The American Board of Urology: Considerations for the urologist in career transitions

Note: This article has been written at the request of Gopal H. Badlani, MD. The intent of this commentary is to summarize activities and policies of the American Board of Urology (ABU) that affect urologists as they manage changes in career, life situation, and end-of-career considerations. The author of this article is a past trustee of the ABU, and as such does not represent the ABU or current ABU trustees. This article largely condenses policy creation that took place during the author’s tenure on the ABU.

Roger Dmochowski, MD

ABU certificates are time-limited, a policy that began in 1985. Between January 1985 and before 2007, recertification was required once every 10 years. Maintenance of Certification (MOC) began in 2007, in compliance with the American Board of Medical Specialties (ABMS). MOC assessed Professionalism and Professional Standing (Licensure and Peer Review), Lifelong Learning and Self-assessment (CME), Assessment of Knowledge, Judgement and Skills (Examinations), and Improvement in Medical Practice (Outcomes and Quality Improvement) every 2 years. In concert with changes in understanding of learning and practice assessment, the ABU now uses the term Lifelong Learning (LLL) to best describe its current program and to replace the term “MOC.” Information regarding the LLL process is available on the ABU website or directly from the ABU office. LLL provides not only continuous update of one’s knowledge, but also the ability to stay abreast of therapeutic guidelines and other developments in the medical and surgical management of urologic disease. The pilot assessment of the new Continuing Urologic Certification (CUC) underscores the educational aspect of LLL and has been constructed to utilize American Urological Association Office of Education materials as components of this program.As urologists progress through their career cycle, this program facilitates knowledge acquisition and educational value.

Changing Career Directions (Clinically Inactive)

Urologists are increasingly being asked to become leaders in health care organizations, governmental agencies, third-party insurers, and other business and regulatory concerns. Demands of these new positions may preclude maintaining an active urologic practice. Therefore, the ABU has established Clinically Inactive Status (with retention of certification). Certain minimal criteria for procedural and patient volume are a prerequisite for the consideration of this status. Urologists who are diplomates of ABU may apply for this status, which retains their board certification on a time-limited basis, with the requirement to remain active in LLL. The diplomate considering this option must apply to ABU certifying non-activity or minimal activity and provide documentation for same. If granted by ABU, all components of LLL must be followed and completed according to LLL requirements. A diplomate who is clinically inactive may revert to their active status by formal notification in writing to the board. There may be some reentry requirements, instituted by the board, depending upon the length of clinical activity, and other unique elements of the diplomate’s experience. This status has a 10-year limit.

Career Completion

Board certification reflects diplomate achievement and is regarded by health care systems, regulatory agencies, and governmental entities as a demonstration of this competency. Diplomates who are 30 years post training and nearing retirement find the process of continuing certification to be burdensome in their new life status. Therefore, the ABU, in concert with the ABMS, recently created the Retired Status designation. This status affirms the value of the diplomate to the ABU and to the public.

Certain eligibility requirements are needed for the retired designation, and these include active certification at the time of retirement, ana unrestricted medical license in any jurisdiction at the time of retirement, an attestation from the diplomate indicating complete disengagement in patient care with no plans to return to practice, and non-performance of any function for which board certification is required. This status is also available to those diplomates whose certificates were either expired or forfeited since January 2015. The status also is available to sub-specialty certificate diplomates. There is a reentry pathway from retired status; however, this requires specific criteria, including administration of the Qualifying Examination or LLL remediation exam.

The ABU continues to reevaluate all policies related to diplomates. As medical practice continues to evolve in United States, and these changes affect the practitioners of medicine, likely further changes will be necessary in board certification procedures. The ABU has been proactive in initiating many changes. The changes noted above are all recent and reflect the commitment of the ABU to support diplomates.