Medical certification organizations should be “relevant, responsive, and innovative,” according to Terry Kowalenko, MD, FACEP, new President of the American Board of Emergency Medicine (ABEM), who was elected in July and will serve for the 2017–2018 term.
Dr. Kowalenko is professor and chair of emergency medicine at the Oakland University William Beaumont School of Medicine in Rochester, Michigan; president and chief medical officer of the Beaumont Medical Group; and senior vice president of Beaumont Health. He has been a member of the ABEM Board of Directors since July 2010 and was elected to the Executive Committee in 2014.
Dr. Kowalenko recently responded in writing to ACEP Now’s questions on his goals as ABEM President and the organization’s approach to certification.
Q: What do you anticipate will be your biggest challenge as ABEM President this coming year?
A: The biggest challenge ABEM faces will be directing a focused conversation about the importance of certification for emergency physicians. ABEM certification is the most valuable professional credential an emergency physician can obtain. Leveraging the strength of that credential to limit “merit badge” requirements and to optimize physician reimbursement through the Medicare Access and CHIP Reauthorization Act of 2015 are high priorities for me and the ABEM Board.
ABEM is committed to remaining relevant, responsive, and innovative. To that end, we are convening a special Board retreat and a maintenance of certification (MOC) summit of emergency medicine stakeholder organizations to explore the development of alternative approaches to MOC and, in particular, the ConCert Examination. ABEM needs to guide the emergency medicine community through a conversation about offering a sound option while still allowing emergency physicians to take the current ConCert Examination if they prefer. Any option must be sufficiently rigorous while also addressing concerns that emergency physicians have expressed. The ABEM MOC program has never been static. It has been constantly revised to increase the relevance and value to emergency physicians while adhering to the American Board of Medical Specialties (ABMS) requirements. I think ABEM has been very successful in doing that. Part of that success has come from emergency physicians providing constructive feedback to ABEM about the program. We really need the specialty and emergency physicians to be partners in this process of revision and innovation.
Q: MOC has been under fire in some states and at the American Medical Association (AMA) House of Delegates. What’s ABEM’s take?
A: I think what has been lost in the discussion about state legislative initiatives is that the importance of certification has held up incredibly well. States where the anti-MOC faction has had success usually involve a physician leading the movement. Interestingly, many of the anti-MOC arguments made by physicians, such as the amount of time spent on MOC, have been rejected by public lawmakers. I’m not saying these are not valid concerns. It’s just that, as physicians, we need to be careful about how we come across to the public and to policymakers. We don’t want to create the impression of a battle between medical self-interests and the public’s best interests.
There’s also very little discussion about states such as Oklahoma, which last year passed an anti-MOC bill that was unenforceable. When the bill was reintroduced this year, it was soundly defeated. In Michigan, anti-MOC bills were unsuccessful last year and have been reintroduced this year but are losing ground. Finally, the degree to which the bill passed in Texas will affect emergency medicine is uncertain.
Within the AMA, the Emergency Medicine Section has been a strong supporter of ABEM certification. Unfortunately, what’s been driving many of the AMA resolutions is not the desire to innovate or improve MOC but to return to lifetime certification. I think that sends a terrible message to the public, especially when research demonstrates that self-directed CME is largely ineffective. A big risk here is our ability to self-regulate. Medicine has lost its battles over cost control, access to care, and quality. We have been slow to address the issue of the aging physician, and now, some hospitals have started mandatory testing programs and making policies aimed at age-based forced retirement. Many of the anti-MOC initiatives surrender professional self-regulation to the government. That’s a horrible precedent. I think our best defense against government control is effective self-regulation through ongoing certification. That’s not just an ABEM concern; it should be a concern of every physician in every specialty.
Q: In what way is ABEM responding? Do you see changes coming to the ABEM MOC program, especially to the ConCert Exam?
A: What’s important to ABEM, and the specialty, is that ABEM wants to get any option or innovation right the first time. ABEM is actively exploring an option to the ConCert Exam, though I suspect that many physicians will still want to take the exam. During the past two years, several ideas have been floating around within our specialty about revising the ConCert, and we need to look closely at these ideas. ABEM has been actively examining pilots being conducted by other ABMS boards. Keeping in mind that ABEM certification will be time-limited and require episodic recertification, any changes will be a topic for open discussion with the entire emergency medicine community.
It’s helpful to remember that ABEM has a role in protecting professional self-regulation through certification. Certification only has value when physicians meet a standard. The rigor of the standard determines the strength of the credential.
Q: There still seems to be substantial frustration about MOC in other specialties. How is ABEM different than other specialty boards?
A: There is a great deal of frustration about MOC in some of the other specialties, and it sometimes spills over into our conversations about emergency medicine. There are a few big differences between the ABEM MOC program and programs in other specialties. ABEM never offered lifetime certification ever. Most other boards have lifetime certificate holders, which has created some factionalism. The notion that ABEM diplomates needed to periodically recertify has always been a part of our professional culture. In many ways, ABEM got the MOC program right the first time. After Lifelong Learning and Self Assessment was introduced in 2004, several changes were made to improve the relevancy and lessen the burden of the activity. Having the American Academy of Emergency Medicine and ACEP provide CME credit added value to the process. Soon, we will be providing rationales for the answers to the questions, offering a choice about which articles you can read, and delivering optional prereading questions that have been shown to enhance learning.
The Part IV Improvement in Medical Practice (IMP) requirement is seamless for most emergency physicians. That’s because ABEM designed the requirement to allow you to get credit for work that you are already doing. ABEM recently finished a project with ACEP to provide IMP credit for physicians participating in the Clinical Emergency Data Registry. We also approved the ACEP E-QUAL Sepsis activity for IMP credit.
Q: To many physicians, especially community physicians, ABEM seems like a closed group. What do you think ABEM can do to be seen as more transparent by emergency physicians?
A: I think that’s an old impression that is no longer warranted. ABEM directors are nominated by every emergency medicine organization and are usually well-known physicians in our specialty. As a sponsor, ACEP has three positions on the ABEM Board for which they nominate directors. ABEM has always had a strict policy that anybody who serves on the Board or is a volunteer must be clinically active. ABEM values community physician input, and we make certain to include community physicians when setting passing scores for any ABEM examination. Also, last year’s Chair of the Test Administration Committee and former ABEM president, Barry N. Heller, MD, is a community physician, as is last year’s President, Michael L. Carius, MD, FACEP.
Q: You are a well-known leader in our specialty, but could you share something personal about you so we can know you even better?
A: I’m a professor and the chairman of the Oakland University William Beaumont School of Medicine department of emergency medicine. I oversee three emergency departments (one academic and two community hospitals). I am the first son of immigrants and grew up with real blue-collar values. I enjoy spending time with my family and friends. I also enjoy just about every outdoor activity regardless of the season. I encourage emergency physicians to talk to me and provide constructive feedback on how to improve ABEM-related programs.