When Kenneth E. Bloom, M.D., sat down in front of a computer monitor and keyboard to take the first-ever pediatric dermatology board certification exam in October, he felt a sense of accomplishment before he entered a single keystroke.
After all, the test was his idea, which he first proposed at a meeting of the Society of Pediatric Dermatology in 1997.
“When I first mentioned this, the idea of physicians taking another test did not go over very well,” recalled Dr. Bloom, a dermatologist in private practice in Minneapolis. “There are a host of reasons why I think this subspecialty needed to take place. One is to recognize a true subspecialty field and to give credibility and recognition to the major advances in the care of children. Plus, while I am formally trained in both pediatrics and dermatology, there are a whole host of pediatric dermatologists who never had formal pediatrics training, who never had any true licensure or board specialty that identified them. This exam makes them unique.”
The exam is also meant to give pediatric dermatologists certain clout with managed care providers, added Elaine Siegfried, M.D., of St. Louis University. When managed care began to flourish in the 1990s, she said, “board certification became not only important for training, but it started becoming economically important. If you didn't have a board-certified specialty, then payers didn't recognize that you existed, so it wouldn't become necessary to include your services for patients.”
Today, Dr. Siegfried calls Dr. Bloom's idea for the exam visionary. But back in 1997, “most of us were busy defining diseases and taking care of sick children, and we didn't really think about what was up ahead,” said Dr. Siegfried, also in private practice in St. Louis. “Ken thought about it from a private practice perspective. He was being shut out of managed care. He had just left the university [setting], so all of these kids he was previously taking care of had limited access to care by a pediatric dermatologist.”
With help and cooperation from the American Board of Dermatology, Dr. Siegfried, as well as Ilona Frieden, M.D., of the University of California, San Francisco, and several other pediatric dermatologists—all members of the Society for Pediatric Dermatology—created a proposal that was submitted to the Committee on Certification. (SKIN & ALLERGY NEws, March 2004, p. 1).
The test marked another milestone for the American Board of Dermatology: its first computer-based exam. Minor technical glitches with some computers created a tense atmosphere early on. “There was a little more anxiety than I thought there would be,” said Dr. Siegfried, vice chair of the committee that assembled the test questions. “Even a few very experienced people who are bright and widely published seemed a little anxious.”
Of the 92 examinees, only 4 failed, for a pass rate of 96%. And 15 of the 200 items on the test were answered correctly by all examinees. An additional 44 items were answered correctly by 95%-99% of examinees.
Susan Bayliss Mallory, M.D., a member of the Society for Pediatric Dermatology since 1980, opted against taking the exam because her daughter was expecting a baby at the time. “But I think it's a great idea,” said Dr. Mallory, director of pediatric dermatology at Washington University in St. Louis. “It's probably more applicable to people coming out of training right now, as opposed to somebody like me, who's older and established in my training. I may indeed take it next time. If I take the exam, it will be because I think it is a good [way to be a] role model for the younger attendings.”
Some of her peers, she added, chose not to take the test because of its $1,600 price tag, and others wondered how it would benefit their practice. That was not the case for Seth J. Orlow, M.D., who began to be squeezed out of managed care physician panels in the late 1990s because many did not recognize pediatric dermatology as a subspecialty.
“They'd say, 'We have enough dermatologists,'” said Dr. Orlow, professor of pediatric dermatology at New York University Medical Center. “I would say to them, 'You don't have any pediatric dermatologists on your panel.' They'd say, 'There's no such thing.'”
He added that for physicians who practice in academic medical centers, the exam “adds an additional level of certification, so you can say, 'I'm actually certified in pediatric dermatology.' I think that's valuable.”
Dr. Orlow said that members of the test committee made “a real effort to be inclusive as to who got to take the exam, rather than be exclusive. It was not meant to restrict people from practicing pediatric dermatology but, rather, to add an independent measure of ability in pediatric dermatology.”