A new certification process for obstetrics in family medicine has begun under the auspices of the American Board of Physician Specialties (ABPS). The new Board of Certification in Family Medicine Obstetrics (BCFMO) is open to family physicians who have completed a fellowship tract or clinical practice tract in obstetrics. Candidates must complete written and oral examinations and proctor-observed surgical competency testing before receiving certification. To date, 25 family physicians have completed the testing process and received certification. In this article, I describe the genesis of this certification and the process that aspiring applicants can expect.
Working to meet a long-standing need
Twenty-five years ago, board certification was admirable, but not essential to practice medicine. Today it is imperative. In family medicine, most physicians completing residency training seek board certification in that specialty. Many of them then pursue training in fellowships, with recognition usually conferred by a certificate of added qualification. Obstetrics has been such an area of specialized clinical focus in family medicine, especially for those serving rural communities.1,2 And women’s health and routine pregnancy care are an integral part of family medicine and the medical home.3
In 1984, Paul D. Mozley, MD, founded Postgraduate Obstetrics Fellowship Training at the University of Alabama School of Medicine in Tuscaloosa, to address the shortage of obstetric providers in rural and underserved areas and a desire by graduating family medicine residents to obtain additional training in obstetrics. Obstetrics fellowships are usually one year in length and include operative obstetrics with cesarean section and instrumental vaginal delivery, limited gynecologic surgery, and office gynecology.4,5
Family medicine and obstetrics and gynecology organizations have also been working together to continually improve care for obstetric patients. One example is the formation of a Joint Task Force in 1998 by the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists, which developed core educational guidelines in OB/GYN care for training family medicine residents.6 Between 2000 and 2005, parties from both specialties approached a number of national organizations about an examination and certification initiative. Although all organizations were supportive and recognized the need, an examination and certification never materialized.
A like-minded certifying partner emerges
In 2005, I made a formal presentation to the ABPS—one of 3 board-certifying organizations in the United States—proposing a program for examination and board certification of family medicine physicians completing obstetrics fellowships.7 In response, the ABPS created a Task Force for the Certification of Family Physicians Practicing Obstetrics, composed of family physicians and obstetrician/gynecologists. The Task Force conducted a nationwide survey of hospitals, hospital credentialing committees, malpractice insurance carriers, obstetrics fellowship programs, and family physicians regarding the importance of examination and certification, a certificate of added qualification, and a separate board of certification for family physicians practicing obstetrics.8 The aggregate response overwhelmingly favored board certification.
In 2006, responding to the increasingly clear need, the ABPS created the American Board of Family Practice Obstetrics, which is now known as the BCFMO.
What the BcFMO examination entails
From 2006 to 2008, using major textbooks on obstetrics, the BCFMO selected 873 test items that were placed in a bank for review and comment by all board members. The BCFMO then prepared questions of equal competency as the examination in obstetrics and gynecology. Questions of equal competency to both specialties were deemed important to give the certification process validity. Using the same text sources, the Board prepared additional items in a form usable for oral examination. The final written examination comprises 200 questions; the oral examination has 4 questions.
Surgical competency testing
The BCFMO also includes observed surgical competency as part of the process. Documentation of physician competency is emphasized by The Joint Commission. In this part of the testing, a Board-approved local proctor—a family physician practicing obstetrics, a general surgeon who performs cesarean sections, or an obstetrician/ gynecologist—is asked to observe and evaluate the surgical competency of a candidate for examination.
Credentialing for the examinations
Eligible applicants are those who, within the last 5 years, have satisfactorily completed (verified in writing by the fellowship director) a 12-month full-time Obstetrics or Maternal and Child Care Fellowship recognized by the BCFMO (http://www.abpsus.org/userfiles/files/BFMOFellowship.pdf). Applicants who have not completed an obstetrics fellowship but have been actively engaged in the practice of surgical obstetrics for at least 5 years may present a case list of the previous 2 years. All applicants to either tract must have performed a minimum of 100 vaginal deliveries and a verified case list of 50 cesarean sections within the last 5 years.9
Applicants successfully completing the computer-based written examination are required to submit verification of competency in surgical obstetrics described earlier, and then successfully complete the oral examination. The first written examination was administered in May 2009, and the oral examination in September 2009. Subsequent written and oral examinations were administered in 2010.