Peabody Michael R, Peterson Lars E, Dai Mingliang, Eden Aimee, Hansen Elizabeth Rose, Puffer James C
American Board of Family Medicine, Lexington, KY.
Fam Med. 2019 Oct;51(9):728-736. doi: 10.22454/FamMed.2019.850799.
Board certification programs have been criticized as not relevant to practice, not improving patient care, and creating additional burdens on already overburdened physicians. Many physicians may feel compelled to participate in board certification programs in order to satisfy employer, hospital, and insurer requirements; however, the influence of forces as motivators for physicians to continue board certification is poorly understood.
We used data from the 2017 American Board of Family Medicine (ABFM) Family Medicine Certification Examination practice demographic registration questionnaire for those seeking to continue their certification, removing physicians who indicated they did not provide direct patient care. We utilized a mixed-methods design. For the quantitative analysis, a proportional odds logistic regression was used to examine the association between predictor variables and increasing levels of external motivation. For the qualitative analysis, we used a deductive approach to examine open-text responses.
Of the analytical sample of 7,545 family physicians, approximately one-fifth (21.4%) were motivated to continue their board certification solely by intrinsic factors. Less than one-fifth (17.3%) were motivated only by extrinsic factors, and the majority (61.2%) reported mixed motivations for continuing their board certification. Only 38 respondents (0.5%) included a negative opinion about the certification process in their open-text responses.
Approximately half of family physicians in this sample noted a requirement to continue their certification, suggesting that there has been no significant increase in the requirements from employers, credentialing bodies, or insurers for physicians to continue board certification noted in previously cited work. Furthermore, only 17.5% of our sample reported solely external motivation to continue certification, indicating that real or perceived requirements are not the primary driver for most physicians to maintain certification.
委员会认证项目饱受批评，被指与实践无关、无法改善患者护理，还会给本就负担过重的医生增加额外负担。许多医生可能觉得有必要参加委员会认证项目，以满足雇主、医院和保险公司的要求；然而，促使医生继续参加委员会认证的各种因素的影响却鲜为人知。
我们使用了2017年美国家庭医学委员会（ABFM）家庭医学认证考试实践人口统计学登记调查问卷的数据，这些数据来自那些寻求继续认证的医生，剔除了表示不提供直接患者护理的医生。我们采用了混合方法设计。对于定量分析，使用比例优势逻辑回归来检验预测变量与外部动机水平增加之间的关联。对于定性分析，我们采用演绎方法来检查开放式文本回答。
在7545名家庭医生的分析样本中，约五分之一（21.4%）的人继续参加委员会认证的动机仅为内在因素。不到五分之一（17.3%）的人仅受外在因素驱动，而大多数（61.2%）表示继续参加委员会认证有多种动机。只有38名受访者（0.5%）在开放式文本回答中对认证过程表达了负面看法。
该样本中约一半的家庭医生指出有继续认证的要求，这表明雇主、认证机构或保险公司对医生继续参加委员会认证的要求并没有如之前引用的工作中所指出的那样显著增加。此外，我们样本中只有17.5%的人表示继续认证的动机完全是外部的，这表明实际的或感知到的要求并非大多数医生维持认证的主要驱动力。
