How Should Board Certification Evolve?

Family Medicine was a child of the 1960s. Triggered by compelling social need for care outside of large hospitals, Family Medicine emphasized access to personal physicians based in the community. As a protest movement, the ABFP required ongoing recertification for all Diplomates, with both independent examination and chart audit. Fifty years later, society and health care have changed dramatically, and it is time again to consider how Board Certification must respond to those change. We propose three interlocking arguments. First, even before COVID-19, health and health care have been in a time of fundamental transformation. Second, given the role Board Certification plays in supporting improvement of healthcare, Board Certification itself must respond to these changes. Third, to move forward, ABFM and the wider Board community must address a series of wicked problems – i.e., problems which are both complex–with many root causes–and complicated- in which interventions create new problems. The wicked problems confronting board certification include: 1) combining summative and formative assessment, 2) improving quality improvement and 3) reaffirming the social contract and professionalism and its assessment.