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Specialty board certification and clinical outcomes: the missing link.
Lisa K Sharp1, Philip G Bashook, Martin S Lipsky
1Department of Family Medicine, Northwestern University, The Feinberg School of Medicine, Chicago, Illinois 60611-3008, USA.
Summary
Specialty board certification is linked to better patient outcomes in many studies. However, few studies used rigorous methods to prove this association, highlighting a need for more research on physician certification and clinical results.
Area of Science:
- Medical research
- Health services research
- Physician quality assessment
Background:
- Specialty board certification is often considered a benchmark for physician excellence.
- A systematic review has not previously assessed the relationship between board certification and clinical outcomes.
- This study addresses the gap by evaluating existing literature on this topic.
Purpose of the Study:
- To systematically review and evaluate published studies examining the association between physician specialty board certification status and clinical outcomes.
- To determine the extent to which existing research supports a link between certification and patient care quality.
Main Methods:
- A comprehensive literature search was conducted in OVID-Medline, PsycLit, and ERIC from 1966 to July 1999.
- Inclusion criteria specified U.S. patients and physicians, verified board certification by an American Board of Medical Specialties member board, clear selection criteria, and use of nationally recognized standards of care.
- Of 1,204 initial papers, 13 studies with 33 relevant findings met the quality and relevance criteria after rigorous screening.
Main Results:
- A significant positive association between board certification and positive clinical outcomes was found in 16 of the 33 relevant findings.
- Three findings indicated worse outcomes for certified physicians, while 14 showed no association.
- Limitations included insufficient case-mix adjustments in some studies and variability in outcome measures preventing meta-analysis.
Conclusions:
- Only a small percentage of reviewed studies (5%) employed research methodologies suitable for investigating the research question.
- Despite methodological limitations in some studies, over half of the evaluated findings suggest a positive association between board certification and improved clinical outcomes.
- Further research with robust methodologies is needed to definitively establish the impact of physician board certification on patient care.