Cardiology ‘has evolved’: Heart societies unite to push for independent medical board
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Key takeaways:
- Leading cardiology societies announced an effort to create an independent board for cardiovascular medicine.
- Competency requirements, if approved, would replace the maintenance of certification process.
Four professional cardiovascular societies announced a push to create an independent board for cardiovascular medicine, part of an effort to simplify a competency process for cardiologists that has recently been a source of controversy.
The proposed new board would be independent of the American Board of Internal Medicine, where the cardiology certification process currently exists. In a press release, the American College of Cardiology, Heart Failure Society of America, Heart Rhythm Society, and Society for Cardiovascular Angiography and Interventions announced they are jointly preparing to submit a new board application, with potential for additional consortium members to join.
“Cardiology is large and has evolved into its own distinct specialty,” B. Hadley Wilson, MD, FACC, president of ACC, executive vice chair of Sanger Heart & Vascular Institute/Atrium Health and clinical professor at Wake Forest University School of Medicine, told Healio. “When we looked across the country, about half of universities and health systems are cardiology programs that are independent of internal medicine. That number is growing, as are the subspecialties within cardiology. We want to recognize cardiology for what it is — its own discipline in medicine.”
‘We want a more streamlined system’
The move comes amid increasingly vocal complaints from cardiologists on social media and other forums, with some stating the American Board of Medical Specialties (ABMS) maintenance of certification (MOC) system requirements were onerous and do not improve competency while charging cardiologists excessive fees. Clinician complaints about the process are not new; previously, physician outcry prompted the American Board of Internal Medicine to make adjustments, but a growing movement has pushed hard for alternative certification options.
“There has been a long period of discontent among our members, over decades,” George D. Dangas, MD, PhD, president of SCAI, professor of medicine and surgery at Icahn School of Medicine at Mount Sinai and director of cardiovascular innovation at the Zena and Michael A. Wiener Cardiovascular Institute at the Icahn School of Medicine at Mount Sinai, told Healio. “There comes a point when the water spills over the top of the glass. Nothing dramatically new happened this week. This has been a long process for various reasons with a generalized feeling of mistrust that we sense members feel from the current process.”
Ajay Kirtane, MD, SM, director of Columbia Interventional Cardiovascular Care and a critic of the MOC process, said he has cautiously applauded the announcement.
“I’m intrigued and relieved that our societies have stepped up to lead the charge on this,” Kirtane told Healio. “The news that our cardiovascular societies are approaching this issue head-on is certainly welcome. It is a perfect role for societies to lead in that way. Of course, we all need to see the details. What could be challenging for membership is if there are additional fees/hours incurred, though I am pretty certain society leadership is fully aware of the issues that exist within the present system. So many physicians are already stressed and burned out. To add meaningless activity as a way of certifying competency is not in anyone’s interest.”
In the release, the consortium stated it will apply to ABMS requesting an independent medical board for cardiovascular medicine to pursue a new competency-based approach to continuous certification. ABMS remains the only authority widely recognized by the public, regulators and payers for initial and ongoing physician certification in the U.S.
The new board would replace the MOC approach with a pathway to continuous certification and competency, “offering diplomates convenience, support, choice and credit for the learning that physicians currently do to keep their knowledge and skills at the highest level,” according to the release.
‘Reinvent’ certification process
Dangas cited complaints from member cardiologists about the MOC process and required courses, which are often “irrelevant” or duplications of courses members have already taken.
“This is not about control; it is about a revamp,” Dangas said during an interview. “So many advances have happened in continuing education. Perhaps the old school is no longer relevant. We need to reinvent the certification and recertification pathways to seamlessly operate in this current educational-rich environment that we practice in.”
Requirements, if approved, will “deemphasize timed, high-stakes performance exams” in the continuous certification process. Instead, the societies said there will be a focus on learning assessments to identify gaps in current knowledge or skills, with recommendations offered on CME learning resources and activities to help close the gaps.
“We feel we can satisfy the educational needs of our cardiologists better,” Wilson said during an interview. “We understand more of what they need, particularly within the subspecialities. We want a more streamlined system, easier for cardiologists to have continuous competency and certification without as much red tape.”
Wilson said he also acknowledged the frustrations of many cardiologists, noting that many members are often not aware of their renewal status or where they may be deficient.
“Cardiologists feel a lot of the testing is not as relevant to what they are practicing and should be managed more by cardiologists rather than a board made up of people who are perhaps not as attuned to the needs and training of cardiologists,” Wilson told Healio.
In the release, the presidents of HFSA, SCAI and HRS called the move a paradigm shift that speaks to the evolving trends in continuing education.
“The priority of this proposed new board is to ensure the requirements truly benefit the cardiology community and the patients we serve,” John Teerlink, MD, FHFSA, president of HFSA, said in the release. “The new board’s focus on competence in the pursuit of continuous certification is a needed paradigm shift for the field, and we look forward to future collaborations with the consortium as we submit the application.”
Call for questions from cardiologists
The application approval process is expected to take several months. If ABMS approves the application, it will then take several additional months before initial certification and continuous certification and competency programs would begin, according to the release.
The statement also notes that transparency will be a “key component” of the process. Wilson said the consortium will hold multiple open informational webinars, with all society presidents attending, to answer any questions and accept suggestions about the process on Wednesday and Nov. 14, with other webinar dates to be announced. Registration can be completed through the website www.cvboard.org.
Wilson said the American Heart Association is collaborating in the development of the application; however, formal support is pending an official review and consideration by its board of directors at its next scheduled meeting.
“We are hoping AHA will also sign on as a founding partner to this application as well,” Wilson told Healio. “This is an exciting time for cardiologists. We want a say in what we think is relevant. This is not a free pass — we are going to make [the process] better. People will know their knowledge gaps. The other advantage with this new board is if gaps are identified, we will have remediation pathways to retest. Hopefully, we will retain more competent cardiologists to help tackle CVD burden as it grows in the U.S.”
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