National survey reveals most hospitals do not require board certification of pediatricians

A survey of 200 hospitals found that nearly 80 percent do not require board certification of pediatricians at the time of initial granting of hospital privileges, although most hospitals do require board certification at some point in the pediatrician's tenure, according to a study in JAMA: The Journal of the American Medical Association.

At hospitals, privileging involves the granting of permission for physicians to perform specific activities under the hospital's jurisdiction. Medical specialties evaluate and recognize competence among physicians through the creation of specialty boards and testing for board certification, according to background information in the article. It is unknown how or if hospitals use board certification as a proxy measure of professional competence in their privileging decisions.

Gary L. Freed, M.D., M.P.H., of the University of Michigan, Ann Arbor, Mich., and colleagues conducted a national survey to determine hospital policies and practices related to the recognition and use of board certification and recertification of pediatricians. The study consisted of a telephone survey, between Jan. 1 and June 30, 2005, of 200 nonspecialty hospitals stratified by teaching status, children's vs. general hospitals, freestanding children's hospital vs. part of hospital system, and urban vs. rural location.

The response rate to the survey was 82 percent (159 eligible hospitals). Overall, survey results showed that 124 hospitals (78 percent) did not require general pediatricians to be board certified at the time of initial privileging; however, 111 hospitals (70 percent) did require pediatricians to be board certified at some point during their tenure. Of the 124 hospitals that did not require board certification, 60 (48 percent) did report having some time frame in which certification must be achieved, typically 4 to 6 years.

"However, many of these hospitals [42 percent] do not have a specific time limit in which certification must be achieved. Thus, it is possible that the stated requirement for board certification is never actually enforced," the authors write.

The researchers add that 43 percent of 113 hospitals required pediatric subspecialists to achieve subspecialty certification within a specific time frame.

"The ability of credentialing committees to discern the competence of physicians in the privileging process is difficult and complex, with the role of board certification varying among hospitals. Expectations of the public regarding the qualifications (including board certification) used by hospitals in these efforts also must be considered by those individuals who determine privileging requirements. The establishment of Maintenance of Certification (MOC) and the institution of recertification by the American Board of Pediatrics (ABP) have created new and potentially useful tools for hospitals to aid in the assessment of physicians. At the same time, efforts must be undertaken by the ABP to assess the impact of recertification and the MOC program on physician quality so that these efforts will provide the maximum utility to hospitals and the patients they serve," the authors conclude.