially since there is evidence that a well-designed recertification process can have a positive impact. Rest assured, I know the ABPD keeps this goal in mind and is engaged and invested in continuous learning adjustment on your behalf.
[1] Choudhry NK, Fletcher RH, Soumerai SB. Systematic Review: The Relationship between Clinical Experience and Quality of Health Care. Ann Intern Med. 2005;142:260-273. doi: 10.7326/0003-4819-142-4-200502150-00008
