Like many doctors, Arlington physician Denise E. Bruner believes that advertising her credentials is the way to attract new patients.

In an advertisement, the 42-year-old doctor says she is “the only area physician Board Certified in Bariatric Medicine.” In the 1993 and 1994 editions of the Washington Physicians Directory, Bruner is listed as being board certified in internal medicine; the 1994 directory lists her subspecialty as bariatric medicine.
What Bruner’s prospective patients probably don’t know is that bariatric medicine, the study and treatment of obesity, has not been recognized by the American Board of Medical Specialties (ABMS), the sole widely accepted authority on board certification.

The American Board of Bariatric Medicine, an independent organization located in a suburb of Denver, is one of more than 100 unofficial – or self-designated – boards that certify doctors. Bruner is one of 80 physicians certified by the bariatric medicine board, according to its executive director.

Bruner says that if patients ask about her bariatric medicine credentials, “I tell them quite frankly what it entails, that the exam I took was just as difficult” as the one she took for the official American Board of Internal Medicine.
But according to records of the American Board of Internal Medicine, Bruner has never been board certified in internal medicine. She did not return several telephone calls after questions about her credentials arose.

As the juggernaut of managed care inexorably transforms the medical landscape, physicians are scrambling to adapt. For many, that means getting on lists approved by giant networks, such as Kaiser Permanente and Cigna, that are providing both health insurance and health care to a growing number of Americans. For consumers and corporations alike, the term “board certified” has become an essential credential that signifies quality medicine.

Once an academic distinction, certification by an official specialty board is now a rite of passage for most new specialists, particularly in urban and suburban areas where competition among doctors is fierce and likely to intensify. In 1973, only 46 percent of doctors were board certified; today, an estimated 66 percent of physicians are board certified.

Known in medicine as “the boards,” the grueling exams are given annually in 24 core specialties, such as internal medicine, and 110 subspecialties including pediatric surgery, aerospace medicine and forensic psychiatry. For decades, the only boards that certified doctors were the relative handful of specialty groups that make up the ABMS, founded in 1933.

In addition to the 24 specialty boards, ABMS members include the pillars of the medical establishment: the American Medical Association, the American Hospital Association, the American Association of Medical Colleges and the Federation of State Medical Boards.

Unlike a medical license, which every state requires, board certification is entirely voluntary. Even so, doctors are finding it increasingly difficult to get a job without it.

Hospitals and managed care companies are demanding it, sometimes refusing to hire well-regarded physicians who haven’t passed their boards. A 1992 survey by the American Hospital Association found that 95 percent of hospitals are requiring board certification of new doctors seeking privileges; a growing number of hospitals also are insisting on board certification before renewing the privileges of doctors already on their staffs. Kaiser Permanente, the nation’s largest health maintenance organization, requires that physicians become board certified within three years of being hired.

“Board certification has become the gold standard for doctors,” says Paul G. Ramsey, chairman of the department of medicine at the University of Washington School of Medicine in Seattle.

Rise of Unofficial Boards

The accelerating demand for board certification by health plans and hospitals has also led to the proliferation of unofficial, self-designated boards that certify physicians. There are at least 126 self-designated boards, according to the Chicago-based ABMS.

Among them: the American Academy of Ringside Medicine and Surgery; the American Academy of Bloodless Medicine and Surgery, and the Council of Non-Board Certified Physicians.

Some self-designated boards have rigorous standards. Others are membership groups that provide a doctor with an impressive-looking certificate, suitable for framing, in exchange for a fee.

“If a doctor is board certified, a patient has a guarantee that the physician has satisfactorily completed an approved training program under supervision, has had practice in that specialty and has passed a rigorous exam, usually two-part, in that specialty. With a self-designated board, there is no guarantee they have done any of these things,” says ABMS vice president Barbara Schneidman.

“You can say you’re `board certified’ and have a plaque on the wall in illegible script and consumers cannot tell the difference,” says Julia M. Reade, a physician who coauthored an article about doctors’ credentials published in the New England Journal of Medicine in 1987.

Reade’s study found that 12 percent of doctors listed in the Hartford, Conn., Yellow Pages who claimed that they were specialists were not board certified. Some lied about their credentials and claimed to be board certified by an ABMS board when they weren’t; most listed certification by self-designated boards.

“There are some extremely reputable {self-designated} boards with very reputable people,” Reade adds. “Then there are these cranks who run these insane diploma mills.”

In most states, doctors, armed with only a valid medical license, may practice virtually any specialty they choose. That means that a doctor with a medical degree and no specialized training can set up a practice as a cardiologist or a cosmetic surgeon. And while a surgeon would probably have a hard time obtaining hospital privileges without residency training and board certification, he or she could legally perform some procedures, such as liposuction or other kinds of cosmetic surgery, in his or her office.

Link to Quality

In the past decade, health care researchers have searched for ways to measure quality. As the University of Washington’s Ramsey notes, “There’s been an increased interest in developing methods that assess doctors’ performance and are feasible, affordable and meaningful.” Those markers, he says, are board certification and where a doctor trained. “After that, it becomes subjective.”

There is some evidence that board certified doctors are superior to those who are not certified by an official specialty board. A 1989 study by Ramsey found that board certified doctors performed significantly better on written competency exams and were more highly rated by colleagues than their non-certified colleagues. The study, published in the Annals of Internal Medicine, involved 250 internists, 185 of them board certified within 10 years after they completed residency training.

While officials at the American Board of Medical Specialties agree that board certification is no assurance of quality, they say it indicates that a doctor has met standards that are higher than those required to obtain a medical license in any state.

“Board certification guarantees that if you go to a doctor who says he’s a surgeon he really is a surgeon,” says the ABMS’s Schneidman.

“As a public health or consumer protection matter, it’s really important, but personally I wouldn’t use it as a benchmark,” says Reade, coauthor of the New England Journal study. “Every doctor knows someone who’s not boarded and is very good. Board certification doesn’t tell you whether a doctor is empathic or a good clinician.”
Lack of board certification, however, may reflect a serious problem with a doctor’s training, competence or character.
A report prepared for the Medical Board of California, the state agency that polices physicians, found that of 69 doctors disciplined since 1991 for the most serious offenses – ranging from rape to gross negligence that resulted in a patient’s death – 68 were not certified by an ABMS board.

“It’s an irrefutable statistic,” said Dixon Arnett, executive director of the California board.

Advertising and the Law

The clamor for doctors’ credentials was fueled in 1975 when the Federal Trade Commission successfully sued the AMA, charging that it unlawfully barred advertising by doctors.

Once the courts allowed doctors to advertise, “all these pseudoboards started forming” that attracted “people who weren’t able to make it within the existing boards,” says Mark Gorney, a past president of the California Society of Plastic Surgeons.

“What you’re looking at is the very peculiar American phenomenon of entrepreneurism by practitioners who cannot be players in a big pond,” says Gorney, a former official of the American Board of Plastic Surgery. “This of course results in enormous confusion in the public mind.”

What makes it even more confusing for consumers is that the names of many self-designated boards are strikingly similar to those of the official boards. The American Board of Neurology, for example, is a self-designated board; the official board is the American Board of Psychiatry and Neurology. The American Board of Radiology and Medical Imaging is an unofficial board. The American Board of Radiology is the ABMS group.

In all but three states – California, Florida and Colorado – there is no law that bars doctors certified by self-designated boards from calling themselves specialists or from advertising that they are “board certified.”
In California, the primacy of the ABMS is being challenged by several groups, including the American Academy of Pain Management, a self-designated board based in Modesto.

“Nobody says the ABMS model is not good, but it fails to recognize a multi-disciplinary approach,” says executive director Richard M. Weiner. “It’s an economic guild issue. . . . The public should be allowed to make its own informed decisions about specialists” and should be able to assess the credibility and competence of boards without government intrusion.

“The ABMS has no acupuncture board, no herbalist board,” Weiner adds. “When $1 out of every $3 is spent on alternative medicine, it would indicate that the ABMS is missing the boat.”

Academies, Societies, Fellowships, Etc.

Board certification is not the only confusing credential. Most consumers find the arcane terminology and alphabet soup of initials after doctors’ names both mystifying and impressive. Deciphering the meaning of such terms as “fellow of,” “diplomate” and “board certified” (the last two are synonymous) is no easy task.

In addition to board certification, many doctors advertise their membership in a professional specialty society. The standards of these societies vary considerably.

Being a fellow of the American Academy of Pediatrics, for example, may sound exalted, but it merely means that a pediatrician is board certified and has submitted two letters of recommendation from other fellows.
A fellow of the American Academy of Family Physicians need not be board certified. Becoming a fellow of the American College of Surgeons is considerably more difficult. A doctor must be board certified, must have practiced in one location for at least two years and must have a hospital appointment in good standing. Candidates also are required to submit a year-long list of all procedures performed, as well as detailed reports of several cases.
Determining whether a doctor’s credentials are genuine can be daunting: Many physicians directories, Washington’s included, print the information a doctor submits without verifying it. While it is uncommon, doctors do lie about their credentials.

A 1988 study of 773 doctors who submitted clinical credentials to Humana found that 39 presented false credentials; 10 said they were board certified when they weren’t. A 1987 congressional audit of 650 Veterans Administration Hospital physicians found that 115 – nearly 18 percent – said they were board certified when they weren’t. Officials of the American Board of Internal Medicine have uncovered 19 cases of fraudulent board certification since 1980 and are currently conducting a multi-specialty study of faked credentials.

“The whole area of credentials is largely unregulated, and some of these self-designated boards are very troubling,” says Julia Reade. “For a layperson, it’s very hard to get access to information about doctors – who’s good and who’s not – that physicians have. Board certification guarantees a minimal level of training and experience.”
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Below are the 24 specialty boards recognized by the American Board of Medical Specialties. Most boards also award certifications in subspecialties. To determine whether a subspecialty is officially recognized or whether a doctor is board certified, call ARMS at 1-800-776-2378.

American Board of……

  • Allergy & Immunology
  • Anesthesiology
  • Colon & Rectal Surgery
  • Dermatology
  • Emergency Medicine
  • Family Practice
  • Internal Medicine
  • Medical Genetics
  • Neurological Surgery
  • Nuclear Medicine
  • Obstetrics & Gynecology
  • Ophthalmology
  • Orthopaedic Surgery
  • Pathology
  • Pediatrics
  • Physical Medicine and Rehabilitation
  • Plastic Surgery
  • Preventive Medicine
  • Psychiatry & Neurology
  • Radiology
  • Surgery
  • Thoracic Surgery
  • Urology

Following is a list of 126 unofficial boards compiled by the American Board of Medical Specialties. These self-designated boards certify physicians and sometimes non-physicians as well. Some have rigorous requirements. Others grant board certificates after a weekend course. Unless otherwise indicated, each is known as the American Board of:

  • Abdominal Surgeons
  • Acupuncture Medicine
  • Addiction Medicine
  • Addictionology
  • Adolescent Psychiatry
  • Aesthetic Plastic Surgery
  • Alcoholism & Other Drug Dependencies

    • {AMSAODD}

  • Algology {Chronic Pain}
  • Alternative Medicine
  • Ambulatory Anesthesia
  • Ambulatory Foot Surgery
  • Anesthesia
  • Arthroscopy {Board of North America}
  • Arthroscopic Surgery
  • Bariatric Medicine
  • Bionic Psychology
  • Bloodless Medicine & Surgery
  • Cardiac Catheterization and Angiography
  • Chelation Therapy
  • Chemical Dependence
  • Clinical Chemistry
  • Clinical Ecology
  • Clinical Medicine and Surgery
  • Clinical Neurology
  • Clinical Neurophysiology
  • Clinical Neurosurgery
  • Clinical Nutrition
  • Clinical Orthopaedic Surgery
  • Clinical Pharmacology
  • Clinical Polysominography
  • Clinical Psychiatry
  • Clinical Psychology
  • Clinical Toxicology
  • Cosmetic Plastic Surgery
  • Cosmetic Surgery
  • Council of Non-Board Certified Physicians
  • Critical Care in Medicine and Surgery
  • Dermatology
  • Disability Evaluating Physicians
  • Electrodiagnostic Medicine
  • Electroencephalography
  • Electromyography and Electrodiagnois
  • Environmental Medicine
  • Epidemiology {College}
  • Eye Surgery
  • Facial Cosmetic Surgery
  • Facial Plastic and Reconstructive Surgery
  • Forensic Examiners
  • Forensic Psychiatry
  • Forensic Toxicology
  • Hand Surgery
  • Head, Facial & Neck Pain & TMJ Orthopedics
  • Health Physics
  • Homeopathic Physicians
  • Homeotherapeutics
  • Hypnotic Anesthesiology {National Board of}
  • Industrial Medicine and Surgery
  • Insurance Medicine
  • Int’l Cosmetic & Plastic Facial Reconstructive Standards
  • Interventional Radiology
  • Laser Surgery
  • Law in Medicine
  • Longevity Medicine/Surgery
  • Malpractice Physicians
  • Maxillofacial Surgeons
  • Medical Accreditation {American Federation for}
  • Medical Hypnosis
  • Medical Laboratory Immunology
  • Medical-Legal Analysis of Medicine & Surgery
  • Medical-Legal Consultants
  • Medical Legal & Workers Comp. Medicine & Surgery
  • Medical Management
  • Medical Microbiology
  • Medical Preventics {Academy}
  • Medical Psychotherapists
  • Medical Toxicology
  • Microbiology {Medical Microbiology}
  • Military Medicine
  • Mohs Micrographic Surgery & Cutaneous Oncology
  • Neuroimaging
  • Neurologic & Othopaedic Dental Medicine and Surgery
  • Neurological & Orthopaedic Medicine
  • Neurological & Orthopaedic Surgery
  • Neurological Microsurgery
  • Neurology
  • Neuromuscular Thermography
  • Nuero-Orthop. Dental Medicine and Surgery
  • Nuero-Orthop. Electrodiagnois
  • Nuero-Orthop. Laser Surgery
  • Nuero-Orthop. Psychiatry
  • Nuero-Orthop. Thor. Medicine/Surgery
  • Nuerorehabilitation
  • Nutrition
  • Orthopaedic Medicine
  • Orthopaedic Microneurosurgery
  • Otorhinotaryngology
  • Pain Management {American Academy of}
  • Pain Management Specialties
  • Pain Medicine
  • Percultaneous Diskectomy
  • Plastic Esthetic Surgeons
  • Prison Medicine
  • Professional Disability Consultants
  • Psychiatric Medicine
  • Psychoanalysis {American Examining Board of}
  • Psychological Medicine {International}
  • Quality Assurance & Utilization Review
  • Radiology and Medicine Imaging
  • Rheumatologic Surgery
  • Rheumatological and Reconstructive Medicine
  • Ringside Medicine & Surgery
  • Skin Specialist
  • Sleep Medicine {Polysomnography}
  • Spinal Cord Injury
  • Spinal Surgery
  • Sports Medicine
  • Sports Medicine & Surgery
  • Toxicology
  • Trauma Surgery
  • Traumatologic Medicine & Surgery
  • Tropical Medicine
  • Ultrasound Technology
  • Urological Surgery
  • Urologic Allied Health Professionals
  • Weight Reduction Medicine