If a sizable group of senior psychiatrists were polled about what professional concerns they think cause high anxiety among their younger colleagues, it is a safe bet that they would place obtaining board certification at or near the top of the list. They would be wrong if the results of a recent survey are correct.

In fact, just a slim majority of board-certified early career psychiatrists (ECPs) say that ABPN certification has a significant impact on their careers, and only about 51 percent said being board certified is an important prerequisite to participation on a managed care panel.

But do ECPs who are practicing without being board certified agree with the positions of their board-certified colleagues? In what may be a surprising finding to many psychiatrists, a substantial majority of ECPs who have not obtained board certification say they have discerned no negative impact on their practice, their income, and their ability to obtain work stemming from the lack of this credential.

These findings come from a survey conducted late last year by the APA Assembly’s Committee of Early Career Psychiatrists.

The impetus for the survey came from the American Association of Directors of Psychiatric Residency Training (AADPRT), whose members wanted to see whether—as they suspected based on anecdotal evidence—ECPs wanted APA to work with the ABPN on improving the board-certification process.

They also wanted to see whether complaints they had been hearing about the timing of the board examinations were widespread among ECPs. Residents and ECPs had voiced objections to their training directors about the lag time between completing residency and sitting for the ABPN certification examinations.

At the root of the timing complaints, according to J.T. Thornhill, M.D., is the delay that ECPs face in being able to join managed care provider panels, which in almost all cases require board certification. Thornhill was the Area 5 representative to the Assembly Committee of Early Career Psychiatrists. (That committee merged earlier this year with the APA Committee on Early Career Psychiatrists, which was a component of the Council on Medical Education and Career Development.)

Members of the Assembly ECP Committee developed and sent a one-page survey asking about the perceived value of board certification and the mechanics of the certification process to a random sample of 2,900 APA members who qualified as ECPs. They obtained a response rate of 27 percent. APA’s criteria for ECP status are that the psychiatrist has to have been in practice for less than five years since he or she completed training or be under age 40.

Several of the survey’s questions asked respondents to use a five-point, Likert-like scale to rate their level of concern about issues related to the timing of the ABPN examinations.

The percentage of ECP respondents who thought it was important to be board certified within one year of completing training was about 54 percent, while only 27 percent indicated it was important to be certified with six months of the end of residency. When asked about gaining an option for taking the written portion of the examination within one month of completing residency, about 38 percent indicated it was important, but an equal percentage said that it wasn’t.

These responses seem to indicate that the discontent that the AADPRT members were hearing about the waiting time to take the certification examination were coming from "a vocal minority and overshadowing the majority’s opinion," Thornhill suggested.

A question also delved into the issue of the importance of board certification to ECPs trying to become members of managed care companies’ provider panels. While managed care exclusion may be an often-discussed topic among ECPs, only a slim majority of respondents, 51 percent, considered board certification an important prerequisite to placement on a managed care panel, while another 20 percent chose the "neutral" category. Board-certified ECPs were significantly more likely to view this as an important factor than were their noncertified colleagues.

Many survey respondents also took the opportunity to include narrative comments. Several, the report pointed out, criticized the ABPN’s examination process. Among the comments offered by more than one respondent were that ABPN should choose clinicians and not academic psychiatrists as board examiners, that the ABPN gives examinees inadequate time to make travel plans to take the examination, and that the oral part of the examination is not a good test of candidates’ competency. Others wanted to see the ABPN release demographic data on the examination performance of minority psychiatrists. "Positive comments were rare," the report noted.

The ECP committee’s report, which was submitted to AADPRT and the APA Assembly, concluded that there is not much call at this time for APA "to work more closely with [its] liaisons to the ABPN concerning the timing of board exams. What [the data] would seem to indicate is significant misconceptions among ECPs about the value and process of board certification and that the ABPN could make some advances to become more consumer friendly."