Board Certification in Psychology: Insights from Medicine and Hospital Psychology

Board certification in Medicine is well established, beginning in 1917 with the establishment of the Board of Ophthalmology. By 1933, the forerunner organization of ABMS was developed for credentialing physicians across specialties (Weiss, 2010). Within medicine, board certification has evolved from a one-time assessment to an essentially ongoing recertification process that requires evidence of the “maintenance of certification (MOC).” By 2006, all of the ABMS specialty boards required re-assessment (e.g., every 6–10 years) as a demonstration of “continuous professional development” (ABMS, 2011) with the objective of assuring the public that health care was being delivered safely and competently. The MOC requirements for psychiatrists are being phased in, comprising four elements: (a) licensure; (b) self-assessment and continuing education; (c) cognitive expertise (i.e., the MOC examination); and, (d) Performance in Practice (PIP) that incorporates clinical and feedback modules (Faulkner & Vondrak, 2010). The expanded requirements for board certification developed within a context of demands for increasing transparency, accountability, and cost-effectiveness within the healthcare system. These expanded board certification requirements also exert pressure on physicians to remain up-to-date with proliferating innovations in assessment and treatments (Kirkner, 2010). Health plans are beginning to reward physicians for participating in MOC programs (Kirner, 2010).

Despite the evolutionary developments emerging in board certification in medicine, and the recognition of the need to enhance the quality of care, even board-certified physicians remain unsure whether the benefits of the new MOC are worth the costs (Kritek & Drazen, 2010). Thus far, the new more intensive process appears to be gaining acceptance (Kirkner, 2010), though it will take time to fully appreciate its benefits and whether the process warrants the associated costs.

Bent, Packard, and Goldberg (1999, 2009), Nezu, Finch, and Simon (2009), and Cox (2010) provide excellent reviews of the history of the ABPP. The ABPP has been certifying psychologists since 1947. Thus far, there are no options or mechanisms for ongoing or continuous quality improvement in board certification (e.g., MOC) for psychologists.

Several factors have been outlined for why psychologists avoid board certification (Dattilio, 2002). It is not known how well the efforts within ABPP to promote board certification will influence psychologists’ perspectives, demystify the application process (Wodushek, 2009), or how commonly psychologists may respond to tangible benefits (e.g., offered in the VA system) of board certification. Some psychologists appear to respond to cultural expectations within certain groups, such as neuropsychologists, where board certification is increasingly articulated as an expectation for practice and training (e.g., postdoctoral residencies in clinical neuropsychology are to have at least one board-certified clinical neuropsychologist [Hannay et al. 1998]).

Potential steps to promote board certification of training directors and possibly even supervisors could be implemented by the Commission on Accreditation (COA) (e.g., imposing requirements mandating it). A less controversial measure would be to publicize the rates of board certification among training directors and supervisors from the data COA currently collects from programs. Similarly, the Association of Psychology Postdoctoral and Internship Centers (APPIC) could encourage training directors to indicate their board certification status in its Directory. The ABPP organization could also develop mechanisms of publicizing the accomplishments and roles of board-certified psychologists that would draw more attention to the association between the achievement of board certification and success in a range of professional endeavors.