You do not need to be board-certified in your specialty to practice medicine. But you do need to be board certified to obtain initial licensure though the Interstate Medical Licensure Compact.
You do not need to be board-certified in your specialty to participate in plain-vanilla Medicare. But you do need to be board certified to participate in some Medicare Advantage Plans.
And many hospitals require board certification to obtain staff membership and clinical privileges.
Here’s one set of bylaws:
For physicians applying for Medical Staff membership and/or clinical privileges on or after February 1, 2012, provide evidence of Board Certification within five (5) years of completing the highest level of postgraduate training by a Board recognized by the American Board of Medical Specialties, the American Osteopathic Association, or the Royal College of Physicians and Surgeons of Canada and maintain such certification throughout their appointment to the Medical Staff. Such Board Certification shall be in a specialty or subspecialty in which the physician maintains clinical privileges. If the Practitioner fails to obtain or maintain certification as required by this section, he/she may apply or re-apply for Medical Staff membership only after he/she has obtained Board certification. If a Medical Staff member originally satisfies this Board Certification requirement in this Section xxx by obtaining certification by a Board Recognized by the American Board of Medical Specialties or the American Osteopathic Association, then a subsequent recertification may be obtained from a Board recognized by the National Board of Physicians and Surgeons. A certification pending under a Board recognized by the National Board of Physicians and Surgeons shall not satisfy this requirement.
So, the magic number in this example is 5 years post-residency/fellowship.
For at least one specialty, the American Board of Neurological Surgery (ABNS), the timeline for completion of certification process post-residency/fellowship is more generous. It is up to 7 years.
There are earlier milestones that must be achieved to drag the process out to 7 years. One needs to have applied and submitted cases and taken one oral examination within 4 years. But you are afforded two extra attempts, bringing the math to 7 years.
So, the ABNS allows for two additional years compared to at least one major hospital system.
Such terms are embedded within hospital bylaws and employment agreements.
To be fair, in the same bylaws above (referencing the 5-year deadline), there are additional discretionary options which can prevent this from becoming an all-or-none make-or-break threshold.
A Practitioner who is subject to this Section xxx but fails to obtain or maintain Board certification as required may be allowed a grace period by requesting a one-time waiver of these requirements from the [Hospital] Network Credentials and Privileges Committee. The granting and the terms of such waiver rest solely within the discretion of the [Hospital] Network Credentials and Privileges Committee. The determination by the [Hospital] Network Credentials and Privileges Committee shall not entitle the physician to the rights afforded by Article xx. If the Practitioner fails to obtain or maintain certification as required by this section, he/she may apply or re-apply for Medical Staff membership only after he/she has obtained Board certification.
Here, the waiver is discretionary.
For practitioners applying after February 1, 2014 a request for a waiver shall include documentation that provides evidence that he/she has made a good faith effort (i.e. taken the exam and failed) to obtain or maintain their Board Certification. Any grace period granted by approval of a waiver by the Network Credentials and Privileges Committee shall be time limited to the next available exam. Requests for waiver and allowance of a grace period will be considered on a case-by-case basis.
And many hospitals do allow for its Board (of Directors) to waive all types of requirements on a case-by-case basis.
After consultation with the appropriate Facility Medical Executive Committee, the Board shall have the authority in its sole discretion to waive any qualification for [Hospital] Medical Staff membership and/or clinical privileges upon determination that such waiver is in the interest of good medical practice and the provision of quality care. This shall be done on an individual basis.
If what you do is in demand, and you otherwise have a great track record, some requirements for medical staff membership and clinical privileges can be waived.
For example, that might be the case is someone trained overseas, and they are a rock star in their local country. Their grandson lives in the USA, and they want to take a sabbatical to live near their family. And practice. Assuming they can get a medical license as part of a medical institution and credentialed by assorted insurance plans, the institution can and likely will make provisions to bring the rock star doctor into its roster.
And let the marketing begin.
The larger point is this.
Pay attention to requirements in hospital bylaws and employment agreements related to initial board certification and ongoing maintenance of that certification. As well as exceptions if you either do not pass, or fail to re-certify. The requirements for your hospital bylaws and employment may be more aggressive than that required by your specialty board certification organization.
Such requirements are not uniform across the country.
What do you think?
