Board Certification

A patient of mine who regularly reads the forum recently asked me about board certification for Ob/Gyn doctors. She explained that there is a lot of confusion about this issue, and that many women's magazines and other media tell women to always seek out the services of an Ob/Gyn who is board certified. So, this looked like a good opportunity to review the board certification process.

In order to graduate from an Ob/Gyn program in the U.S., doctors must first go through 4 years of medical school, then 4 years of residency (sometimes the first year of residency is also called the "internship"). During med school there are 3 main licensure tests, and about a hundred smaller tests one must pass before graduation. During residency there are a handful of in-training exams. Just after graduation from residency, doctors take a written board certification exam that lasts all day. In order to take the more grueling oral exam, and to finally be board certified, one must first pass the written test. More about that later.

After residency many Ob/Gyns go in to practice, while others stay on to do 1-3 more years of training in a subspecialty, a time called "Fellowship." Subspecialties in Ob/Gyn include reproductive endocrinology (infertility), maternal-fetal (high risk OB) medicine, and gynecologic (cancer) gynecology. Each of these has their own board certification process!

One the written exam is taken just after completing residency, doctors have 1 year to adjust to practicing in their community or hospital. The next year they complete a large "case list" where every single surgery, hospital admission, baby that is delivered, and many office visits are logged (thankfully, now by a computer program) into a database that is turned in a few months before the oral board exam. The professors who give the boards review this material and ask you questions about cases that they find interesting or unusual. (Please note that patient names and other identifying information is left off of the case list).

Each November or December, a bunch of nervous Ob/Gyns travel to Chicago, where they take over a hotel downtown to take their oral boards. It has cost thousands of dollars in test fees, travel expenses, and hotel charges to get there. 6 professors, in groups of 2, ask you questions for about an hour each. They show slides and ask you what you see, and how you would treat the problem. They "inquire" why you delivered this baby this way, and the other another way, why you induced labor on this patient, and why you chose a vaginal hysterectomy on one lady versus an abdominal one on another. The questions get harder and harder, until you can't answer them. It can be extremely stressful for the applicant. Most ob/gyns can recall with great clarity their oral board exams, including specific questions or slides, even 30 years later! The pass rate varies, but is somewhere around 80-85% overall. Receiving the letter that starts "Congratulations...." is one of the most rewarding experiences in an ob/gyns career.

Unfortunately, the women's magazines and media do not tell you that an ob/gyn *must* be in practice at least 2 years before he or she can even take the oral exam. Thus, if an ob/gyn is in practice for 2 years, she cannot be board certified, and if you call her office asking "Is Dr. Smith, board certified", the answer will be no. Is it necessary to wait until a doctor is board certified to see him? I don't believe so, since doctors just out in practice have already treated thousands of patients during their training, have done hundreds of surgeries, and are up-to-date on the newest techniques. In fact, many "mature" ob/gyns recruit newer doctors to teach them the latest techniques. I remember a patient who called my office two weeks before my oral boards to ask if I were board certified. She was told no, but I should be by January (my staff was apparently optimistic). She actually waited until January to see me! Of course, I was no better (or worse) a doctor than I was in December!

Some of the best doctors I have met are board certified, but others have chosen to not take the test, or get too nervous during their orals and fail the test. They are excellent doctors but just lack confidence during the test. In contrast, some of the very worst doctors I have met have passed their boards and are board certified. They take tests with ease, and may be board certified, but they will never touch one of my relatives or friends. Thus, while board certification is a nice way of saying that older doctors think a doctor is competent, it does not guarantee that a doctor is top-notch. It is currently the best system we have. If your doctor is not board certified, ask her or him why not, and keep an open mind to the explanation.

I hope this clarifies the issue of board certification in Ob/Gyn.