To Be or Not to Be Board Certified? A Question of Quality and Identification for Psychologists

Achieving board certification in psychology is an important step in a psychologist's professional development. Board certification serves as a quality indicator for consumers, employers, and other stakeholders while providing enhanced opportunities for psychologists who complete the peer‐review process that leads to it. This commentary provides an update on trends in board certification in psychology and explores the roles and benefits of board certification as well as barriers to pursuing board certification. Board certification is an important issue to consider because more mental and physical healthcare clinicians and researchers are now embracing the biopsychosocial model. Board certification could well help with maximizing reimbursement or clinical opportunities, as well as produce a greater understanding of the biobehavioral underpinnings of comorbid mental and physical disorders. Specialist data from the American Board of Professional Psychology and membership data from the American Psychological Association were reviewed across specialty areas. The work was archival and involved no human subjects, and therefore, this study was exempt from review by the Institutional Review Board of the University of Minnesota. There are currently 4,198 board certifications across the 15 boards of the American Board of Professional Psychology. These represent a relatively small proportion (less than 4%) of U.S. licensed psychologists. The numbers correlate positively with membership levels in corresponding APA divisions. Between 2011 and 2015, there was a 25.8% increase in the number of board‐certified psychologists. Board certification appears to be undergoing a period of rapid growth among psychologists. This trend appears to reflect multiple factors, including an increased number of boards representing expanding areas of specialization in the field, a growing interest in board certification as part of increasing quality emphasis within healthcare, and psychologists' desire to distinguish themselves in a competitive marketplace. Board certification in diverse areas, including clinical health psychology, affords various professionally and personally rewarding linkages and opportunities.     

BOOK REVIEW: Preventing Childhood Disorders,Substance Abuse,and Delinquency

Discusses (a) what roles the specialty of clinical child psychology fulfills and how societal and professional changes have enhanced the need for the specialty, (b) how the field defines itself, (c) how models of training are conceptualized for the specialty, and (d) how some training programs implement specialty training with broad, interdisciplinary components. Clinical child psychology is a professional field of research and practice that, when adequate training is provided, properly deserves a places as a specialty.The dangers of overspecialization and narrowness are more likely present in traditional clinical (adult) psychology than in clinical child psychology, especially when the clinical child training is done in a broadly comprehensive and integrated manner.     

Specialty board certification and clinical outcomes: the missing link.

PURPOSE: Specialty board certification status is often used as a standard of excellence, but no systematic review has examined the link between certification and clinical outcomes. The authors evaluated published studies tracking clinical outcomes and certification status. METHOD: Data sources consisted of studies cited between 1966 and July 1999 in OVID-Medline, psychological abstracts (PsycLit), and the Educational Research Information Clearinghouse (ERIC). Screening criteria included: only U.S. patients and physicians used as subjects; verified specialty board certification status by an American Board of Medical Specialties' (ABMS') member board using the ABMS database or derivative sources; described selection criteria for patients and physicians; selected nationally recognized standards of care for outcomes; and nested patient data by individual physician. The computerized searches that were conducted in 1999 identified 1,204 papers; one author and a research assistant selected 237 papers based on subject relevance, and reduced the list to 56 based on study quality. The authors independently applied inclusion and exclusion criteria to identify 13 of the 56 papers containing 33 separable relevant findings. RESULTS: Of the 33 findings, 16 demonstrated a significant positive association between certification status and positive clinical outcomes, three revealed worse outcomes for certified physicians, and 14 showed no association. Three negative findings and one finding of no association were identified in two papers with insufficient case-mix adjustments in the analyses. Meta-analytic statistics were not feasible due to variability in outcome measures across studies. CONCLUSIONS: Few published studies (5%) used research methods appropriate for the research question, and among the screened studies more than half support an association between board certification status and positive clinical outcomes.     

Yellow professionalism. Advertising by physicians in the Yellow Pages

We compared the specialty listings of physicians in the Yellow Pages of the 1983 Hartford, Connecticut, telephone book with the board certifications in specialties of the American Board of Medical Specialties as listed in the American Medical Association directory or the Marquis Directory of Medical Specialists. There were 1179 listings by 946 physicians under 61 specialty headings in the Yellow Pages. We found that a mean of 12 percent of "specialists" listed in the Yellow Pages were not board-certified in a specialty, although they had had ample opportunity to obtain board certification. We conclude that specialty advertising in the Yellow Pages is potentially misleading to consumers and that member boards of the American Board of Medical Specialties should consider ways to diminish this possible misrepresentation.     

Classifying the content of board certification examinations

A system of medical classification based on the fundamental dimensions of body system, etiology, and stage of disease was evaluated by classifying the content of one specialty board's examinations. Ten physicians encoded 2,310 test items that constituted three previously administered certification-recertification examinations of the American Board of Family Practice. Analysis of the data for the major content of one of these certification examinations suggests that a profile based on this classification system might provide a specialty board, the residency programs, and candidates for certification with important information not produced by discipline labels or disease names. This classification system may allow a board to define more effectively the content of its examinations, monitor other requirements for certification, and communicate its standards to the medical profession and society.     

Recognition of clinical immunology as a distinct medical subspecialty: importance for the practice of allergy

BACKGROUND: Although residents trained in accredited teaching programs in allergy and immunology are exposed to many areas of clinical immunology, the vast majority of these residents' subsequent practices are composed of caring for patients with allergic and asthmatic conditions. Except for rheumatologists, almost all other clinical immunologists appear to lack organized training programs, defined certification pathways, and clear career opportunities. OBJECTIVE: Recognition of clinical immunology as a distinct medical subspecialty with many areas of expertise will enhance the image of allergists and clinical immunologists, ensure subspecialty certification, and provide better career opportunities. METHODS: Documents, publications, and private opinions of individuals within professional allergy and clinical immunology organizations were evaluated for possible contribution to the subject content of this article. RESULTS: There is a need for defined residency programs, medical board certification, and professional organizations that speak for and provide postgraduate education for all clinical immunologists. Molecular and genetic discoveries are delineating the central role of fundamental immunology in all immune-mediated diseases and future therapy of allergic and immunologic diseases. CONCLUSIONS:Allergists of the 21st century should participate in the growing recognition of clinical immunology as an important medical subspecialty that can provide science-based therapies for allergic and immunologic disorders. The future practice of allergy depends largely on the molecular and genetic discoveries that serve to unite all practitioners of clinical immunology. Forging common alliances of education, certification, and career pathways with other clinical immunologists is the correct investment for a bright future for allergy.     

Publication productivity of clinical and counseling psychologists

Compared the research productivity of clinical versus counseling psychologists and found surprisingly few differences. A serendipitous finding was low productivity across the board and a question was raised about the success of the scientist-practitioner model in both clinical and counseling psychology doctoral programs in instilling a research/publication ethic among professional (as opposed to experimental, social, etc.) psychologists. © 1996 John Wiley & Sons, Inc.     

Life-long learning and self-assessment

New Frontiers in Pathology is a unique educational event intended to meet the ongoing educational needs of practicing pathologists. Continuous medical education (CME) is required for maintenance of licensure by virtually all state licensing bodies. Satisfying CME requirements hinges on earning a minimum number of American Medical Association Physician Recognition Award category 1 credits through various activities, including courses like New Frontiers in Pathology that are accredited by the Accreditation Council for Continuing Medical Education. Self-assessment modules (SAMs) are a key component of the American Board of Pathology expectations for maintenance of board certification. Beginning in 2006, the American Board of Pathology granted only time-limited certificates as part of an American Board of Medical Specialties-wide process for maintenance of board certification. Maintenance of board certification has requirements in 4 categories: professional standing, life-long learning and self-assessment, cognitive expertise, and evaluation of performance in practice. Life-long learning and self-assessment includes not only the traditional elements of CME but also the SAMs that are defined as educational products comprising self-administered examinations with a predetermined minimum performance level and a mechanism for receiving feedback. New Frontiers in Pathology will offer SAMs, in addition to the American Medical Association Physician Recognition Award category 1 credits, which it has been accredited to do since its inception, at its 2012 conference scheduled for August 3 through August 5 at The Homestead Resort, Michigan's largest waterfront resort on beautiful Lake Michigan.     

Consultation and interprofessional collaboration: modeling for the future

Consultation and interprofessional collaboration by psychologists occur with individuals, groups, programs, and organizations. The practice of consultation and interprofessional collaboration involves interdisciplinary relationships, preparation, and advanced skill development within specialty areas of psychology (e.g., clinical, counseling, industrial-organizational, and school). The Workgroup on Consultation and Interdisciplinary Relationships engaged in a planning process at the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology to address fundamental issues regarding consultation and interprofessional collaboration in professional psychology. The Workgroup articulated working definitions, consensus points about psychologists as consultants and interprofessional collaborators, a consulting and interprofessional competency blueprint for preparation and assessment strategies, and future directions. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.     

A statistical analysis of board certification in clinical neuropsychology.

In this paper, we use tools from decision theory to evaluate the effectiveness of the current psychology board certification process used by the American Board of Clinical Neuropsychology (ABCN). These analyses indicate that ABCN's current process is likely to be failing to certify too many competently trained candidates, and identifying relatively few truly competent neuropsychologists. In fact, we estimate that ABCN is only certifying between 16 and 52% of competent clinical neuropsychologists. This is in contrast to the processes of the American Board of Medical Specialties (ABMS), after which ABCN has indicated that it models its examination. ABMS estimates that 89% of all practicing physicians are board-certified by one of their member boards. Based on our analyses, specific recommendations for change are offered for credentialing the profession of neuropsychology.     

Twenty-first century education: toward greater emphasis on context-social, economic, and educational

In calling for a greater emphasis on the social, economic, and educational contexts, the discussion presented in this article is generally supportive of C.R. Snyder and T.R. Elliott's (this issue, pp. 1033-1054) vision of 21st century graduate education in clinical psychology. Attention is directed toward the asocial nature of professional psychology, a brief analysis of the influence of economics on the development of clinical psychology education, and the American Psychological Association's accreditation process as it shapes professional psychology education.     

The Professional Adolescence of Clinical Child and Adolescent Psychology and Pediatric Psychology: Grown Up and Striving for Autonomy

We review the present and future of the specialty field of clinical child and pediatric psychology. The progress in education and training, science, practice, and organizational developments in this specialty is described with attention to the special issues of the developing field. Clinical child and pediatric psychology are well positioned for continued healthy development.     

Genetic counseling globally: Where are we now?

The genetic counseling profession is continuing to develop globally, with countries in various stages of development. In some, the profession has been in existence for decades and is increasingly recognized as an important provider of allied health, while in others it is just beginning. In this article, we describe the current global landscape of the genetic counseling specialty field's professional development. Using examples of the United States, United Kingdom, Canada, Australia, South Africa, and various countries in Asia, we highlight the following: (a) status of genetic counseling training programs, (b) availability of credentialing through government and professional bodies (certification, registration, and licensure), and potential for international reciprocity, (c) scope of clinical practice, and (d) health-care system disparities and cultural differences impacting on practice. The successful global implementation of precision medicine will require both an increased awareness of the importance of the profession of “genetic counselor” and flexibility in how genetic counselors are incorporated into each country's health-care market. In turn, this will require more collaboration within and across nations, along with continuing engagement of existing genetic counseling professional societies.     

Credentials and clinical activities of internship supervisors in neuropsychology: a comparison of VA and non-VA training sites.

Surveyed 69 VA and 101 non-VA internships to (a) delineate the credentials and activities of supervisors in clinical neuropsychology, and (b) compare the credentials and activities of the two groups. Questionnaires were returned by 83% of VA and 62% of non-VA internships. A majority of each group was trained in clinical psychology. The proportions of supervisors with board certification and relevant coursework and/or training experiences (e.g., postdoctoral fellowship) were the same for both groups. Similarities were noted in time devoted to research and training, number of interns supervised, preferred assessment tools, and favored approach to clinical evaluation. Conversely, VA instructors devoted more time to clinical practice, while non-VA personnel claimed more publications. The majority of VA supervisors were trained in VA settings, while most non-VA respondents interned at university medical centers or state hospitals. The training and credentials of both groups evidenced wide ranging competencies. The need for improved training and credentialing of practitioners and supervisors was discussed.     

The relationship between performance on the medical genetics and genomics in-training and certifying examinations

PurposeThe American Board of Medical Genetics and Genomics (ABMGG) certifying examinations (CEs) are designed to assess relevant basic knowledge, clinical knowledge, and diagnostic skills of board-eligible candidates in primary specialty areas. The ABMGG in-training examinations (ITEs) provide formative feedback regarding knowledge and learning over time and assess readiness to attempt board certification. This study addresses the validity of the ABMGG ITE by evaluating its relationship with performance on CE utilizing established psychometric approaches.MethodsStatistical analysis included bivariate Pearson correlation coefficients and linear regression to evaluate the strength of associations between ITE scores and CE scores. Logistic regression was used to assess the association between ITE scores and the probability of passing each CE.ResultsLogistic regression results indicated that ITE scores accounted for 22% to 44% of the variability in CE outcomes. Across 3 certification cycles, for every 1-point increase in ITE scores, the odds ratio for earning a passing score increased by a factor of 1.12 to 1.20 for the general CE, 1.14 to 1.25 for the clinical CE, and 1.12 to 1.20 for the laboratory CEs.ConclusionThe findings show a positive correlation between performance on the ITE examination and performance on and passing the ABMGG CE.     

A reorientation of clinical psychology? Look before you leap

A recent proposal by Fox (1982) has suggested that the field of clinical psychology needs to undergo a reorientation away from psychopathology to the totality of human problems. This is viewed as a natural extension of the evolution of clinical psychology and is justified by the position that “Psychology is the only discipline that has both a comprehensive science of human behavior and an established professional arm” (Fox, 1982, p. 1052). Evidence is cited that suggests that many of the roles which Fox sees as appropriate for doctoral-level clinical psychologists can and are being performed adequately by master's-level professional social workers. The proposed reorientation of clinical psychology would be neither cost effective of educational resources nor feasible in terms of training adequate numbers of psychological service providers. This proposal by Fox further reflects a lack of awareness of the empirically based service tradition of many professional social workers (Thyer, 1981).     

Primary care by desire or default? Specialty choices of minority graduates of US medical schools in 1983.

This study was undertaken to determine if US medical school students of different racial/ethnic backgrounds demonstrate similar patterns of evolution of specialty choice between their senior year of medical school and their third postgraduate year. The study identified the specialty choices of US medical school seniors in 1983 through their responses to the Association of American Medical Colleges Graduating Medical Student Questionnaire (GQ). The cohort was classified into three groups: underrepresented minorities, non-underrepresented minorities, and whites. Using these AAMC data as baseline, each racial/ethnic background group was tracked through their third residency year. Comparisons were made between anticipated specialty choices as senior medical students and actual specialties as revealed through residency tracking. The study found that more than 95% of the cohort began residencies in specialties compatible with their GQ choices. Unexpectedly, almost 20% of blacks, Commonwealth Puerto Ricans, and other Hispanics were not in graduate medical education in their third postgraduate year. This group needs to be studied further in order to learn the proportion of these physicians who subsequently completed residency training and the reason(s) for attrition in physicians who did not fulfill minimum training requirements for board certification.     

Commentary: the relative research unit: providing incentives for clinician participation in research activities

Recent nationwide initiatives to accelerate clinical and translational research, including comparative effectiveness research, will increasingly require clinician participation in research-related activities at the point-of-care, activities such as participant recruitment for clinical research studies and systematic data collection. A key element to the success of such initiatives that has not yet been adequately addressed is how to provide incentives to clinicians for the time and effort that such participation will require. Models to calculate the value of clinical care services are commonly used to compensate clinicians, and similar models have been proposed to calculate and compensate researchers' efforts. However, to the authors' knowledge, no such model has been proposed for calculating the value of research-related activities performed by noninvestigator-clinicians, be they in academic or community settings. In this commentary, the authors propose a new model for doing just that. They describe how such a relative research unit model could be used to provide both direct and indirect incentives for clinician participation in research activities. Direct incentives could include financial compensation, and indirect incentives could include credit toward promotion and tenure and toward the maintenance of specialty board certification. The authors discuss the principles behind this relative research unit approach as well as ethical, funding, and other considerations to fully developing and deploying such a model, across academic environments first and then more broadly across the health care community.