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Primary Certificate in Vascular Surgery

What is a primary certificate?

Primary certificates (also known as general certificates) are issued by each of the 24 Member Boards of the American Board of Medical Specialties (ABMS) to formally recognize physicians’ qualifications in their chosen specialty fields. Primary certificates may be distinguished from subspecialty certificates, which are also issued by most ABMS member boards. Vascular surgery is currently designated as a subspecialty certificate issued by the American Board of Surgery (ABS). Other ABS subspecialty certificates include pediatric surgery, surgery of the hand, and critical care surgery. Subspecialty certificates may be held only by physicians who hold general certification in the parent specialty. Primary certificates can be held by physicians without the requirement of certification in the parent specialty—in our case, the American Board of Surgery.

What are the advantages of a primary certificate in vascular surgery?

A primary certificate will enhance the appeal of vascular surgery careers and will provide better training to those who choose vascular surgery as a specialty. Specifically, a primary certificate will help bring about the following changes:

• Shorter training period. By reducing the time spent in general surgery rotations,   the primary certificate will result in a shortened vascular surgery training period for junior  residents or medical students who choose vascular surgery early on. This will enhance the  attractiveness of the specialty to young physicians.
• More opportunities to choose vascular surgery. The primary certificate will bring more freedom of career choice to medical students and residents, who would be able to make the vascular surgery choice at various stages of training—during medical school, after several years of initial surgical training, or after completion of full general surgery training.
• Expanded training in vascular surgery-specific areas. The primary certificate will make more time available for training in areas such as nonoperative prevention, diagnosis and management of vascular disease.

What options are being pursued for vascular surgery training?

Current models

• Seven-year track—allows for certification in both general surgery and vascular surgery.
• Fast track (“4 + 2”)—also allows certification in both general surgery and vascular surgery.

Primary certificate models

• Six-year track (“3 + 3”)—vascular surgery certification only, for residents who match in  initial surgical training. This is analogous to the plastic surgery training model.
• Five-year track—vascular surgery integrated track for trainees who match during medical  school.
• APDVS is currently working to define the curricula necessary for both of the new models.

Do other specialties have primary certificates?

Yes, five Boards have multiple primary certificates.

• American Board of Radiology
• American Board of Medical Genetics
• American Board of Pathology
• American Board of Preventive Medicine
• American Board of Psychiatry & Neurology

What is the timeline for the vascular surgery primary certificate approval process?

After successfully moving through the extensive ABMS application process, ABMS approval of the primary certificate is anticipated in March 2005. The timeline for the approval process is shown below.

January 2004. The American Board of Surgery voted unanimously to move forward to create a primary certificate in vascular surgery after considering information about the impact of the primary certificate on other specialties and their training programs, resources of teaching hospitals, and funding implications.

March 2004. The official 12-point application was submitted by the Vascular Surgery Board of the ABS to the American Board of Medical Specialties (ABMS).

September 2004. Initial review of the application by the ABMS Committee on Certification, Subcertification and Maintenance of Certification (COCERT) took place. COCERT serves as a forum for interested parties to comment on the proposed new primary certificate.

March 2005. Final review by COCERT is scheduled in preparation for endorsement and submission to the Assembly of the ABMS for ultimate approval.

Does a primary certificate affect future prospects of creating an independent Vascular Surgery Board?

Both SVS and APDVS support pursuit of both a primary certificate and an independent certifying board (ABVS), reaffirming this support in February 2005.  While some proponents of an independent Board have suggested that a primary certificate could affect prospects for an independent board, legal opinion just obtained by SVS confirms that a primary certificate will not worsen the chances of accomplishing the goal of an independent Board. These concerns are based on a provision in the ABMS bylaws and essentials (last revised in 2000) that two different Boards cannot issue certificates in the same specialty, unless agreed to by the two Boards. However, the legal opinion obtained by SVS was that this provision in the ABMS bylaws applied to all certificates issued by a Board (whether primary or secondary). Thus, if the ABMS were to approve the application by the ABVS for independent board status, the ABS would also have to give up its current secondary vascular certificate or the two Boards would have to agree to each issue certificates in vascular surgery, as currently occurs for critical care, toxicology and a few other specialties. This has been confirmed again this week through an opinion from the SVS legal counsel and by discussions with the current president of the ABMS.

Vascular surgeons should keep in mind that securing ABMS approval for a new Board can be a lengthy and complex process. With the support of SVS and APDVS, the American Board of Vascular Surgery (ABVS) applied for independent Board status in May 2002. That application was denied. The ABVS is appealing the denial. The most recent Member Board approved by the ABMS was the American Board of Medical Genetics, in 1991.