Board certification is a valuable way physicians can demonstrate their commitment to the highest quality care, and to receive recognition for the many long years of work they have put into achieving expertise. Board certification sets the physician apart as a recognized specialist in the eyes of patients, hospitals, employers, and insurers. Certification is the gold standard for medical specialization in the United States.
Board certification is a voluntary process. It is different and distinct from licensure to practice medicine, a function regulated by state government. A valid medical license is required to be Board certified, but certification is not necessary for licensure. A Board certified physician has met certain standards and passed tests that are developed to assure the public that he or she has been adequately trained in a given specialty.
There are currently 29,172 Board Certified Orthopaedic Surgeons.
In order to be allowed to begin the process of becoming Board certified, a surgeon must be a graduate of an accredited four-year medical school and have successfully completed a five-year accredited orthopaedic residency program in the United States or Canada. The final 24 months of the training must be obtained in a single program.
Part I: The Written Examination
Orthopaedic surgeons who have completed an accredited residency may apply and be admitted to take the written examination. This examination, which is a timed, secure, computer-administered exam, consists of approximately 320 multiple choice questions covering all of orthopaedics. It is given at Prometric testing sites throughout the United States on a single day in July. It involves eight hours of testing time divided into seven sections.
The questions are produced through the work of practicing orthopaedic surgeons, with the help and professional guidance of the National Board of Medical Examiners (NBME). Each question submitted is required to be supported by at least two peer reviewed references, and is subject to review by at least three different groups of surgeons before appearing on a test: the Question Writing Task Force (QWTF), the Field Test Task Force (FTTF), and the written examination committee of the ABOS. Extensive statistics are kept by the NBME on the performance of each question and poorly performing questions (too hard, too easy, non-discriminating) are discarded. The passing score is set each year by the written examination committee based on an item-by-item analysis and the work of yet another group of volunteer orthopaedic surgeons, the standard setting task force.
A surgeon who has passed the Part I written examination and is practicing while awaiting admission to Part II is deemed Board Eligible. This term is not appropriate for surgeons who have not passed Part I, or who have been refused admission to Part II. The limit of Board Eligibility is five years; surgeons who have not passed Part II within 5 years of taking Part I are no longer Board Eligible, and must re-take Part I before moving on to Part II.
Part II: The Oral Examination
After passing Part I, candidates have a period of five years to apply for and pass the Part II oral examination. If they do not, they must re-take Part I to be admitted to the oral examination. It is each candidate's responsibility to know deadlines and make a correct, complete application if they wish to be Board certified. In order to be admitted to the oral examination, a candidate must have a full and unrestricted medical license, and have been in practice for 20 months in one location, association and affiliation. The Board will obtain peer review of the candidate from certified orthopaedic surgeons who are familiar with their work, and get evaluations from the hospital chief of staff, chief of orthopaedics, surgery, anesthesia, and nursing staff in the operating room and orthopaedic wards. This information is reviewed by the credentials committee of the ABOS, who will decide which applicants are admitted to sit for the Part II examination.
Once admitted to take the oral examination, a candidate must submit a list of all surgical cases performed during a defined six-month period. The cases are submitted electronically, through a program called Scribe. The case lists must be verified by medical records technicians at each facility in which the candidate operates. Those case lists are reviewed by volunteer certified orthopaedic surgeons, and 10 cases are selected.
The examination is administered in Chicago each July. The examination consists of 2 hours of examination time, divided into four 25 minute periods with two examiners in each period. The examiners independently grade each case presentation on data gathering and interpretation, diagnosis, treatment plan, technical skill, outcomes, and applied knowledge. In addition, the case list is evaluated on surgical indications, handling of complications, ethics, and professionalism. The Oral Board examiners are all volunteer orthopaedic surgeons who are re-certified. The panels are organized into subspecialty groups for general orthopaedics, trauma, spine, pediatrics, foot and ankle, sports, adult reconstruction, oncology, and hand, shoulder, and elbows.
After passing Part II, a surgeon receives a certificate and becomes a diplomate of the ABOS for 10 years.