Is Board Certification an Assurance of Good Medical Care?
Board certification is an excellent marker of physician competence and demonstrates comprehensive training, knowledge, and skill, but it is not the sole assurance of good care—actual clinical performance, experience, and ongoing quality metrics must also be considered. 1
Board Certification as a Quality Indicator
Board certification serves as a strong but imperfect proxy for quality care:
Board-certified physicians demonstrate better patient outcomes in several documented areas: lower mortality rates following acute myocardial infarction for board-certified internists and cardiologists, reduced mortality and morbidity after colon resection for board-certified surgeons, and improved obstetrical outcomes. 2
The correlation between board certification and clinical performance is moderate, with correlation coefficients between 0.55 and 0.59, indicating a positive but not absolute relationship. 2
Board certification is associated with fewer malpractice claims and disciplinary actions, suggesting better overall practice patterns. 2
Critical Limitations and Evidence Gaps
The evidence supporting board certification as a quality assurance mechanism has important weaknesses:
No direct data links board certification to quality of care in many specialties—the American Gastroenterological Association explicitly acknowledged in 2005 that there were no data linking ABIM certification or recertification in gastroenterology to quality of care, a gap that extends across internal medicine specialties. 2
Effect sizes are modest and results are not unequivocal—while board-certified physicians generally provide better patient care, the improvements are small and not consistent across all measures. 3
Patient experience scores show minimal differences—studies comparing board-certified physicians enrolled in Maintenance of Certification (MOC) versus those not enrolled found no statistically significant differences in most patient experience metrics. 4
When Board Certification Is Not Sufficient
Professional societies explicitly recognize that board certification alone does not guarantee competence:
The American College of Emergency Physicians states that board certification is "an excellent but not the sole benchmark" for determining a physician's ability to practice emergency medicine. 1
Other critical qualifications include: objective measurement of actual care provided, sufficient clinical experience, prior training, and evidence of continuing medical education. 1
"Legacy physicians" without board certification who have demonstrated quality care through experience should not be forced out solely based on certification status—they should be subject to the same quality standards as board-certified physicians. 1
The Role of Subspecialty Certification
For complex subspecialty care, board certification becomes more important:
Board certification serves as "one marker" of expertise in subspecialties like Adult Congenital Heart Disease (ACHD), though expert clinicians exist who are not board-certified, including those trained before formal certification programs or outside the United States. 1
Patients with complex conditions managed by subspecialty board-certified physicians in specialized centers have better outcomes, including improved survival for ACHD patients undergoing invasive procedures. 1
Common Pitfalls to Avoid
Do not equate board certification with guaranteed quality—it is a credential that demonstrates baseline competence and knowledge at a point in time, not ongoing clinical excellence. 2
Do not ignore non-certified physicians with demonstrated quality metrics—actual clinical performance data (complication rates, patient outcomes, peer review) may be more relevant than certification status alone. 1
Recognize that public perception exceeds the evidence—while employers, managed care organizations, and the public increasingly rely on board certification as a quality indicator, this reliance outpaces the actual evidence linking certification to superior outcomes. 2
Practical Clinical Approach
When evaluating physician quality, use board certification as one component of a comprehensive assessment:
- Prioritize board certification for initial credentialing and as evidence of baseline competence 1
- Require ongoing quality metrics including complication rates, patient outcomes, and peer review 1
- Value continuing medical education and participation in quality improvement activities 1
- Consider specialty-specific experience and procedural volume, particularly for complex interventions 1
Board certification demonstrates that a physician has met standardized educational and testing requirements, but ongoing clinical performance and quality metrics provide better assurance of actual care delivery. 2, 3