Re-Certifying Physicians and Improving Outcomes

As in many professions, physicians who obtain certifications often keep them for life, subject only to continuing education requirements.  In 1990 The American Board of Internal Medicine began requiring that internists be re-certified every ten years.  This supposedly would improve quality and also could reduce costs.  Researchers have sought to test this theory by examining Medicare beneficiaries treated in 2001 either by doctors who had been grandfathered out of the new requirement or by physicians who had just re-certified.  (NEJM Article)  The primary outcomes were ambulatory-care sensitive hospitalizations, those believed to be preventable through good primary care, and annual costs of care.   Beneficiaries were attributed to a general internist based upon the regularity of their visits to a particular doctor.  The two groups of beneficiaries were matched on a variety of characteristics.  There were roughly an equal number of re-certified and exempt physicians.  Being re-certified did not appear to have any association with the level of ACSHs, or with any hospitalization or any emergency room visit.  Being re-certified did seem associated with a small but statistically significant decline in total costs, including for lab testing and imaging.  While these re-certification requirements may help reduce costs, likely by updating physicians on efficient use of medical resources, they do not appear to improve health outcomes, at least by the avoidable hospitalizations measure.  Whether re-certification is the best method to ensure efficiency should be examined, as it undoubtedly imposes a significant cost on doctors.