Association Between Physician Time-Unlimited vs Time-Limited Internal Medicine Board Certification and Ambulatory Patient Care Quality

John Hayes, MD; Jeffrey L. Jackson, MD, MPH; Gail M. McNutt, MD; et al Brian J. Hertz, MD; Jeffrey J. Ryan, MD; Scott A. Pawlikowski, MD

JAMA. 2014;312(22):2358-2363. doi:10.1001/jama.2014.13992


Dr Teirstein Comments

The authors are not conflicted. This is a comparison of clinical outcomes when patients are cared for by grandfathered versus non-grandfathered ABMS certified physicians in four VA hospitals. The study found no difference in patient outcomes. It completely and simply supports our position that MOC has no impact on patient care quality. ABMS always leaves this paper out of their marketing materials.

Dr Cohen Comments

This is a fairly straightforward observational study comparing processes and intermediate outcomes of care between physicians with time-unlimited board certification vs. time-limited certification (which is considered as a proxy for MOC). The study was conducted in primary care clinics of 4 VA hospitals and demonstrated no differences across 10 different outcome measures. The authors note that improving processes and outcomes of care is just one goal of MOC, but certainly one that is most straightforward to quantify.

Dr Ajay Kirtane Comments

This manuscript is a retrospective analysis of 10 primary care performance measures at 4 VA medical centers. 105 primary care physicians (71 time-limited ABIM certification and 34 time-unlimited certification) with a mean panel size of 610 patients were surveyed. Before statistical adjustment, time-unlimited physicians performed better in 3/10 categories, but after adjustment, there were no differences in outcomes by certification status.

The strengths of this study are the ability to ascertain performance within the well-characterized VA system. Additionally, the time from initial certification among time-unlimited physicians was long – approximately 30 years compared with approximately 15 years for the time-limited certification group – suggesting a robust comparison. Stated limitations of the study include the VA-only design (representing a system with ongoing performance benchmarking), and possible roles of medical school affiliations and continuous review within the hospitals in the study.