Factors Leading to Change
While the call for more rigorous certification maintenance requirements for all health professionals dates back 20 years or more, the concept received a major push forward thanks to the 2001 publication of the Institute of Medicine's Crossing the Quality Chasm
, which described shoddy certification practices in the health professions as a major factor in the poor quality of health care in the US. Nearly 10 years after that landmark IOM publication, the call for more rigorous certification maintenance standards movement has advanced to the point in which health care professions that do not adequately require recertification risk being discredited. Consumer advocacy groups are calling for tougher state laws; state regulatory bodies have started to threaten revocation of licensure for those with lifetime certifications; and certification boards who do not require rigorous assessment of continuing competency are being scrutinized and risk obsolescence. We believe that these trends can no longer be ignored, and that they have a potential impact on all CNMs and CMs and the integrity and stature of our profession.
In that context, ACNM supports AMCB's decision to require time-limited certifications for all CNMs and CMs in active clinical practice, in order to preserve public safety; protect CNM/CM's eligibility for State licensure; maximize eligibility for government-program payments for CNM/CM services; safeguard a positive reputation for ACNM, AMCB, and the profession of midwifery; and limit otherwise potentially-extensive liability exposure for AMCB and ACNM.
In recent years, approximately 59% of pre-1996 CNMs have been enrolled in CCA, but fewer than two thirds reported having completed the program requirements. Additionaly, routing audits demonstrated that 20% of participants in CCA could not provide adequate documentation of CEUs. Based on these data, the only statement we can make definitively is that 29% of pre-1996 CNMs were completing the suggested CE requirements.
Since 1996, consumer advocates and policymakers have intensified their scrutiny of CE, competency, and certification. Lifetime certification has become a red flag in the health care quality improvement movement. (For example, read Citizen's Advocacy Center's 2006 publication "Implementing Continuing Competency Requirements for Health Care Practitioners"
) When we compare the continuing competency requirements of CNMs to other health professions it is clear that the midwives of ACNM were trailing rather than leading the pack. At a time when we are presented with unprecedented opportunities to advocate for expansion of the midwifery profession as a key strategy for increasing access to high-quality maternity care and primary care, the continuation of lifetime certification for CNMs poses risks to our profession.
The National Commission for Certifying Agencies which accredits AMCB and is the leading accreditor of certification programs, setting the standards to which these programs are held accountable. The purpose of NCCA accreditation is to provide the public and other stakeholders the means by which to
identify certification programs that serve their competency assurance needs. According to Standard 19 of the current NCCA Standards for the Accreditation of Certification Programs
NCCA-accredited certification programs "must require periodic recertification and establish, publish, apply, and periodically review policies and procedures for recertification."