Changes coming from the ABFM

Submitted by: Becky Wimmer, MDAFP, Executive Director

In January 2019, the ABFM will be launching a pilot program that will assess the value and feasibility of a longitudinal assessment option to the 10-year high-stakes reaccreditation examination.

It’s a beautiful, Saturday afternoon, and 30 of your peers have gathered in a single-window, hotel conference room to complete an American Board of Family Medicine (ABFM) Knowledge Self-Assessment (KSA). 

While some value this exercise, many feel that this process, as well as others required by the ABFM for board certification, is just another hoop to jump through for busy family physicians that adds little to no value when it pertains to meaningful, life-long learning, and improved patient care. The stress felt through the systematic testing of knowledge and professional mastery, in the name of maintenance of certification, is as burnout inducing to some as prior authorizations, electronic health record (EHR) documentation, and other administrative burdens. 

As a chapter executive, I hear the tired frustration in the voices of members who are angry at the ABFM. Chapters have a unique role to advocate for change on your behalf. Through years of relationship building, we are now able to see the beacon of light at the end of the tunnel and it’s coming from a source you might not expect (but probably should) – the ABFM. After diligently collecting and listening to member feedback, accepting the American Academy of Family Physicians’ (AAFP) rigorous report recommending needed improvements for continuing certification, the ABFM is making major improvements. 

Recently, the ABFM hired a new CEO and a new senior vice president who are resetting the tone at the ABFM; their entire leadership team is fixated on enhanced transparency and making their case for value to their 91,000 Diplomates as the number one priority. Programs, both old and new, are getting a refresh with your daily, “In the Trenches” needs in mind. 

Here’s a look at how the ABFM is making meaningful changes that can simplify your life: 

Self-Directed and Organizational Performance Improvement Pathways – Did you know that you can claim performance improvement in practice (PIP) credit for quality improvement (QI) activities that you are already doing in your daily work? It’s called the self-directed performance improvement pathway and it’s a terrific way for physician practices of all types and sizes, even the most non-traditional, to capture credit for meaningful change that’s already occurring in practice. 

According to Elizabeth Baxley, MD, senior vice president for the ABFM, “Back in 2004, when the ABFM first developed performance improvement options for physicians to use, there were few options for practice-aggregated data, and doing quality improvement in clinical practice was not as commonly done as it is today for individuals or teams of physicians. Now, meaningful QI is commonplace. The self-directed pathway allows for activities to be submitted for approval to avoid having the physician to do ‘extra work’ thus reducing burden beyond what is already part of practice and increasing the relevance of the activity to the practice and the family physician.” 

The self-directed pathway does not require a physician to be in a practice that has a consistent patient population or a broad scope of care. In fact, the benefit of this system is that it can be custom tailored to fit any practice type. Dr. Baxley explained further, “A family physician can be a hospitalist, work in a student health center, or maybe provide care in an adult prison facility. Whatever the heart of the matter, the activity just needs to be focused on improving some aspect about the way care is delivered. For example, a family physician working in an urgent care setting could set up a process to improve lab turn-around time, identification and patient callbacks regarding abnormal labs, or reduce unnecessary imaging. None of these processes require continuity over time or assessment of a chronic disease condition.” 

Additional information on the ABFM’s self-directed pathway can be found by logging into your ABFM physician portfolio at, selecting “Access Performance Improvement Activities” from the main screen, and choosing “ABFM Self-Directed Performance Improvement Project: Clinical.” 

Additionally, groups of physicians can claim credit together for practice improvement change by utilizing the Organizational Performance Improvement Pathway. For teams of more than 10 physicians, the ABFM has created a way for customizable, ongoing, QI initiatives that can be tracked and reported to the ABFM at one time. The person reporting the data can be a non-physician team member or practice designee. 

For example, if a family physician led Accountable Care Organization (ACO) is already tracking and reporting improvement to payers or government entities, one-point person in the ACO could be designated to complete and submit a web-based report detailing the participation and outcomes of the project accomplished on behalf of the team. It’s that simple and frankly, it’s about time! Additional information about this pathway can be found on the ABFM website.

Longitudinal Assessment Pilot (Your Alternative to the High Stakes Exam!) Announced at the AAFP Congress of Delegates in October, the ABFM will be testing a pilot program to begin in January 2019 that will assess the value and feasibility of a longitudinal assessment option to the 10-year secure examination. Physicians who are current with continuous certification and are due to take the examination in 2019 would be eligible to participate in the pilot. 

Jerry Kruse, MD, chair of the ABFM board of directors stated, “Based on the popular Continuous Knowledge Self-Assessment (CKSA) platform, the longitudinal assessment pathway will deliver 25 questions online each quarter to those Diplomates who choose this new option. This approach is more aligned with the ongoing changes in medicine and draws upon adult learning principles, combined with modern technology, to promote learning, retention, and transfer of information. Over time, we will be able to assess the core clinical knowledge of board-certified family physicians and recognize the vast majority who work to keep up-to-date to take care of their patients.” 

Physicians in the audience at the Congress of Delegates enthusiastically welcomed the news and echoed the sentiments of the ABFM’s incoming President and CEO Warren Newton, MD, “That longitudinal assessment can meet many of the needs and desires we have heard voiced by family physicians.” Additional details regarding the longitudinal assessment pilot are outlined in a press release found on the ABFM website.

Coming Soon
Earlier this fall, the ABFM convened a small workgroup of chapter executives and AAFP leaders to discuss how they can effectively support physician issues on the state level. I was fortunate to represent Maryland’s family physicians at the table and relayed your desires for more comprehensive, transparent communication; consideration for competency-based testing activities; and additional opportunities for leadership development. In addition, I voiced your concerns about costs associated with maintenance of certification and testing. 

After nearly two-days of intense, but productive, brain storming, the ABFM proposed creation of a chapter-mobilized advisory group of physicians and residents of diverse practice types to provide the ABFM with a wide perspective of family medicine input from across the country. Though the specifics of how this important advisory group would work are still being detailed, the ABFM is clearly signaling its intention to be a working partner with America’s family physicians. 

We are encouraged by the recent development and pledge to continue to represent the needs of our family physician members as we work alongside the ABFM to improve processes and communication. 

This article was written in collaboration with Kate Mahler, CAE of the Ohio Academy of Family Physicians.

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