American specialty Boards play an essential role in setting standards for basic medical competence for graduates of residency programs. Historically, passing a Board exam was the final milestone to beginning a lifelong career in a medical specialty. In the last 10 to 20 years, however, Boards began to issue certificates which were time-limited, generally to 10 years. Under this scheme, a two-tier system of physician certification is established, namely that candidates who have passed the board exam more recently hold a time-limited certificate whereas physicians who took and passed the boards years or even decades earlier enjoyed the privilege of lifelong board certification. This dichotomy is not only anomalous but clearly unfair to more recent graduates of residency programs. There is no reason to believe, for example, that more recent graduates of residency programs are any less up to date with current medical practice than are their more senior colleagues. In fact, one could well believe that the opposite is true. For many physicians, there is a tendency toward specialization and therefore an increasing distance from the knowledge base of some areas of practice.
Given the rapid advances in biomedical research, it is probably a good idea to require periodic recertification of all physicians in their specialty area, and 10 years seems to be an appropriate interval. Ensuring that physicians are up to date with their field is consistent with the current trends towards emphasis on quality in the delivery of healthcare. This means that for a typical physician, he or she would be required to re-certify about three or four times in the course of a career. For those physicians who hold lifelong certificates, recertification in pathology is currently optional. Whether it remains that way is uncertain. It is entirely possible that hospital staffing committees or payers will require that all practicing physicians undergo periodic recertification if it is available. One point seems clear: if physician recertification is going to be required, it should be required for all physicians.
