Policy on Professional Conduct

PREAMBLE:

Certification by the ABNM represents that a diplomate has demonstrated the professionalism, knowledge, and skills to practice safely in the specialty. Consequently, ABNM certification holds a special status in society as a mark of expertise and trustworthiness and is relied upon by the public and members of the medical community.

 

POLICY:

The demonstration of conduct consistent with professional norms by diplomates is a condition for ABNM certification.

  • Professionalism is a fundamental expectation of competent specialty practice and a pre-requisite for ABNM certification.
  • This Policy applies to all applicants for certification and all diplomates.
  • Diplomates are assumed to satisfy professional standards of conduct unless credible verifiable evidence exists of relevant misconduct. “Relevant misconduct” is any conduct related or unrelated to a diplomate’s practice that represents, in the judgment of the ABNM, the following:
  • A risk to the safety of patients, members of the diplomate’s health care team or the public; or
  • A threat to the trustworthiness of the profession or of the certification.

Licensure:

To be eligible for ABNM Certification or Continuing Certification, a physician must maintain a current, full, and unrestricted license to practice medicine in at least one (1) jurisdiction in the United States, its territories, or Canada. The physician also must have a current, full, and unrestricted license to practice medicine in all jurisdictions where the physician is licensed, and, except as provided in Section 3, must never have had a license that was restricted or limited, revoked or suspended, or voluntarily surrendered or allowed to expire to avoid action(s).

The ABNM will investigate and, if appropriate, take action regarding certification or Continuing Certification in the event it becomes aware that a physician’s medical license in the United States, its territories, or Canada, has become subject to a disciplinary action, probation, conditions or requirements (whether imposed by a licensing authority, or as the result of an agreement and/or stipulation between the physician and a licensing authority) or has been restricted or limited, revoked or suspended, voluntarily surrendered, or allowed to expire to avoid action(s). Actions taken by the ABNM may include disciplinary sanctions, such as: denial of initial certification; suspension of certification (where the physician’s certification is suspended for a specified time or pending further investigation and/or action); probation (where the physician continues to be certified during a specified period with stipulated conditions, such as periodic contacts and meeting the requirements of Continuing Certification); and revocation of certification (where the physician ceases to be certified). The ABNM reserves the right to determine the appropriate action based on the seriousness of the infraction that resulted in a medical licensure board taking an action against a physician’s license. The physician will be notified, in writing, of any action proposed to be taken by the ABNM. Such notification will:

  • advise the physician that the ABNM Credentials Committee (CC) will determine on behalf of ABNM, at least sixty (60) days after the date of the notice, whether to recommend any disciplinary action;
  • summarize the relevant evidence in ABNM’s possession;
  • include copies of any relevant documentary evidence in ABNM’s possession;
  • provide the physician with an opportunity to make a written submission to the CC;
  • disclose the policy(ies) and/or procedure(s) pursuant to which ABNM may recommend an action, and the possible action(s);
  • advise the physician that the failure to respond within sixty (60) days to the notice may be considered unprofessional and weighed against the physician by the CC; and
  • advise the physician that if the CC recommends an action, the physician will have the right to make a written appeal to a panel designated by ABNM’s Board of Directors.

All submissions to ABNM by or on behalf of the physician shall be in writing.

In the event the CC decides that it intends to recommend an action; it shall notify the physician in writing. Such notification will:

  • set forth the factual bases for such determination;
  • summarize the reasons for such determination;
  • advise the physician of his or her right to request an appeal of the CC’s determination;
  • advise the physician that any request for an appeal of the determination must be submitted to ABNM, in writing, within thirty (30) days of the date of the notice of the CC’s determination;
  • provide procedural information about the appeals process; and
  • advise the physician that while a recommended action is not final and does not affect a physician’s Board Certification status, a physician who is subject to a recommended action is not eligible to participate in the Certification process.

If a physician does not submit an appeal of a recommended action within thirty (30) days of the date of the notice, the recommended action determined by the CC shall become the final decision of ABNM. All submissions to ABNM by or on behalf of the physician shall be in writing.

An appeal of a recommended action by the CC shall be determined by an Appeals Panel consisting of three (3) directors of the ABNM who do not serve on the CC. The Appeals Panel shall have the discretion to affirm, rescind, or modify a recommended action, or impose an alternative action. The CC shall provide each member of the Appeals Panel and the physician appellant with copies of the documentary record for the recommended action and appeals proceedings. In its consideration of an appeal of a recommended action, the Appeals Panel shall not be bound by any technical rules of evidence and shall consider any information timely submitted by or on behalf of the physician at any stage of the proceeding along with any information provided by ABNM. After reaching a decision, the Appeals Panel shall notify the physician of its decision in writing. Such a written decision should include the factual basis of the decision and a summary of the reasons for the decision. The decision of the majority of the Appeals Panel shall be the final decision of ABNM.

Exceptions to Policy:

The ABNM may, in its discretion, allow a physician to be certified or continue certification even though the physician’s license to practice medicine in one or more jurisdictions has been restricted or limited, suspended or revoked, voluntarily surrendered, or allowed to expire to avoid action(s), so long as the physician is able to practice at the standard of a certified physician within the restrictions or limitations established by the relevant licensure board and at least one (1) of the following exceptions applies:

  • The physician has an unrestricted license in all jurisdictions where the physician currently practices medicine;
  • The physician has a restricted or limited license and the restriction or limitation has been put in place because of a disability; or
  • The physician does not have an unrestricted license in any jurisdiction in the United States, its territories, or Canada, but there are additional circumstances supporting the goal of physician rehabilitation that justify allowing the physician to be certified or maintain certification.

Institutional Licensure:

The ABNM may, in its discretion, allow a physician to become certified while practicing under an institutional license while the physician is in specialty or subspecialty training provided all the following requirements are met. The physician must:

  • Provide the ABNM with a written statement from the physician’s training program stating the anticipated completion date of the training;
  • Notify the ABNM, in writing, within thirty (30) days of discontinuation or completion of the training, and
  • Provide the ABNM with satisfactory, written proof that the physician 1.) has obtained full and unrestricted licensure within sixty (60) days following the last day of the physician’s full participation in the training program or 2.) is still in an approved training program and is covered by an institutional license of that program.

If any of these requirements are not met within sixty (60) days of the last day of the physician’s full participation in the training program, the physician’s certification will be suspended. Certification will be revoked for failure to obtain a licensure within an additional sixty (60) days.

Foreign Licensure:

The ABNM does not allow a physician practicing medicine exclusively outside the United States, its territories, and Canada, to be certified or maintain certification, without a full and unrestricted license in at least one (1) jurisdiction in the United States, its territories, or Canada.

Breach of professionalism or medical ethics:

In the event the ABNM becomes aware of a breach of professionalism or medical ethics, as defined by the American Medical Association or the American Board of Medical Specialties, it may, in its discretion, take action regarding certification or Continuing Certification, and/or notify a physician’s medical licensing board(s), other American Board of Medical Specialties (ABMS) Member Boards, law enforcement agencies, and local credentialing bodies, of such breach and/or action. Breaches of professionalism and medical ethics include, but are not limited to, the following:

  • cheating on certification or other exams;
  • copying or sharing questions and answers (for example, “recall questions”) from exams;
  • providing false information to current or potential employers, state medical licensing board, medical organizations, the ABNM, or other professional groups;
    research fraud;
  • billing fraud;
  • violation of a patient’s legal rights; and
  • serious or repeated acts of negligence or malpractice causing or likely to cause patient harm and indicating the physician is not practicing at the standard of a certified physician.

The ABNM will inform a physician, in writing, of its intention to act regarding his or her certification, or Continuing Certification, according to the procedure described in Section 1 (b) of this policy.

Professional Norms:

The ABNM will verify that diplomates are meeting professional norms:

  • The ABNM will annually verify that each diplomate is licensed in good standing by at least one (1) licensing jurisdiction in the United States or its territories or Canada. “In good standing” means that the license has not been subject to any actions arising out of relevant misconduct.
  • Any and all additional licenses currently held by a diplomate shall be in good standing.
  • Any and all additional licenses previously held by a diplomate shall have been in good standing at the time of their expiration, provided such information is available to the ABNM.
  • The ABNM will review information about actions by other regulatory, governing and credentialing bodies received or made available to the ABNM.
    • ABMS may provide information to ABNM from state licensing boards, the Centers for Medicare and Medicaid Services, the Drug Enforcement Agency or court filings to support Member Board deliberations.
    • At their sole discretion, Member Boards may choose to obtain information independently, which may include reports from the National Practitioner Data Bank, medical or professional societies, court filings or actions by other governing authorities.
  • In cases where a diplomate holds a certificate from more than one ABMS Member Board, the Member Board that has received credible evidence of potential professional misconduct should promptly advise the other Member Boards about its receipt of such evidence.
  • The ABNM may consider available credible evidence of any crime or conduct involving moral turpitude or unethical behavior for which a diplomate is convicted, enters a plea of guilty or nolo contendere or is found liable by a judge or jury (e.g., violent or sexual crimes, medical malpractice or harassment) as evidence of a lack of professionalism.

Judgement of Misconduct

The ABNM will render an independent judgment about professional misconduct based on the context of each case:

  • Prior to rendering a decision regarding the diplomate’s certification, the ABNM shall examine all available credible evidence to determine whether the alleged conduct breached the professional norms established by the ABNM.
    • The ABNM may consider the context of actions taken by state licensing boards and may choose not to act if they believe that professional norms have not been breached.
    • The ABNM may act based on information from other sources if they believe that the information demonstrates that professional norms have been breached.
  • The diplomate’s underlying conduct may be unrelated to the practice of medicine yet may nevertheless constitute misconduct that creates a safety risk or undermines the trustworthiness of the profession or of the certification.
  • The ABNM may obtain supplemental information and may consider all relevant evidence outside the scope of any state medical board investigation.
  • The ABNM retains full discretion over the determination to revoke or impose a limitation on certification based on a diplomate’s breach of professional norms.
  • A diplomate who has been granted a license with practice limitations may be deemed to follow this Policy unless the diplomate breaches professional norms.
  • A diplomate who is suffering from a mental or substance use disorder may be encouraged to seek care through a physician health program (“PHP”) or similar program providing a safe environment in which to receive treatment and support in recovery. A diplomate who is participating in a PHP may be deemed to follow this, Policy.