Health Policy Corner: Is Board Certification a Necessary Professional Credential?

Richard J. Seime, PhD, ABPP
Board Certified in Clinical Health Psychology and Clinical Psychology
Consultant Emeritus, Department of Psychiatry and Psychology, Mayo Clinic
President, American Board of Clinical Health Psychology

Dr. Annie Bradford, editor of the Health Psychologist, invited me to write this piece about board certification and its importance for specialty practice in our field, the institutional practice of psychologists, and to an individual psychologist. This piece will not be a thorough review of the topic of board certification but I will refer to others who have provided valuable perspectives. At the outset, I must state that I am an unequivocal advocate of board certification for psychologists, which is born of my experience as a board certified psychologist for 35 years; professional career spent as clinical health psychologist in academic health centers; experience in education and training of graduate students, interns, and postdocs; experience in administration of programs and psychology within academic health centers; and my involvement in professional affairs and accreditation at the national level. Second, I will discuss some of the forces that may usher in a new era where board certification becomes an expectation for health service psychologists rather than a credential that is viewed as “nice” but optional.

Board Certification is not the Norm
Robiner, Dixon, Miner, and Hong (2012) conducted a survey of the attitudes towards board certification of psychologists in medical school and hospital-based settings. They made several observations based upon that survey that are relevant to the present discussion. First, they observed that there was a “lack of consensus about this matter [board certification]” (p. 36). Second, they noted that, “within the profession there is fairly widespread indifference or resistance to making board certification a requirement for practice” (p. 36). Third, they concluded that, “board certification in psychology continues to be an area of aspiration for some psychologists…a source of ambivalence or resistance among other psychologists” (p. 37). Their observations run true from discussions with many psychologists over the years. I have frequently heard the argument that for a practicing psychologist licensure is sufficient or that there is no benefit to boarding because it is just another “hoop,” most practicing psychologists are not boarded, and that it does not appear necessary. The ambivalence or skepticism about board certification is certainly not shared by medical colleagues in academic health centers or hospital settings. Board certification among physicians is recognized as essential and typically a requirement for academic promotion or even initial academic appointment, and considered essential to medical staff membership and clinical privileging. Further, board certification and the maintenance of board certification to assure quality and accountability is now embedded in the culture of professionalism for physicians and required by medical specialty boards (c.f., Robiner, et al., 2012). I am disappointed that comparatively few psychologists have embraced board certification, especially in this era of increased emphasis on competencies, accountability, and specialty expertise. However, I am optimistic that in the near future this will change and licensure alone will no longer be viewed as sufficient for psychologists practicing in various specialties.

Importance of Board Certification
Our Society for Health Psychology colleague Ron Rozensky (2011, 2012) has written extensively about the increased opportunities and roles for professional psychology in the health care system as a result of the Patient Care and Affordable Care Act. He has argued that psychology has found a professional home in academic health centers and hospitals are  “clearly held together by the mortar of competence” (Rozensky, 2012, p. 355).  He has also articulated how especially within hospital-based accountable care organizations there is and will be increased accountability for providers to include requiring graduation from accredited programs and specialty board certification (Rozensky, 2011). The distal indicant of that advanced competence and specialization is board certification. Within psychology, the board certification system for identifying psychologist specialists is the examination process of the American Board of Professional Psychology (ABPP) through its affiliated specialty boards. In fact, in the petition to maintain clinical health psychology’s recognition as a specialty prepared at the 2010 Riverfront Conference and submitted to the APA’s Commission on Recognition of Specialties and Proficiencies in Professional Psychology (CRSPPP);1 ABPP board certification is specifically cited (p. 76) as a credential that the specialty of clinical health psychology uses to identify  those who are qualified to practice the specialty. While the discussion above of importance of board certification has been has focused in context of practice in academic health centers or hospitals, the clinical health psychology CRSPPP petition also specifically states that faculty members who teach and supervise in internships and postdoctoral programs (italics added for emphasis) with major emphasis in clinical health psychology should have credentials in health psychology and have a “majority of faculty board certified in clinical health psychology or at minimum a majority board certified in some area” (p. 52). The presence of faculty who are board certified sends a strong message to graduate students, interns, and postdocs that specialty credentialing is important, necessary and an expected outcome for health service psychologists practicing clinical health psychology.

What Board Certification Signifies
Being board certified in clinical health psychology or one of the other specialties of ABPP means that a psychologist has undergone peer review of specialty credentials and passed an examination focused on foundational and functional competencies of the specialty. Board certification means that a psychologist has been examined and deemed competent in a formally recognized specialty. It further signifies that the specialist has voluntarily sought peer review and examination. Beginning in 2016, board certification requires maintenance of certification (MOC) that will occur at 10-year intervals. The requirement for MOC clearly puts us in step with our colleagues in other health service professions such as medicine and nursing and in step with today’s culture of accountability and quality improvement. ABPP board certification is an unequivocal credential certifying that the individual “has met the qualifying, examination, and professional standing requirements for specialty board certification” (as described on clinical health board certificate). Board certification is a valuable credential in medical settings, clinical practice, and in the education and training sectors at the doctoral, internships, and postdoctoral levels.

Board Certification as an Expected Credential
Historically, psychologists not board certified and skeptical of the value of board certification have often cited major disincentives, with emphasis on the “costs” rather than “benefits” of an ABPP credential. Among the disincentives cited have been costs, perceived lack of relevance, lack of tangible benefit for being boarded, and absence of an expectation for board certification by institutions or the specialty itself. However, there are practice settings such as the military and the VA where there is a financial incentive associated with board certification. While a more indirect incentive, board certification of faculty in training programs seeking APA accreditation or reaccreditation has relevance because ABPP board certification is an important avenue to demonstrate that the faculty are well-qualified in the specialty.

Among the specialties in psychology, clinical neuropsychology has been unequivocal in the expectation that clinical neuropsychologists must be ABPP board certified in clinical neuropsychology. As a result, board certification as a clinical neuropsychologist is the norm rather than the exception. The same could happen with other specialties including clinical health psychology as specialty standards and educational and training guidelines become more specific regarding board certification.

The changes in health care noted above are also setting the stage for a change in the perceived value and necessity of being board certified. Medical systems recognize the importance of board certification, and board certification is expected of the physician staff. It will be increasingly difficult for psychologists – especially those working in academic medicine – to argue that a psychologist does not need to be board certified. When medical institutions require board certification, psychologists will become board certified. It seems to me to be an to assert that board certification should not be expected of psychologists in a medical setting when board certification is expected of others on the medical staff is an indefensible stance. While it is still rare that ABPP board certification is a requirement for staff membership or faculty appointment, Mayo Clinic is an exception: board certification by an ABPP specialty board is required for consulting [medical] staff membership and for promotion to academic rank above assistant professor. As a result, Mayo Clinic has the largest percentage of board certified specialists of any academic health center in the country. That same expectation is now in place for the fully integrated Mayo Clinic Health System, which includes clinics and hospitals in several regions.

Facilitating Board Certification
I am optimistic that achieving board certification will be seen as an attractive goal for most psychologists. I look forward to a time when the majority of practicing psychologists are board certified and those who don’t have boards are primarily involved in basic research unrelated to health service provision. ABPP board certification is now viewed as something that should be accomplished early in a career rather than reserved for the most experienced psychologists, as was the case when I was boarded in clinical psychology in 1981. For example, ABPP has an early entry option for individuals in training to bank credentials so that upon completion of their training they can immediately pursue board certification. Another example is the provision that clinical health psychologists are immediately eligible to sit for the clinical health specialty board when they have graduated from an APA-accredited postdoctoral program in clinical health psychology.

We have reached an inflection point of big changes in psychology exemplified by the adoption of APA-accredited doctoral program and internship as standard for licensure as a result of the new blueprint for education and training in health service psychology (Health Service Psychology Education Collaborative, 2013). Similarly, after years of discussion about the need to revise APA accreditation Guidelines & Principles, new APA Standards of Accreditation been adopted. Likewise, with the interest in health care and the many changes in health care delivery, more psychologists than ever will be practicing in organized health care delivery systems.  In turn, the role of specialists and credentialing of specialists will assume greater importance ((c.f., Rosenzky, 2011). I am buoyed by the interest I have seen in board certification in clinical health psychology. The American Board of Clinical Health Psychology presently has nearly 100 psychologists in the “pipeline,” i.e., somewhere in the process of obtaining board certification.

For those interested in board certification in clinical health psychology, please visit ABPP’s website at http://www.abpp.org/i4a/pages/index.cfm?pageid=3285 and click on the link to American Board of Clinical Health Psychology and American Academy of Clinical Health Psychology. I can assure you that helpful mentors are available and that the entire process is collegial.

1CRSPP petition for specialty recognition of clinical health psychology is available by request from APA.

References

Health Service Psychology Education Collaborative. (2013). A blueprint for health service psychology education and training. Washington, DC: American Psychological Association.

Robiner, W. N., Dixon, K. E., Miner, J. L., & Hong, B. A. (2012). Board certification in psychology: Insights from medicine and hospital psychology. Journal of Clinical Psychology in Medical Settings, 19, 30-40. doi: 10.1007/s10880-011-9280-1

Rozensky, R. H. (2011). The institution of the institutional practice of psychology: health care reform and psychology’s workforce. American Psychologist, 66, 794-808. doi: 10.1037/a0024621

Rozensky, R. H. (2012). Psychology in academic health centers:  A true healthcare home. Journal of Clinical Psychology in Medical Settings, 19, 353-363. doi: 10.1007/s10880-012-9312-5