Physicians Board’s ‘Monopoly’ at America’s Military Hospitals Is Depriving Servicemembers of Care, Rival Group Alleges

A physicians group representing about 5 percent of America’s doctors is asking Congress to break a monopoly held by its rival — the nation’s largest medical board certification group — which it charges has gained exclusive control over military and veterans hospitals, shutting out qualified physicians with needed specialty skills.The American Board of Physician Specialists certifies doctors in 21 fields, including familiar practices such as anesthesiology, diagnostic radiology, family medicine, and obstetrics and gynecology, as well as distinct specialties like integrative medicine and pain management. The group’s CEO, Jeff Morris, says that uniquely skilled doctors are being ignored by the military because of a sweetheart arrangement with the American Board of Medical Specialties, which represents more than 900,000 doctors nationwide. He contends the deal is driving up costs, reducing innovation, and denying access to care.“Reaching medical readiness is important,“ Mr. Morris tells the Sun. “If you have just one entity controlling that, you no longer have a difference of thought. So then what happens to innovation in medicine?”The National Defense Authorization Act recognizes credentials from five boards. They include the American Medical Specialties Board as well as the AOA Bureau of Osteopathic Specialists, and specialty boards for podiatric medicine, foot and ankle, and oral and maxillofacial surgery. The act lists qualifications that other boards must meet to become credentialed with the military’s medical care provider, the Defense Health Agency. An official with the agency tells the Sun that any physician who meets its standards can work at a military facility, regardless of board certification. “Board certification is not required for any physicians hired by the military to work within our military medical treatment facilities,” the official said. “Our physicians need to have an appropriate license and applicable degree from an accredited institution, along with appropriate post-graduate training certificates for their specialty such as internship residency or fellowship, and evidence of current clinical competency, but board certifications are not required for hiring or for retention.”While board certification is said to be optional, without it, doctors don’t get hired, Mr. Morris asserted, claiming that the military’s hiring authorities are members of the pre-eminent boards. One emergency medicine doctor with the military added that doctors can only earn the annual incentive pay bonus for certification if they are certified by a credentialed board. “In terms of practicing in the military, it’s a pay issue because you have a pay incentive if you are board certified through an organization that is recognized by the military,” the doctor, who has been working as a reservist for more than three decades, tells the Sun. “Your board certification was not recognized unless it was through the ABMS.”The Defense Health Agency official did not provide the number of physicians who operate without board certification or the percentage of certified physicians who are certified by the medical specialties board. Founded by the American Medical Association in the 1930s in an effort for physicians to assert their medical expertise, the American Medical Specialties Board represents 95 percent of America’s doctors and offers certification by 24 boards in 136 subspecialties.The organization’s associate vice president for communications, Susan C. Morris, tells the Sun that her organization had no role in determining which boards were recognized in the defense bill, “whether by name or through the standards.” She added that the defense authorization act mirrors the American Medical Association’s standards policy.“ABMS and AOA are inherently recognized as having unique credentials with respect to board certification,” she said. “The high quality and rigor of the ABMS member boards’ certification programs lead to better care and outcomes for patients.”Mr. Morris predicts that without recognition of other boards, lack of innovation and increasing costs will only get worse. Last month, Republicans on the House Judiciary’s antitrust subcommittee wrote several residency programs and accreditation councils asking whether hiring practices suppress doctors’ mobility and pay and contribute to doctor shortages. The medical residency antitrust exemption passed by Congress in 2004 “has distorted the American medical residency market, undermining free market principles to the detriment of the nation’s doctors and the patients who rely on them,” wrote the House Judiciary’s antitrust subcommittee chairman, Scott Fitzgerald.Among the letter’s recipients was the Accreditation Council for Graduate Medical Education, which was co-founded by the American Medical Specialties Board and earns $76 million annually in accreditation fees from residency programs permanently funded by American taxpayers to the tune of $15 billion per year.* The accreditation council is the only body permitted to accredit these residency programs. “Now you have two entities that work together to control physicians and how medicine is taught completely,” Mr. Morris said.Ms. Morris disputed claims that her board plays a role in the governance of the accreditation council but acknowledged that some member boards “have programs to help educate residents about the board certification process for that specialty or subspecialty.”The federation representing state medical licensing authorities also notes that board certification is voluntary, but “other practical considerations — such as obtaining hospital privileges — lead most physicians to obtain specialty certification.”At least seven licensing authorities — in Alabama, Iowa, Minnesota, Oregon, Tennessee Medical, Virginia, Wyoming — give preferential treatment to candidates certified by the American Medical Specialties Board. These preferences include allowing physician candidates additional time to obtain a medical license, lowering post-graduate training requirements, and increasing the number of exam attempts a physician can take.This preference system is just another example of how a stranglehold on board recognition lowers standards without improving care, Mr. Morris said, noting that military members, including Special Forces being deployed with a medic, are disadvantaged as a result.“There are a lot of boards that don’t even exist yet because medicine is constantly changing,” he said. “These certifying bodies should be able to present themselves, and the Defense Health Agency looks and says, you meet the standard, you’re accepted.”*An earlier version of this story misstated that the Accreditation Council for Graduate Medical Education receives $15 billion in annual taxpayer funding directly. Instead, the residency programs it accredits receive the funding. We apologize for the mistake.

Physicians Board’s ‘Monopoly’ at America’s Military Hospitals Is Depriving Servicemembers of Care, Rival Group Alleges

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