New Cardiology Board Denied but ‘Not Done With This Fight’

Leaders of a group convened to establish a new, independent board for cardiology are reviewing options after the American Board of Medical Specialties (ABMS) rejected their application to establish the American Board of Cardiovascular Medicine and invoked a 2-year wait time to reapply.

The ABMS rejected the application on February 26, just over a year after five societies — the American College of Cardiology (ACC), the American Heart Association (AHA), the Heart Failure Society of America (HFSA), the Heart Rhythm Society (HRS), and the Society for Cardiovascular Angiography and Interventions (SCAI) — submitted a formal application for a new board of cardiovascular medicine, which would be governed by cardiologists, operating under the ABMS.

Business ‘We Are Deeply Disappointed’

“We are deeply disappointed,” American Board of Cardiovascular Medicine President Jeffrey Kuvin, MD, chair of cardiology at Northwell Health in New York, said in a statement. “The decision ignores the evolution of cardiovascular medicine into its own distinct medical specialty, separate from the field of internal medicine, requiring its own set of knowledge, skills, and competencies to sustain professional excellence and effectively care for cardiovascular patients.”

“We are not done with this fight,” he explained in an interview. “The profession needs to be governed by cardiologists. Clinician competency, in all of our estimation, [should] not [be] based on a timed examination [when] you’ve been practicing for 30 years.”

Some of the reasons for the denial stated in the ABMS letter focused on “the financial feasibility of a new board,” Kuvin pointed out.

Business Financial Feasibility Questioned

“We put forth many analyses pro forma to suggest that if we are awarded an independent board of cardiovascular medicine, we believe wholeheartedly that this would be a financially feasible new board. We knew that this would be a controversial step because it would take the existing certification from the ABIM [American Board of Internal Medicine] and move it to a new board,” he said. The roadblock came when the ABMS said “there was a possibility they would allow a competing board.” In other words, there would be a board from the ABIM and a competing board called the American Board of Cardiovascular Medicine.

They fought that, Kuvin said, because “first, there should be one certifying body. Second, if one has a competing board, that poses a tremendous amount of confusion for the diplomates or physicians, or the hospitals employing the physicians, and the patients.” He explained that the ABMS “has not admitted a new board in over 30 years.”

Although replacing the ABIM as the certifying board was financially feasible, the American Board of Cardiovascular Medicine stated that competing with it would not be. “It would not be feasible for any start-up board to compete with any organization, such as the ABIM, which has deep pockets and could easily lower the cost,” Kuvin said.

“When we were handed the decision, they suggested to us that because we told them that a competitive board would not be feasible for a start-up board, they denied our application. They put us in a position where we couldn’t counter it,” Kuvin said.

The ABMS felt that the board of cardiovascular medicine did not meet some of their standards for ensuring that a cardiologist is continuously certified. “We felt very strongly that we met all of the criteria,” he added.

The board of cardiovascular medicine partners echoed Kuvin’s disappointment. “Our quest for the creation of this new, independent board, in collaboration with the AHA, HFSA, HRS, and SCAI, has been several years in the making and in direct response to repeated calls from members for a new approach to assessment and maintenance of competency,” ACC President Cathleen Biga, MSN, and Vice President Christopher M. Kramer, MD, said in the statement. “We recognize and share in the deep disappointment this decision brings. While it is a setback,” they added, “this important work remains at the heart of ACC’s Strategic Plan.”

Business Precedent for Dissent

Cardiology has been part of the ABIM since 1941. The current effort by the American Board of Cardiovascular Medicine is not the first time physicians have diverged from the ABIM. In 2015, criticism of ABIM requirements drove a group of physicians, led by cardiologist Paul Teirstein, MD, chief of cardiology at the Scripps Clinic in La Jolla, California, to form the National Board of Physicians and Surgeons, which now provides a path to certification for “all of the broadly recognized” specialties, its website states.

At the beginning of the board of cardiovascular medicine application process, Teirstein said that he welcomed the proposal — and the competition in general — as a solution to the ABIM monopoly. The National Board of Physicians and Surgeons mission statement includes its dedication to provide competition and choice in continuing certification. “The fact that the ACC, SCAI, AHA, HRS, and HFS have come together to form a new cardiovascular board indicates just how fed up cardiologists and cardiology leadership is with the ABIM,” he explained.

Although the board of physicians and surgeons offers another choice, “it is not recognized by a majority of payers and/or hospitals,” Kuvin noted. A board formed under the ABMS would already have the acceptance of all payers and hospitals, he pointed out, which is why cardiovascular medicine chose that route.

The ABMS does not comment on the specifics of individual applications, a spokesperson explained, and the Policy on Admission of New Medical Specialty Boards to Membership in ABMS, which is available publicly, governs membership applications.

In its rejection letter, the ABMS stated that “they felt we didn’t have broad enough professional support across the medical field,” Kuvin explained.

“I can’t imagine broader support than having the five leading cardiologist [societies] that represent almost every single cardiologist in this country behind this application process and financially supporting it,” he said.

Kuvin and Teirstein reported no relevant financial relationships.