Editor’s Note: For more on this topic, check out the January issue of Academic Medicine.

By: David Price, MD, FAAFP, FACEHP, senior vice president, American Board of Medical Specialties (ABMS) Research and Education Foundation, and executive director, ABMS Multi-Specialty Portfolio Approval Program

Medical licensure and Board Certification mean very different things for physicians practicing in the United States and the patients for whom they care.

A license is required to practice medicine in this country. Medical licensure indicates that a physician has met minimum requirements for the undifferentiated practice of medicine. To obtain a medical license, individuals must graduate medical school, receive postgraduate training, and pass a comprehensive national medical licensing examination. They must submit proof of their education and training, and provide details about their work history to their state medical board, according to the Federation of State Medical Boards, which represents the 70 state medical and osteopathic regulatory boards within the United States, its territories, and the District of Columbia. They are obligated to reveal information that may affect their ability to practice, such as health status, malpractice, and criminal convictions. Only after meeting a state’s qualifications will physicians be granted permission to practice medicine. (State-specific requirements for medical licensure can be found at http://www.fsmb.org/policy/public-resources/state_specific.) Physicians must renew their license periodically, usually every one or two years, to continue their active status. During this process, physicians must show that they have maintained acceptable standards of ethics and medical practice, and have not engaged in improper conduct. In most states, physicians must demonstrate that they have participated in a program of continuing medical education. This process takes at least 60 days from the time a completed application is submitted and a license granted.

Board Certification by one or more of the 24 American Board of Medical Specialties (ABMS) certifying boards indicates that a physician has gone above and beyond basic medical training to demonstrate proficiency in a particular specialty. (Osteopathic physicians undergo a similar process to become board certified by the American Osteopathic Association, although I am focusing here on ABMS Board Certification.) Board Certification is not required to practice medicine–the fact that most US physicians have chosen to become certified speaks to its importance.

Physicians who wish to obtain ABMS Board Certification must meet the same requirements for medical licensure plus complete three to five years (or more) of rigorous training in a residency or fellowship training program accredited by the Accreditation Council for Graduate Medical Education; provide letters of attestation from their program director and/or faculty of their satisfactory performance; and pass a written examination created and administered by an ABMS Member Board. Some certifying boards require physicians to pass an oral examination or simulation exercises, as well as undergo a review of their patient records and outcomes. Once board certified, physicians maintain their specialty-specific expertise by participating in the ABMS Program for Maintenance of Certification (ABMS MOC^®), a comprehensive process of ongoing assessment and improvement adopted by the ABMS Member Boards in 2000. The Program for MOC focuses on key physician skills and knowledge critical for improving health care and keeping current in an increasingly complex practice environment. In 2015, the standards that provide a framework for developing the Program for MOC were updated to reflect the proliferation of medical knowledge, advancing technology, emerging adult learning principles, the increasing importance of physicians meaningfully engaging in quality improvement, and changes in health care delivery systems, as well as the rapidly changing skill sets required by physicians to provide optimal care for their patients. Although these standards are common across the Member Boards, they permit relevant distinctions among the specialties. The standards encourage innovative approaches for continuing professional development and assessment that physicians should find relevant, meaningful, and workable.

Both medical licensure and Board Certification serve the public and the medical profession, the latter of which has been granted the privilege of self-regulation. Given this privilege, it is essential that certification continues to evolve to keep current with advances in the medical community amid growing patient expectations. Achieving and maintaining Board Certification is a source of pride to many physicians, and a reflection and tangible demonstration to patients and the public of a physician’s ongoing commitment to lifelong learning and continuous improvement.