title: Association between physician time-unlimited vs time-limited internal medicine board certification and ambulatory patient care quality.
abstract: OBJECTIVE
  American Board of Internal Medicine (ABIM) initiatives encourage internists with time-unlimited certificates to recertify. However, there are limited data evaluating differences in performance between internists with time-limited or time-unlimited board certification.
  
  
  OBJECTIVE
  To determine whether there are differences in primary care quality between physicians holding time-limited or time-unlimited certification.
  
  
  METHODS
  Retrospective analysis of performance data from 1 year (2012-2013) at 4 Veterans Affairs (VA) medical centers. Participants were internists with time-limited (n = 71) or time-unlimited (n = 34) ABIM certification providing primary care to 68,213 patients. Median physician panel size was 610 patients (range, 19-1316), with no differences between groups (P = .90).
  
  
  METHODS
  Ten primary care performance measures: colorectal screening rates; diabetes with glycated hemoglobin (HbA1c level) less than 9.0%; diabetes with blood pressure less than 140/90 mm Hg; diabetes with low-density lipoprotein cholesterol (LDL-C) level less than 100 mg/dL; hypertension with blood pressure less than 140/90 mm Hg; thiazide diuretics used in multidrug hypertensive regimen; atherosclerotic coronary artery disease and LDL-C level less than 100 mg/dL; post-myocardial infarction use of aspirin; post-myocardial infarction use of β-blockers; congestive heart failure (CHF) with use of angiotensin-converting enzyme (ACE) inhibitor.
  
  
  RESULTS
  After adjustment for practice site, panel size, years since certification, and clustering by physician, there were no differences in outcomes for patients cared for by internists with time-limited or time-unlimited certification for any performance measure: colorectal screening (odds ratio [OR], 0.95 [95% CI, 0.89-1.01]); diabetes with HbA1c level less than 9.0% (OR, 0.96 [95% CI, 0.74-1.2]); blood pressure control (OR, 0.99 [95% CI, 0.69-1.4]); LDL-C level less than 100 mg/dL (OR, 1.1 [95% CI, 0.79-1.5]); hypertension with blood pressure less than 140/90 mm Hg (OR, 1.0 [95% CI, 0.92-1.2]); thiazide use (OR, 1.0 [95% CI, 0.8-1.3]); atherosclerotic coronary artery disease with LDL-C level less than 100 mg/dL (OR, 1.1 [95% CI, 0.75-1.7]); post-myocardial infarction use of aspirin (OR, 0.98 [95% CI, 0.58-1.68]) or β-blockers (OR, 1.0 [95% CI, 0.57-1.9]); CHF with use of ACE inhibitor (OR, 0.98 [95% CI, 0.61-1.6]).
  
  
  CONCLUSIONS
  Among internists providing primary care at 4 VA medical centers, there were no significant differences between those with time-limited ABIM certification and those with time-unlimited ABIM certification on 10 primary care performance measures. Additional research to examine the difference in patient outcomes among holders of time-limited and time-unlimited certificates in non-VA and nonacademic settings and the association with other ABIM goals may help clarify the potential benefit of Maintenance of Certification participation.
authors.affiliation: Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin.
authors.forename: John
authors.initials: J
authors.lastname: Hayes
authors.affiliation: GIM Section, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Jackson
authors.affiliation: William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.
authors.forename: Gail M
authors.initials: GM
authors.lastname: McNutt
authors.affiliation: Hines VA Medical Center, Chicago, Illinois.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Hertz
authors.affiliation: Jesse Brown VA Medical Center, Chicago, Illinois.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Ryan
authors.affiliation: Hines VA Medical Center, Chicago, Illinois.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Pawlikowski
mesh_terms: D000553:Ambulatory Care / Q000592:standards*; D002318:Cardiovascular Diseases / Q000175:diagnosis; D002568:Certification / Q000592:standards*; D002983:Clinical Competence; D015179:Colorectal Neoplasms / Q000175:diagnosis; D003920:Diabetes Mellitus / Q000175:diagnosis; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007388:Internal Medicine / Q000592:standards*; D008297:Male; D008403:Mass Screening; D005791:Patient Care / Q000592:standards; D010820:Physicians / Q000592:standards; D011320:Primary Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D013044:Specialty Boards; D013997:Time Factors