Otology & Neurotology 35:e159Ye162 Ó 2014, Otology & Neurotology, Inc.
Acceptance of Neurotology Board Certification Among Leaders in the Field *Hashir K. Saeed( and †Anthony A. Mikulec *Saint Louis University School of Medicine; and ÞDepartment of OtolaryngologyYHead and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, U.S.A.
Introduction: Neurotology board certification was born a decade ago and is available to otolaryngologists who specialize in clinical neurotology. The degree of participation in this voluntary program among leaders in the field has not been previously assessed. Methods: The Web sites of ACGME accredited otolaryngology programs were used to identify chairpersons who self-identified as neurotologists. Past presidents of the American Neurotology Society (ANS) since 1997 were also evaluated. The participation of both groups in neurotology board certification (NC) was ascertained using the search tool available on the American Board of Otolaryngology Web site (aboto.org).
Results: Of the 26 chairmen (all were men) identified as neurotologists, 18 (69%) participated in NC. Ten of 13 past presidents (77%) of the ANS participated in NC. Combining the 2 groups, 28 (72%) of 39 leaders in neurotology in the United States participated in NC. Conclusion: Adoption of the NC process among leaders in the field of neurotology in the United States has been robust, despite the significant costs entailed in participation. Key Words: Board certificationVEducationVLeadersVMaintenance of certificationVNeurotologyVOtolaryngology. Otol Neurotol 35:e159Ye162, 2014.
In 2004, the first group of otolaryngologists took the subspecialty certification examination in neurotology through the American Board of Otolaryngology. The examination was available to diplomates of Otolaryngology in the United States. Attainment of certification required the applicant to pass a written and oral examination, and the resulting certification is valid for 10 years, at which point additional testing is required for recertification. When the NC was introduced, 2 groups of otolaryngologists were eligible to attempt the neurotology board certification exam: graduates of accredited neurotology fellowships and practicing otolaryngologists who demonstrated sufficient experience in performing neurotology surgical procedures, termed the alternative pathway (AP). To take part in the alternative pathway, an otolaryngologist needed to provide documentation of a minimum of 10 intracranial procedures over 2 years before application, such as vestibular schwannoma resection or middle fossa approach to cerebrospinal fluid leak repair (Fig. 1). Cochlear implants and stereotactic radiosurgical procedures were excluded. The last day to apply for the AP was September 1, 2011. Currently, the only remaining pathway
to neurotology certification is completion of an approved neurotology fellowship (Fig. 2) and passage of the certification examination. The introduction of (NC) posed a dilemma for otolaryngologists specializing in the field of neurotology who obtained their otolaryngology certification before 2002, as these diplomates were provided lifetime certification and subspecialty certification in neurotology would shift the diplomate to a pathway that required participation in the Maintenance of Certification (MOC) program throughout the physician’s active practice lifetime. The MOC process imposes additional burdens on time and finances beyond lifetime certification including the need to recertify every 10 years and to perform annual online learning modules (1,2). The purpose of this study is to document the birth of the neurotology certificate and determine its use among the leaders in the field of neurotology in the United States. Although multiple criteria could be used to define a leader in the field of neurotology, we have chosen to examine the chairpersons of Departments or Divisions of Otolaryngology in the United States who are also subspecialized in neurotology and past presidents of the American Neurotology Society (ANS).
Address correspondence and reprint requests to Anthony A. Mikulec, M.D., Department of OtolaryngologyYHead and Neck Surgery, Saint Louis University School of Medicine, 3635 Vista Ave, 6th FL FDT, Saint Louis, MO 63110; E-mail: [email protected] The authors disclose no conflicts of interest.
MATERIALS AND METHODS The present study was deemed exempt by Saint Louis University’s institutional review board. We investigated accredited
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Copyright © 2014 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.
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FIG. 1.
H. K. SAEED AND A. A. MIKULEC
Abbreviated description of procedures and current procedural terminology (CPT) codes that qualified for the alternative pathway.
Otolaryngology programs based on the Accreditation Council for Graduate Medical Education (ACGME) listing of otolaryngology programs. The listing obtained was valid as of June 30, 2012. The listing contained a total of 105 programs. We excluded armed forces programs, leaving 100 programs. For each program, using publically available Web sites, we determined the chairperson’s name, his/her specialty, sex, and neurotology fellowship if available, which was compiled into a spreadsheet. The chairperson’s name was also entered into the Board Certification Investigation Tool on the American Board of Otolaryngology Web site (http://www.aboto.org/), which provides information on whether he/she participates in the Maintenance of Certification program.
We selected those physicians who practiced neurotology and excluded all other subspecialties. We further considered past presidents of the American Neurotology Society as leaders in the field of neurotology and evaluated their participation. We included presidents starting with the 1998Y1999 term of Dr. John W House until President-Elect Dr. Anil K. Lalwani. We then excluded those presidents who were already counted among the previous cohort of chairpersons. MOC status of these neurotologists was also searched on the Board Certification Investigation Tool, and the data were compiled together. Discussions were conducted with administrators at the American Board of Otolaryngology to determine some of the background information presented here.
FIG. 2. Available Neurotology residency (a.k.a. fellowship) programs that qualify the graduate for Neurotology board certification, as of March 2013. Otology & Neurotology, Vol. 35, No. 5, 2014
Copyright © 2014 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.
ACCEPTANCE OF NEUROTOLOGY BOARD CERTIFICATION RESULTS We evaluated a total of 100 otolaryngology programs. Of these, 26 of the chairpersons belonged to the Otology and Neurotology subspecialty. All 26 Chairpersons were male subjects. Place of otolaryngology residency and fellowship varied among individuals, with place of fellowship ranging from domestic U.S. programs to international programs, notably at the University of Zurich. Place of fellowship was unavailable for 2 for the chairmen. It was found that 18 of the 26 chairmen participated in the MOC program, with 8 chairmen choosing not to, yielding a 69% participation rate. Previous ANS presidents beginning from the 1998Y1999 term included 13 neurotologists. Of these, 11 were male subjects and 2 were female subjects. This represented the past 14 years of presidents and was a window which was arbitrarily chosen. Ten of these were found to participate in the MOC program, yielding a 77% participation rate. Combining the 2 data sets, a total of 39 unique neurotologists who were determined to be leaders in the field were evaluated in this study, with 28 choosing to participate in MOC and 11 opting out, yielding a 72% participation rate.
DISCUSSION Three pathways have existed to neurotology certification (NC). A small group of neurotologists were grandfathered into the subspecialty so that they could become test writers and/or oral board examiners for the first cohort of test takers in 2004. Practicing neurotologists with a lifetime otolaryngology certificate were allowed to apply for NC if they could demonstrate sufficient neurotologic surgical volume. This alternative pathway closed in 2011. The third and only remaining pathway allows physicians who have completed an otolaryngology residency and graduated from an approved neurotology fellowship to apply for the NC (Fig. 2). The introduction of the NC required an initial cadre of experts to write the examination questions and to serve as examiners for the oral portion of the examination. The small group that created the examination consisted of directors and senior examiners of the American Board of Otolaryngology. Thus, several otolaryngologists received NC in exchange for their participation in the initiation of the NC program. The American Board of Otolaryngology refuses to release the number or names of otolaryngologists who were grandfathered in this way, but private communication with some of the otolaryngologists involved suggest that the number was around 5. It should be noted that these first 5 or so holders of the NC certificate must also participate in the MOC process. Otolaryngology diplomates holding a lifetime certification but specializing in neurotology were faced with a conundrum when the NC was introduced. They could continue to practice neurotology as a board certified otolaryngologist without the burdens of annual MOC and once per decade testing or opt to participate in the new neurotology certification process. Participation in the alternative pathway
e161
to NC would entail forfeiture of lifetime certification and entail added financial and time costs. A primary goal of this study was to determine what percentage of the leaders of the field of neurotology in the United States would opt to make the personal sacrifice that participating in NC entails. Of the 100 nonmilitary otolaryngology residency programs in the United States, 26 were headed by chairmen (all were men) who identified themselves as neurotologists on their programs’ Web sites. Of these 26, 18 (69%) chose to participate in NC. Examination of the presidents of the American Neurotology Society (ANS) since 1997 showed that 10 (77%) of 13 participated in NC. Not surprisingly, there is overlap between neurotology chairmen and presidents of the ANS and when the data sets are combined, a total of 28 (72%) of 39 chose to participate in NC. The age of the leaders in neurotology shows that all must have achieved NC via the alternative pathway (except for the 5 or so who were grandfathered in), thus forfeiting lifetime otolaryngology certification. This shows a fairly high degree of participation of the NC process among leaders in the field of otolaryngology within the United States. In contrast, participation in the MOC process by all lifetime certificate holders in internal medicine is 1% (3). As of 2012, there were 286 holders of the neurotology certificate (NC). The leaders in neurotology compromise 39 of the 286 total neurotology diplomates. It is not possible to determine what percentage of otolaryngologists who met the criteria for the neurotology alternative pathway chose not to participate in NC. The burden of the MOC process for NC holders has not been fully quantified but involves a once per decade written examination and annual online learning modules, which are still evolving. The annual cost for certificate upkeep as of 2012 for a NC holder is $310 as opposed to $75 for an otolaryngology lifetime certificate holder. In 2012, the first group of NC holders took the MOC recertifying exam, with a passing rate of 49/50 (98%). The following year, the 2013 MOC neurotology recertification exam tested 38 individuals, and of that, number 3 failed. These data were obtained from conversations with the staff of the American Board of Otolaryngology (4, personal communication via phone, Janet Wise.) The only pathway to NC currently available is to graduates of a 2-year-long neurotology residency (commonly referred to as fellowship) since 2002. Such candidates also need to be board certified otolaryngologists. The 2012 neurotology exam (as opposed to the renewal examination discussed previously) tested 42 individuals, and of that number, 1 failed. Since 2007, from 11 to 14 neurotology residency positions have been available each year through the SF match program. The number of applicants has exceeded the number of positions by between 5 and 12 each year since 2007 (5, www.sfmatch.org). Limitations of this study include the limited data of the practice patterns of the 44 otolaryngologists deemed to be leaders in the field of neurotology. All data utilized are publicly available on institution Web sites or the American board of Otolaryngology Web site (aboto.org). It is possible that some neurotology leaders we have identified Otology & Neurotology, Vol. 35, No. 5, 2014
Copyright © 2014 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.
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H. K. SAEED AND A. A. MIKULEC
using these resources do not actually practice the full spectrum of neurotology required for access to the alternative pathway for NC. Thus, the 72% NC participation rate among leaders in the field of neurotology represents the lower bound of the participation level. In summary, adoption of the NC process among leaders in the field of neurotology in the United States has been robust. The NC adoption rate among all practitioners of neurotology in the United States remains uncertain.
REFERENCES 1. Miller RH. Certification and maintenance of certification in otolaryngology-head and neck surgery. Otolaryngol Clin North Am 2007;40:1347Y57,ix-x. 2. Medina JE, Miller RH. Maintenance of certification in U.S. otolaryngologists: an update. Ear Nose Throat J 2007;86:184Y87. 3. Iglehart JK, Baron RB. Ensuring physicians’ competenceVis maintenance of certification the answer? N Engl J Med 2012;367:2543Y9. 4. SF Match Residency and Fellowship Matching Services. http:// www.sfmatch.org. Accessed September 1, 2013.
Otology & Neurotology, Vol. 35, No. 5, 2014
Copyright © 2014 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.
Acceptance of Neurotology Board Certification Among Leaders in the Field *Hashir K. Saeed( and †Anthony A. Mikulec *Saint Louis University School of Medicine; and ÞDepartment of OtolaryngologyYHead and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, U.S.A.
Introduction: Neurotology board certification was born a decade ago and is available to otolaryngologists who specialize in clinical neurotology. The degree of participation in this voluntary program among leaders in the field has not been previously assessed. Methods: The Web sites of ACGME accredited otolaryngology programs were used to identify chairpersons who self-identified as neurotologists. Past presidents of the American Neurotology Society (ANS) since 1997 were also evaluated. The participation of both groups in neurotology board certification (NC) was ascertained using the search tool available on the American Board of Otolaryngology Web site (aboto.org).
Results: Of the 26 chairmen (all were men) identified as neurotologists, 18 (69%) participated in NC. Ten of 13 past presidents (77%) of the ANS participated in NC. Combining the 2 groups, 28 (72%) of 39 leaders in neurotology in the United States participated in NC. Conclusion: Adoption of the NC process among leaders in the field of neurotology in the United States has been robust, despite the significant costs entailed in participation. Key Words: Board certificationVEducationVLeadersVMaintenance of certificationVNeurotologyVOtolaryngology. Otol Neurotol 35:e159Ye162, 2014.
In 2004, the first group of otolaryngologists took the subspecialty certification examination in neurotology through the American Board of Otolaryngology. The examination was available to diplomates of Otolaryngology in the United States. Attainment of certification required the applicant to pass a written and oral examination, and the resulting certification is valid for 10 years, at which point additional testing is required for recertification. When the NC was introduced, 2 groups of otolaryngologists were eligible to attempt the neurotology board certification exam: graduates of accredited neurotology fellowships and practicing otolaryngologists who demonstrated sufficient experience in performing neurotology surgical procedures, termed the alternative pathway (AP). To take part in the alternative pathway, an otolaryngologist needed to provide documentation of a minimum of 10 intracranial procedures over 2 years before application, such as vestibular schwannoma resection or middle fossa approach to cerebrospinal fluid leak repair (Fig. 1). Cochlear implants and stereotactic radiosurgical procedures were excluded. The last day to apply for the AP was September 1, 2011. Currently, the only remaining pathway
to neurotology certification is completion of an approved neurotology fellowship (Fig. 2) and passage of the certification examination. The introduction of (NC) posed a dilemma for otolaryngologists specializing in the field of neurotology who obtained their otolaryngology certification before 2002, as these diplomates were provided lifetime certification and subspecialty certification in neurotology would shift the diplomate to a pathway that required participation in the Maintenance of Certification (MOC) program throughout the physician’s active practice lifetime. The MOC process imposes additional burdens on time and finances beyond lifetime certification including the need to recertify every 10 years and to perform annual online learning modules (1,2). The purpose of this study is to document the birth of the neurotology certificate and determine its use among the leaders in the field of neurotology in the United States. Although multiple criteria could be used to define a leader in the field of neurotology, we have chosen to examine the chairpersons of Departments or Divisions of Otolaryngology in the United States who are also subspecialized in neurotology and past presidents of the American Neurotology Society (ANS).
Address correspondence and reprint requests to Anthony A. Mikulec, M.D., Department of OtolaryngologyYHead and Neck Surgery, Saint Louis University School of Medicine, 3635 Vista Ave, 6th FL FDT, Saint Louis, MO 63110; E-mail: [email protected] The authors disclose no conflicts of interest.
MATERIALS AND METHODS The present study was deemed exempt by Saint Louis University’s institutional review board. We investigated accredited
e159
Copyright © 2014 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.
e160
FIG. 1.
H. K. SAEED AND A. A. MIKULEC
Abbreviated description of procedures and current procedural terminology (CPT) codes that qualified for the alternative pathway.
Otolaryngology programs based on the Accreditation Council for Graduate Medical Education (ACGME) listing of otolaryngology programs. The listing obtained was valid as of June 30, 2012. The listing contained a total of 105 programs. We excluded armed forces programs, leaving 100 programs. For each program, using publically available Web sites, we determined the chairperson’s name, his/her specialty, sex, and neurotology fellowship if available, which was compiled into a spreadsheet. The chairperson’s name was also entered into the Board Certification Investigation Tool on the American Board of Otolaryngology Web site (http://www.aboto.org/), which provides information on whether he/she participates in the Maintenance of Certification program.
We selected those physicians who practiced neurotology and excluded all other subspecialties. We further considered past presidents of the American Neurotology Society as leaders in the field of neurotology and evaluated their participation. We included presidents starting with the 1998Y1999 term of Dr. John W House until President-Elect Dr. Anil K. Lalwani. We then excluded those presidents who were already counted among the previous cohort of chairpersons. MOC status of these neurotologists was also searched on the Board Certification Investigation Tool, and the data were compiled together. Discussions were conducted with administrators at the American Board of Otolaryngology to determine some of the background information presented here.
FIG. 2. Available Neurotology residency (a.k.a. fellowship) programs that qualify the graduate for Neurotology board certification, as of March 2013. Otology & Neurotology, Vol. 35, No. 5, 2014
Copyright © 2014 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.
ACCEPTANCE OF NEUROTOLOGY BOARD CERTIFICATION RESULTS We evaluated a total of 100 otolaryngology programs. Of these, 26 of the chairpersons belonged to the Otology and Neurotology subspecialty. All 26 Chairpersons were male subjects. Place of otolaryngology residency and fellowship varied among individuals, with place of fellowship ranging from domestic U.S. programs to international programs, notably at the University of Zurich. Place of fellowship was unavailable for 2 for the chairmen. It was found that 18 of the 26 chairmen participated in the MOC program, with 8 chairmen choosing not to, yielding a 69% participation rate. Previous ANS presidents beginning from the 1998Y1999 term included 13 neurotologists. Of these, 11 were male subjects and 2 were female subjects. This represented the past 14 years of presidents and was a window which was arbitrarily chosen. Ten of these were found to participate in the MOC program, yielding a 77% participation rate. Combining the 2 data sets, a total of 39 unique neurotologists who were determined to be leaders in the field were evaluated in this study, with 28 choosing to participate in MOC and 11 opting out, yielding a 72% participation rate.
DISCUSSION Three pathways have existed to neurotology certification (NC). A small group of neurotologists were grandfathered into the subspecialty so that they could become test writers and/or oral board examiners for the first cohort of test takers in 2004. Practicing neurotologists with a lifetime otolaryngology certificate were allowed to apply for NC if they could demonstrate sufficient neurotologic surgical volume. This alternative pathway closed in 2011. The third and only remaining pathway allows physicians who have completed an otolaryngology residency and graduated from an approved neurotology fellowship to apply for the NC (Fig. 2). The introduction of the NC required an initial cadre of experts to write the examination questions and to serve as examiners for the oral portion of the examination. The small group that created the examination consisted of directors and senior examiners of the American Board of Otolaryngology. Thus, several otolaryngologists received NC in exchange for their participation in the initiation of the NC program. The American Board of Otolaryngology refuses to release the number or names of otolaryngologists who were grandfathered in this way, but private communication with some of the otolaryngologists involved suggest that the number was around 5. It should be noted that these first 5 or so holders of the NC certificate must also participate in the MOC process. Otolaryngology diplomates holding a lifetime certification but specializing in neurotology were faced with a conundrum when the NC was introduced. They could continue to practice neurotology as a board certified otolaryngologist without the burdens of annual MOC and once per decade testing or opt to participate in the new neurotology certification process. Participation in the alternative pathway
e161
to NC would entail forfeiture of lifetime certification and entail added financial and time costs. A primary goal of this study was to determine what percentage of the leaders of the field of neurotology in the United States would opt to make the personal sacrifice that participating in NC entails. Of the 100 nonmilitary otolaryngology residency programs in the United States, 26 were headed by chairmen (all were men) who identified themselves as neurotologists on their programs’ Web sites. Of these 26, 18 (69%) chose to participate in NC. Examination of the presidents of the American Neurotology Society (ANS) since 1997 showed that 10 (77%) of 13 participated in NC. Not surprisingly, there is overlap between neurotology chairmen and presidents of the ANS and when the data sets are combined, a total of 28 (72%) of 39 chose to participate in NC. The age of the leaders in neurotology shows that all must have achieved NC via the alternative pathway (except for the 5 or so who were grandfathered in), thus forfeiting lifetime otolaryngology certification. This shows a fairly high degree of participation of the NC process among leaders in the field of otolaryngology within the United States. In contrast, participation in the MOC process by all lifetime certificate holders in internal medicine is 1% (3). As of 2012, there were 286 holders of the neurotology certificate (NC). The leaders in neurotology compromise 39 of the 286 total neurotology diplomates. It is not possible to determine what percentage of otolaryngologists who met the criteria for the neurotology alternative pathway chose not to participate in NC. The burden of the MOC process for NC holders has not been fully quantified but involves a once per decade written examination and annual online learning modules, which are still evolving. The annual cost for certificate upkeep as of 2012 for a NC holder is $310 as opposed to $75 for an otolaryngology lifetime certificate holder. In 2012, the first group of NC holders took the MOC recertifying exam, with a passing rate of 49/50 (98%). The following year, the 2013 MOC neurotology recertification exam tested 38 individuals, and of that, number 3 failed. These data were obtained from conversations with the staff of the American Board of Otolaryngology (4, personal communication via phone, Janet Wise.) The only pathway to NC currently available is to graduates of a 2-year-long neurotology residency (commonly referred to as fellowship) since 2002. Such candidates also need to be board certified otolaryngologists. The 2012 neurotology exam (as opposed to the renewal examination discussed previously) tested 42 individuals, and of that number, 1 failed. Since 2007, from 11 to 14 neurotology residency positions have been available each year through the SF match program. The number of applicants has exceeded the number of positions by between 5 and 12 each year since 2007 (5, www.sfmatch.org). Limitations of this study include the limited data of the practice patterns of the 44 otolaryngologists deemed to be leaders in the field of neurotology. All data utilized are publicly available on institution Web sites or the American board of Otolaryngology Web site (aboto.org). It is possible that some neurotology leaders we have identified Otology & Neurotology, Vol. 35, No. 5, 2014
Copyright © 2014 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.
e162
H. K. SAEED AND A. A. MIKULEC
using these resources do not actually practice the full spectrum of neurotology required for access to the alternative pathway for NC. Thus, the 72% NC participation rate among leaders in the field of neurotology represents the lower bound of the participation level. In summary, adoption of the NC process among leaders in the field of neurotology in the United States has been robust. The NC adoption rate among all practitioners of neurotology in the United States remains uncertain.
REFERENCES 1. Miller RH. Certification and maintenance of certification in otolaryngology-head and neck surgery. Otolaryngol Clin North Am 2007;40:1347Y57,ix-x. 2. Medina JE, Miller RH. Maintenance of certification in U.S. otolaryngologists: an update. Ear Nose Throat J 2007;86:184Y87. 3. Iglehart JK, Baron RB. Ensuring physicians’ competenceVis maintenance of certification the answer? N Engl J Med 2012;367:2543Y9. 4. SF Match Residency and Fellowship Matching Services. http:// www.sfmatch.org. Accessed September 1, 2013.
Otology & Neurotology, Vol. 35, No. 5, 2014
Copyright © 2014 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.
