ABSTRACT

The professional responsibility for assessing competence is far greater for the certifying system in medicine than in law, where responsibility for specialty certification rests at the state level and there are far fewer lawyers than physicians currently certified as specialists. Recertification, requiring engagement with the world of practice and with health services research, has extended the boards' gaze from the educational to the health care system. The supermarket model suggests that the boards might develop as service agencies, marketing sophisticated measurement techniques. Under this model, specialties and/or subspecialties might be defined by buyers as a mix-and-match collection of multiple competencies. An alternative model is to extend the boards' role, collectively, as an instrument to improve quality in the health care system. Engagement with the health system enlarges the cast of characters involved in physician competence and expands the traditional network on which the boards have long relied, to include employers as well as members of the public.