To the Editor:
Your editorial on the American Medical Accreditation Program (AMAP) (July 3 issue) 1 was flawed both logically and factually. The American Medical Association (AMA) did not design AMAP as a “surrogate” for board certification. AMAP accreditation and specialty-board certification differ substantially in their requirements. Board certification attests to the physician's completion of prescribed training in a specialized area of medicine and to the successful completion of examinations that primarily test the fund of knowledge in that specialty. AMAP accreditation is based not only on education and training but also on such personal characteristics as ethical behavior, involvement in a biennial self-assessment, willingness to be reviewed by peers, and participation in programs of clinical-data collection and feedback. Furthermore, the AMAP office-site review addresses the practice's safety, facilities, administrative systems, staffing, and medical records with a standardized set of review criteria. A score of at least 70 percent on the site review is one requirement for AMAP accreditation. Field tests have shown this
to be a rigorous standard for even board-certified physicians to meet. And AMA membership is not required for a physician to be accredited by AMAP.
Despite the breadth of AMAP accreditation and its different focus, the program reinforces the considerable importance of board certification as one characteristic of a high-quality physician. Together, certification and recertification by a board recognized by the American Board of Medical Specialties (ABMS) carry more weight than any other factor in qualifying a physician for AMAP accreditation.
You also criticized AMAP governance because “a large plurality of its 17 [voting] members currently have or have had direct ties to the AMA.” You neglected to mention that AMAP governance includes representation from consumers, employers, managed-care organizations, hospitals, and others to ensure the credibility and accountability of the program. Unless a recent change has occurred, the governance of the American Board of Internal Medicine (ABIM) includes only board-certified internists. Those who live in glass governance houses should probably not cast stones.