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Time-Limited Eligibility FAQs

Why has the American Board of Pediatrics (ABP) adopted a time limit for eligibility policy that requires supervised practice for individuals who have not achieved initial certification within 7 years of completing required training?

The American Board of Medical Specialties has mandated that each Board must have a Board Eligibility Policy and must establish the process for re-entry into the certification process. The ABP has determined that the satisfactory completion of a period of supervised practice in the environment of an accredited training program for a minimum of 6 months that could be spread out over a longer period of time is required. This experience must involve direct patient care, with hands on experience, under the consistent supervision of attending physicians as well as more senior trainees, if appropriate. There must be sufficient exposure time per assessor in order to provide a valid assessment of the individual’s contemporary competence to practice pediatrics unsupervised.

Why did the ABP revise the policy that was adopted in 2009 that required 1 year of additional accredited training to regain eligibility?

The ABP recognized that some individuals had difficulty in meeting the initial policy due to its lack of flexibility. On advice from both general pediatrics and subspecialty program directors, the ABP determined that 6 months in the environment of the accredited program will be adequate to assess current competence. Some program directors may believe that longer than 6 months is necessary to assess competence or may only be able to provide supervised practice experience if the individual takes a resident or fellow position for an entire year. In these cases, a longer period of supervised practice is acceptable to the ABP. In addition, the ABP decided to require that subspecialists embarking on a period of supervised practice must submit a plan for preapproval to ensure that the experience will meet the ABP’s expectations.

What specific experiences must be completed within the period of supervised practice in the accredited training environment to regain eligibility in general pediatrics?

The ABP allows some flexibility when planning the additional supervised practice experiences but requires that the individual engage in direct broad-based patient care. The practice must be supervised, be evaluated by faculty, and include inpatient and outpatient experiences, care of newborn infants and emergency medicine, including recognition and stabilization of critically ill patients. While no specific period of critical care training is required, one must demonstrate the ability to manage a critically ill child. This could be accomplished by experiences in pediatric critical care medicine, neonatal-perinatal medicine, or emergency medicine/urgent care. It is not necessary for the individual to lead or supervise a team. The experiences may address deficiencies but not be narrowly focused and should ensure overall competence in general pediatrics in the context of the broad experiences described above. Refer to the Plan for Supervised Practice and Assessment of Competence in General Pediatrics in the Accredited Training Program for detailed requirements.

What specific experiences must be completed within the period of supervised practice in the accredited environment to regain eligibility in a subspecialty?

The ABP will not delineate specific, detailed experiences for each subspecialty. Core clinical experiences in the subspecialty must be completed as per the usual ACGME requirements. Neither research nor advanced subspecialty training or experiences such as electrophysiology (cardiology) or nutrition (gastroenterology) can meet the requirement. Refer to the Plan for Supervised Practice and Assessment of Competence in a Subspecialty in the Accredited Training Program for detailed requirements.

May the individual remain in his or her usual site of practice in order to meet the requirement?

The plan for supervised practice provides some flexibility for an individual to complete up to 1 month in his/her usual practice, if it is in the same discipline for which eligibility is sought. The other specified requirements must be met within the accredited training program. This option is at the discretion of the program director of the accredited program. The program director must agree to review 10 de-identified case records and 360 degree assessments by at least 2 physicians and 2 nurses in the practice, and 10 patients/families. For subspecialists, this option is available to those whose site of practice is in the community and not at an academic institution with a fellowship program.     

How does an individual regain eligibility to take the certifying examination?

The ABP will not review an individual’s credentials until he/she applies for the certifying examination. An application may be submitted pending the completion of the period of supervised practice if it will be completed by the established deadlines. As part of the credentialing of the application, the ABP will seek assurance from the program director that the individual exhibits contemporary competence to practice unsupervised, based upon evaluations conducted during the period of supervised practice.

Does the individual have to assume the usual residency or fellowship role and take a formal ACGME position?

The individual may take a training position, but this is not a requirement. Such individuals should not be listed on the ACGME roster, participate in ACGME surveys of trainees, or undergo formal milestone reporting to ACGME. Regardless of whether a training position is taken, the ABP will not include certifying examination results of those who complete supervised practice in the accredited program in reports sent to training programs or to ACGME. Those in supervised practice may not take in-training examinations.

Does the ABP have guidance to programs surrounding issues of billing, salary, malpractice insurance, credentialing, etc.?

Those issues are within the purview of the institution and are to be negotiated by the individual and the institutional officials. Some programs may be unwilling or unable to offer supervised practice positions.

Could the individual be appointed as a junior faculty member where there is some independence, yet oversight by the attending faculty?

The ABP does not require an individual to have a specific title; it is acceptable for the individual to have an appointment and salary as a faculty member. However, it is critical that the individual be under the consistent supervision of attending physicians as well as more senior trainees if appropriate. The goal of the 6 months of supervised practice is to provide sufficient exposure time per assessor in order to provide a valid assessment of the individual’s contemporary competence to practice unsupervised.

Can training be completed on a part-time basis?

Supervised practice may be completed on a part-time basis if appropriate supervision and continuity of experience are ensured. The period of time counted toward the supervised practice requirement must be clearly delineated.

For those who are subspecialists who have not achieved certification in general pediatrics, can eligibility be regained in both during a single period of supervised practice in general pediatrics, a subspecialty, or a combination of both?

No. The full requirement for supervised practice for both general pediatrics and the pediatric subspecialty must be completed if one seeks certification in both areas. This will take a minimum of 1 year.

How will the ABP assist individuals to arrange for a supervised practice position in the accredited program?

The ABP cannot assist in this effort.

Does the ABP require prospective review of the planned supervised practice?

Prospective approval for the planned supervised practice for both general pediatrics and subspecialty is required. A program director should send an outline of the experiences to the ABP for prospective review. The plan must also describe the process of assessment and include who will assess the individual and how the assessment will take place.

Has the ABP considered an alternative requirement for those who have been in practice for several years? For example, can CME meet the requirement in lieu of supervised practice? Or may faculty complete a designated, individualized plan in which deficiencies or problems are addressed?

The ABP does not believe that there is any substitute for direct observation of practice in the environment of the accredited training program that provides the usual faculty supervision and evaluation and final verification of competence by the ACGME designated program director.

What happens if competence is not verified at the end of the period of supervised practice?

If the individual seeking to regain eligibility in general pediatrics does not demonstrate contemporary competence at the end of the period of supervised practice, he/she must complete 3 years of ACGME accredited training in general pediatrics. An individual seeking to regain eligibility in a subspecialty must complete 2 years of ACGME accredited training. The requirement for scholarly activity is waived.

What happens if the individual successfully completes the period of supervised practice, but does not become certified within the next 7 years?

If the individual seeking to regain eligibility in general pediatrics is deemed to possess contemporary competence after the period of supervised practice, but does not become certified in the next 7 years, he/she must complete 3 years of ACGME accredited training in general pediatrics. An individual seeking to regain eligibility in a subspecialty must complete 2 years of ACGME accredited training. The requirement for scholarly activity is waived.

July 6, 2012
Revised November 18, 2014
Edited October 14, 2015
Edited May 26, 2016