Hospitalized Heart Attack and Heart Failure Patients Die Less Frequently When Treated by American Board of Internal Medicine Certified Doctors
BMJ Open study looks at more than 180,000 Pennsylvania patients over six years
Philadelphia, PA – April 27, 2022 – Far fewer heart attack and heart failure patients in Pennsylvania hospitals died when treated by physicians who earned their initial American Board of Internal Medicine (ABIM) certification, with additional benefits for those who participated in Maintenance of Certification (MOC) throughout their careers.
That’s according to a new study published today in BMJ Open further associating the relationship between physicians who demonstrate the “knowledge, skills, and attitudes essential for excellent patient care,” and better outcomes for patients.
The authors report that after studying 184,115 acute myocardial infarction (AMI) and congestive heart failure (CHF) hospitalizations at all Pennsylvania hospitals and facilities from January 1, 2012 to December 31, 2017, initial certification was associated with a 15.9% decrease in in-hospital mortality compared to those cared for by non-certified physicians.
Physicians who went on to participate in MOC were associated with an 18.9% decrease in-hospital mortality compared to those cared for by physicians who were not participating in MOC. MOC is the program through which internists and others demonstrate they are staying current in medical knowledge and practice throughout their careers.
Those conclusions were made after adjusting for multiple physician, patient, and hospital characteristics and doing sensitivity analyses so the results are robust.
The authors, led by John Norcini, Ph.D., President Emeritus, Foundation for Advancement of International Medical Education and Research, based their study on AMI and CHF because they occur frequently and are used to measure the quality of care received at many facilities.
Candidates must have graduated from a US medical school or been certified by the Educational Commission for Foreign Medical Graduates (ECFMG), satisfactorily completed accredited training, have an unrestricted license to practice medicine, and, for those in the MOC group, must have performed successfully on the certifying examination. There have been some changes in the MOC program over time, but the program has typically required initial certification, an unrestricted license to practice medicine, some form of ongoing educational experience, and successful performance on an assessment after initial certification.
“Our results show a very large effect size-adding to the evidence that as a group, certified doctors provide better care than those not certified,” says co-author Rebecca Lipner, PhD, Senior Vice President of Assessment and Research for ABIM.
“This study is consistent with numerous previous studies which conclude that the more physicians know about medicine, the better the medical judgement they will pass along to their patients, and that there is a strong connection between medical knowledge and patient outcomes,” adds Furman McDonald, MD, MPH, a co-author and Senior Vice President for Academic and Medical Affairs at ABIM.
“Board certified doctors and doctors who maintain their certification are more likely to provide better care,” says lead author Dr. Norcini. “This would be consistent with doctors staying current in medical knowledge including the most updated evidence-based practices.”
The authors used the “Strengthening the Reporting of Observational Studies in Epidemiology” reporting guidelines and drew data from the records of the Pennsylvania Health Care Cost Containment Council, the American Medical Association Physician Masterfile, the American Board of Internal Medicine and the Educational Commission for Foreign Medical Graduates.
They conducted a retrospective observational study and cannot establish causality, but used a cohort design which is a particularly strong study design for studies of prognosis.
“Associations between initial American Board of Internal Medicine certification and Maintenance of Competence status of attending physicians and in-hospital mortality of patients with acute myocardial infarction or congestive heart failure: a retrospective cohort study of hospitalizations in Pennsylvania, USA,” by John Norcini, Ph.D., Weifeng Weng, Ph.D., John Boulet, Ph.D., Furman S. McDonald, M.D., M.P.H., and Rebecca S. Lipner, Ph.D. was published in BMJ and may be found on the website.
Board Certified Doctors Make a Difference
Internists and subspecialists who earn and maintain board certification from the American Board of Internal Medicine (ABIM) differentiate themselves every day through their specialized knowledge and commitment to continual learning in service of their patients. Established as an independent nonprofit more than 80 years ago, ABIM continues to be driven by doctors who want to achieve higher standards for better care in a rapidly changing world. Visit ABIM's blog to learn more and follow ABIM on Facebook, Twitter and Instagram. ABIM is a member of the American Board of Medical Specialties.
Lisa Finnegan 215.399-3992