Medical specialty credentialing in the United States.

Specialty boards serve the function of defining qualifications and issuing credentials to assure the public of the specialist's preparation and skill. Over the past 72 years, 23 such boards have been approved and now issue 31 different types of general specialty certificates and 57 types of subspecialty credentials. For 50 years, the American Board of Medical Specialties has encouraged a system of recertification to demonstrate that the certified specialist has maintained skill and has incorporated the new knowledge associated with advancing medical science. Presently, 17 of the 23 boards are committed to time-limited certificates requiring recertification every seven to ten years, and others are currently planning such a process. New methods of performance assessment are being used for recertification processes. In addition to recertification, the other major change in specialty credentialing is the number of subspecialty certificates sought and authorized. The numbers have increased dramatically during the past 20 years and reflect the advances in science as well as new styles of practice. As a consequence, some specialties are moving toward accreditation without certification to improve training, even if there is no authorized type of certification. Another consequence of subspecialty proliferation is concern about fragmentation of medical care and its effect on the costs of health care.