Becoming board certified is a rite of passage. It has become a de-facto must-have document in addition to licensing. For many jobs, you need to be board certified or board eligible. Many hospitals require it to become part of its active medical staff. If you want privileges at many healthcare institutions, you must be board eligible or board certified.
Many insurance plans require the same thing.
While you don’t have to be board certified to participate in Medicare, some Medicare Advantage Organizations do require its network providers be board certified.
You do not need to be board certified to obtain a medical license.
But if you want to apply to participate in the Interstate Medical Licensure Compact (IMLC), you must “Hold a current specialty certification or time-unlimited certification by an ABMS or AOABOS board.” IMLC is a streamlined process to obtain medical licensure in multiple states. Interestingly, once you are in the IMLC ecosystem, you do not need to stay board certified.
“The Compact does not require a physician to participate in Maintenance of Certification (MOC) at any stage, nor does it require or make mention of the need to participate in MOC as a licensure renewal requirement in any state. Board certification is only an eligibility factor at the initial entry point of participation in the Compact process.”
Becoming board certified is a high-stakes exam.
When I became board certified, the oral examination process was three one-hour sessions. There was a senior and a junior examiner.
The white-haired (or no-haired) senior examiner viewed his/her role as narrow. Make sure I wasn’t going to kill or maim patients. And make sure I didn’t bring shame to the profession.
The youthful junior examiner’s role was to show off to the senior examiner how much he/she knew. And how dumb I was.
The youthful junior examiner had much to learn about what being board certified was for.
Not everyone takes tests well. They may be talented in the exam room. Proficient in the operating room. Have the respect of their peers. And still struggle with passing.
What I’ve learned over time is that some very smart candidates struggle with a cryptic “disability.” Meaning a disability as defined by the Americans with Disabilities Act.
The law is clear.
Federal law mandates that candidates be provided equal access to obtaining certification. But it does not guarantee certification.
If a candidate has a disability, they must be provided reasonable accommodations, as long as those accommodation does not pose an undue hardship on the entity making the provision.
Under the Americans with Disabilities Act (ADA), “undue hardship” refers to a situation where providing a reasonable accommodation to a qualified individual with a disability would cause the employer (or in this case, the testing entity) significant difficulty or expense. This is determined on a case-by-case basis, considering the specific circumstances of the employer and the nature of the accommodation requested.
In addition, any accommodation cannot fundamentally alter the examination’s ability to assess the skills and knowledge it is designed to measure.
As an example, the American Board of Surgery (ABS) notes:
Further, no candidate will be granted an accommodation that would compromise either examination’s ability to accurately assess the skills and knowledge it is designed to measure. Similarly, no auxiliary aid or service will be provided that would fundamentally alter either examination or would result in an undue burden to the ABS.
The ABS allows appropriate accommodations in order to best ensure that the results of the examination reflect each individual’s proficiency in the content areas, rather than reflecting an individual’s impaired sensory, manual, cognitive, or psychological skills (except where those skills are the factors that the examination purports to measure). While the intent of the use of an examination accommodation is to enable an individual to demonstrate their proficiency in the knowledge being assessed, granted, or approved accommodations are not a guarantee of improved performance, test completion, a passing score, or ABS certification.
What about giving a candidate extra time, if that is the reasonable accommodation required to address a disability, such as Attention Deficit Hyperactivity Disorder (ADHD)?
The American Board of Anesthesiology does allow select accommodations for specific individuals with ADHD.
Requests for Extended Examination Time. Any requests or recommendations for extended examination time must be justified by documentation that includes a rationale supported by objective data and explicit data-based arguments that demonstrate why additional time is necessary. During evaluations, we encourage both standard and extended time administration, which could provide objective evidence of the benefit of additional time.
The American Board of Emergency Medicine is less flexible.
By and large, ADA accommodations are not available for the Oral Exam. By policy, accommodations can not change the construct of the exam or the knowledge, skills, or info intended to be tested. As the Oral Exam, in part, tests a candidate’s ability to function under time constraints, etc., any and all of the common ADA accommodations are not available for the Oral Exam.
Medical courtesy requests may still be applicable and most do not require approval.
Arguably, both anesthesiologists and emergency physicians care for patients where time is of the essence. Still, most physicians do not experience a constant staccato of crises (multiple cases over three hours) requiring immediate answers. While “The Pitt” makes for excellent television, it does not mirror the real world. And even if there were exceptional situations, such as managing a mass casualty, that should not be the metric for passing or failing your boards.
Does the American Board of Emergency Medicine (ABEM) allow for extra examination time or more frequent breaks for breastfeeding candidates?
If you need an accommodation for the Qualifying Exam, please submit your written request immediately by filling out this form or emailing qualify@abem.org. There is limited seating for candidates testing under special circumstances.
If you request accommodations under the Policy on Americans with Disabilities Act or the Guidelines on Courtesy Modifications Requests (e.g., for temporary conditions, such as pregnancy, breastfeeding, crutches, or medical equipment), ABEM must schedule your exam appointment for you. Pearson VUE cannot work directly with you to schedule or change appointments if you are testing under special circumstances.
ABEM distinguishes between a temporary condition and a disability covered by the ADA.
Pregnancy is not considered a disability under ADA.
Case law arising from the Americans with Disabilities Act (ADA) suggests that medical conditions related to pregnancy are protected, according to labor and HR experts. That means that courts are starting to recognize that morning sickness, placenta previa, a high risk of miscarriage, gestational diabetes and other pregnancy-related ailments are conditions employers must accommodate, said Jon Hyman, a partner in the labor and employment practice at Ohio-based Kohrman Jackson & Krantz PLL.
There are also federal laws (outside of ADA) that afford workplace protections and employment rights for workers who are pregnant or nursing.
Back to other specialty boards, such as the American Board of Surgery.
It can get complicated.
Pregnant Candidates
Pregnant candidates may request a “frequent break accommodation” (taken during an exam session) and/or an “access to medication accommodation.”
Additional Break Time Accommodations for Lactating Candidates
- The General Surgery Qualifying Examination (GSQE) and the Vascular Surgery Qualifying Examination (VSQE) will start with a bank of 70 minutes of break time.
- To express breast milk during the GSQE or the VSQE, lactating candidates will receive an additional 60 minutes of break time added to the break bank, for a total of 130 minutes of break time.
- The Pediatric Surgery Qualifying Examination (PSQE), the Complex General Surgical Oncology Qualifying Examination (CGSO QE), and Surgical Critical Care Certifying Examination (SCC CE) will start with a bank of 20 minutes of break time.
- To express breast milk during the PSQE, the CGSO QE, or the SCC CE, lactating candidates will receive an additional 30 minutes of break time added to the break bank, for a total of 50 minutes of break time.
- With break banking, the candidate has the flexibility to choose how much break time (if any) to use at scheduled breaks between exam sections during the examination. To add further flexibility and more break time, any unused exam time from the previous exam section will be added to the break bank. An examinee’s break bank balance will appear in the dialog box when their exam is placed in scheduled break mode. Examinees may wish to make note of this balance. Examinees are responsible for managing their own break time. Pearson VUE staff will not monitor break time and will not provide examinees with reminders.
- Note: If an examinee exceeds the break time allotted in their bank, that time will be deducted from their next exam section.
Different specialty boards have different policies on whether they’ll allow extra time to complete the examination and/or extra time for breaks. To me, this is not unreasonable. In my estimation, the specialty board examinations are a floor. Not an aspirational ceiling.
Yes, I believe there are some basic skills that must be mastered, and demonstrated for some specialties, where time is of the essence. For example, intubation—for anesthesiologists and emergency medicine physicians. And central line placement. And running a code. But that list is short.
If a specialty board allows extra time for a woman candidate who is breast feeding, what about a male who has galactorrhea?
Yes, they do exist. They may have a prolactinoma. Sometimes it’s caused by hypothyroidism. Or even some SSRIs.
What if a candidate has a colostomy, and it should be timely emptied?
I can give other examples.
My point is this. I’m not convinced rigidly enforcing time limits on a board examination actually tests a candidate’s knowledge and skills in most domains. And given how high the stakes are in becoming board certified, I hate to see otherwise qualified individuals make it through 4 years of medical school, 7 years of residency, receive the support of peers and mentors, obtain a medical license, and then freeze on an exam because they can’t ignore a ticking clock. And then their employment opportunities contract. A lot.
I sometimes wish we can go back to the days when the senior examiners just tested to make sure the candidates wouldn’t kill or maim patients, nor bring shame to the profession.
What do you think?
