Benefits of Certification

SHERRY SCOVELL, MD MY AVLS PHYSICIAN EDITOR

The need for medical certification has been a concept that has been around since the mid-1700s when the “first Medical Society in the thirteen United States of America” was introduced and vowed to examine “every Candidate for Practice, either Apprentice or any Physician or Surgeon within this Country or Foreigner, coming into this Country.” 1 The more modern advent of board certification began in Boston, Massachusetts at a meeting of the American Medical Association in 1865. Concerns were raised regarding the concept of specialism when it was noted that some physicians were advertising that they possessed special expertise in various areas of medicine without any additional formal training or scientific proof of an extended knowledge base. The topic was debated widely over the course of the next four years, until the AMA formally recognized specialties as “proper and legitimate forms of practice” in 1869. However, they also resolved that it was not acceptable for specialists to publicly advertise themselves as such without a proper title granted from an academic institution after a specified period of study. 1,2 In the early 20th century, there became a call for a thirdparty verification of special clinical skills, which led to the formation of formal medical boards. 1

Since 1933, the American Board of Medical Specialties developed a national system of standards for recognizing physicians for having expertise in a specific specialty and providing that information to the public for their education. This served the dual purpose of demonstrating excellence in a given specialty for the physician, but also allowed the public to become more educated about the skills of the physicians by whom they chose to provide their care. Certification allows the patients to know that their physicians are staying current in their knowledge and skills via continuous learning and assessment throughout their careers.

The field of Venous and Lymphatic Medicine is a relatively new sub-specialty, and until recently, there was not a specific fellowship program in the United States devoted to this field. Historically, training in venous disease has been sparse and not particularly emphasized. Even in current times and across all primary disciplines, training still remains disparate and not well standardized with respect to venous and lymphatic curriculum. The route through which physicians learn about the physiology, pathophysiology, diagnosis, and treatment of these diseases may vary widely depending upon the time and emphasis given to these topics during training.

ABVLM CERTIFICATION 3

In 2007, the American Board of Venous & Lymphatic Medicine (ABVLM) was established with the goal to “improve the standards of medical practitioners and the quality of patient care related to the treatment of venous disorders.” Subsequently, the ABVLM developed and published a Core Content document as well as Program requirements, to serve as the foundation on which to build one-year VLM fellowships. The ABVLM certification was also developed to standardize the depth and breadth of knowledge that is necessary to provide high-level care to patients. This certification communicates an extended base of knowledge in venous and lymphatic disease to other physicians that are looking for a referral base. It also communicates to patients, many of who are informed and educated consumers, that a physician has proven their commitment to and has extensive expertise in the field of venous and lymphatic medicine.

Candidates may apply online to sit for the board examination. All candidates must hold a current medical license and proof of completion of an accredited residency. The requirements vary slightly depending upon whether the physician is recently out of training or more experienced, but all require written references, a clinical case log consisting of superficial and/ or deep venous pathology, documentation of ultrasound training and experience via an ultrasound case log, and 45 CME over the past three-year period (40 related to the field of venous and lymphatic medicine). Once an application has been approved, the examination is scheduled at one of the Pearson VUE Test Centers and is a comprehensive, computerbased examination. When the examination has been passed, the candidate becomes a Diplomate of the American Board of Venous & Lymphatic Medicine, and the certification is valid for a period of ten years, assuming the Diplomate continues to meet MOC and licensing requirements.

There are multiple resources that are available to candidates prior to the examination, which are found on the ABVLM website. A general examination outline delineates the content areas and percentage of questions in each given topic. This outline can be helpful in guiding candidates during preparation. There is a complimentary practice exam online as well as recommendations for live and online review courses, including the AVLS Phlebology Review Course, and a list of key references that are available to assist in preparation. Preparation for the examination will naturally lead to a review of core material and thus be educational.

The benefits of ABVLM certification are many. To other physicians and patients, certification through the American Board of Venous & Lymphatic Medicine demonstrates a commitment to providing the highest level of quality care to patients with venous and lymphatic disorders as well as a documented level of expertise and core knowledge in this specialty. John Landi, MD, a vascular surgeon from Florida and Diplomate of the ABVLM, was among the first to take the certifying examination. He cited credibility and the desire to fully dedicate himself to the treatment of venous and lymphatic disease for his patients as two of the most important reasons for his desire to become a Diplomate. Cynthia Asbjornsen, DO, a family medicine physician from Maine and Diplomate of the ABVLM, agrees and adds that most patients appreciate knowing that their physician is totally committed to the field of venous and lymphatic medicine and that the optimal way to illustrate this is through board certification. Additionally for Diplomates, the required on going continuing educational Online Learning & Assessment platform (OLA) is a powerful, user-friendly tool to keep up to date and identify areas that deserve further study. This program replaces the requirement for an every 10-year recertification exam.

Additionally, Diplomates of the ABVLM have the option of having their practice listed in the ABVLM “Find a Certified Phlebologist” database as well as being highlighted as a Diplomate of the ABVLM on the American Vein & Lymphatic Society “Find a Provider” website. These databases are available to the public for free and may be customized to include a listing of the contact information for each practice as well as a link to the individual physician website for ease of use. Brochures are also available for display in the physician office to educate patients and patient families about the significance of certification. A complete list of benefits of certification in venous and lymphatic medicine is documented in the adjacent flyer.

RPHS CERTIFICATION 4

Similarly, there are certification options available for the other essential members of the venous and lymphatic team. For physicians, physicians assistants, nurse practitioners, and venous vascular ultrasound technologists, there is the Registered Phlebology Sonographer (RPhS) certification by Cardiovascular Credentialing International (CCI), which was developed in 2009. This is a unique credential developed specifically for medical professionals who provide care to patients with venous disease.

The RPhS exam, which is entirely focused on venous disease, is distinctly different from the RVT and RVS certification examinations, in which venous disease consists of less than 25% of the exam content. It is a computerbased examination that tests knowledge in clinical venous disease as well as knowledge of ultrasound. The majority of the examination includes questions that focus on patient diagnosis, performance of diagnostic testing, and minimally invasive and invasive treatment of patients with a smaller percentage of the examination focusing on maintaining information, facility, safety, and conservative treatment/therapy of patients. Diana Neuhardt, RPhS, RVT, FSVU, who serves as the Phlebology Registry Examination Chair for CCI, suggests that Fundamentals of Phlebology: Venous Disease for Physicians is a wonderful resource for exam preparation. She also recommends the RPhS review course offered through the AVLS for a more intensive review.

The RPhS credential is active for 9-12 months after passing the examination. After the first renewal, maintenance of active status requires submission of triennial renewal fees, signature of the Code of Ethics, and completion of 35 Continuing Education Units (CEU, with at least 30 cardiovascular CEUs) every three years.

The RPhS credential signifies dedication and expertise in the field of venous disease. Linda Antonucci, RPhS, RVT, RDCS, highlights the fact that sharing a venous-related credential between sonographers, physicians, physician assistants, and nurse practitioners translates to a higher level of dialogue regarding patient care and a unified sense of accomplishment which makes the team function in a more collaborative manner. She suggests that many venous-based practices often prefer to hire an ultrasonographer who is RPhS credentialed. Paula Heggerick, RPhS, RVT, FSVU also adds that having the RPhS credential demonstrates a dedication to the field of Phlebology and serves to identify medical professionals that are dedicated to the diagnosis and treatment of venous disease. The RPhS credential is also being increasingly recognized by Medicare and third-party payors in some parts of the country and may play in role in reimbursement in the future, predicts Ms. Neuhardt.

CLT-LANA CERTIFICATION 5

CLT-LANA certification originally came out of a desire to create national standards for lymph therapists. The Lymphatic Association of North America (LANA) was founded in 1999. It was created as a result of the 1998 American Cancer Society Lymphedema Workshop recommendation for certification guidelines to assure standardization in lymphedema treatments. As a result, the multidisciplinary Board of Directors identified a need for and created a national certification examination for lymphedema therapists. This certification examination focuses on fundamental knowledge that is required in the management of lymphedema. LANA is currently celebrating its 20th anniversary.

To be eligible to sit for the LANA examination, proof of the successful completion of a qualified instructional course in Complete Decongestive Therapy (CDT) is required. This requirement includes a minimum of 135 classroom hours, one third of which is from theoretic instruction (including anatomy and physiology), and twothirds from laboratory, hands-on-training (such as bandaging, skin care, etc.). There are multiple specialists that may apply for CLT-LANA certification, including occupational therapists, physical therapists, physicians, registered nurses, and certified athletic trainers. In addition, massage therapists who have additional training in soft tissue massage are also eligible. Recertification occurs every 6 years.

Katina Kirby, MS/OTRL, CLT-LANA, Executive Director of LANA, notes that there are numerous benefits to becoming certified, and applicants have doubled this year. She also cites the ability to promote oneself, as an expert in the field of lymphedema is one of the most prominent benefits to CLT-LANA certification. Robyn Bjork, MPT, CWS. CLWT, CLT-LANA, who is the Founder and President of the International Lymphedema & Wound Training Institute, adds that those with the credential have a consistent level of training and knowledge and demonstrate commitment to delivering the best level of care possible for all individuals with lymphedema. Additional benefits include networking with others who have the certification and regional liaisons, which serve as a guide to resources. There is a downloadable brochure on the LANA website to display in your office and to educate patients about CLT-LANA certification and what it exactly means. The therapists may also be listed on the LANA website. Therapists are able to upload their biography and a link to their website, which is a wonderful marketing tool. Additionally, in at least one state, there has been a mandate that lymphedema therapists must be CLT-LANA certified (or CLT-LANA eligible for a period of 3 years) for reimbursement through Medicaid/Medicare. As a bonus, if you are thinking about taking the examination to become CLT-LANA certified, there is special pricing through December 31, 2019 to celebrate the 20th anniversary of LANA!

A special thank you to those who contributed to this article via discussion regarding the significance of certification, including John Landi, MD, Cindy Asbjornsen, DO, Diana Neuhardt, RPhS, RVT, FSVU, Linda Antonucci, RPhS, RVT, RDCS, Paula Heggerick, RPhS, RVT, FSVU, Katina Kirby, MS/OTRL, CLT-LANA, and Robyn Bjork, MPT, CWS, CLWT, CLT-LANA.

REFERENCES 1. BARON RJ. PROFESSIONAL SELF-REGULATION IN A CHANGING WORLD: OLD PROBLEMS NEED NEW APPROACHES. JAMA 2015;313(18):1807-1808. 2. FITZ R. THE RISE OF THE PRACTICE OF INTERNAL MEDICINE AS A SPECIALTY. N ENGL J MED 1950;242(15):569-574. 3. HTTPS://WWW.ABVLM.ORG 4. HTTP://WWW.CCI-ONLINE.ORG/CCI/CERTIFICATIONS/RPHS.ASPX 5. HTTPS://WWW.CLT-LANA.ORG/LANA-CERTIFICATION-EXAMINATION.HTML