Martin L. Rohling, Ph.D. Associate Professor University of South Alabama

1. Clinical Neuropsychology Boards: Descriptive Statistics, Comparisons Amongst Other ABPP Boards, and Contrasts to the American Board of Medical Specialties Martin L. Rohling, Ph.D. Associate Professor University of South Alabama

2. Objective Three peer-review credentialing boards exist in Clinical Neuropsychology. This makes it difficult for consumers to discriminate the quality of practitioners who have been credentialed by one of these entities or none at all (Rohling et al., 2003). All three have indicated that they are modeling their certification process after that used by medicine. This research was designed to compare and contrast the two largest of Neuropsychology boards, to one another, to other American Board of Professional Psychology (ABPP) specialties, and the member boards within the American Board of Medical Specialties (ABMS). I compared relative pass rates, percent of practicing clinicians who obtained board certification, and trends across the most recent 15 years. I believe that these data provide an important foundation to examining the Neuropsychology boarding process in light of the processes for health care professionals more generally. Rohling - INS Convention Portland

3. Participants & Methods In order to determine the extent to which the results of the boarding process in Neuropsychology mirror those found in medicine, we obtained longitudinal data from the ABPP, including the American Board of Clinical Neuropsychology (ABCN), the American Board of Professional Neuropsychology (ABPN), and the American Board of Medical Specialties (ABMS). Specifically, we obtained data regarding absolute numbers of applicants who began the respective certification processes and the numbers of applicants successfully completing each stage. Rohling - INS Convention Portland

4. Results For the neuropsychology boards (ABCN & ABPN), results appear similar in terms of overall pass rates. Of the applicants who begin either exam, 50% do not complete the process (see Tables 1 & 2 for details). Approximately 32% of ABCN candidates and 19% of ABPN candidates drop out of the exam process after failing one of the exam stages. Another 15% of ABCN candidates and 31% of ABPN candidates drop out of the process despite having passed the most recent exam stage. Notable in the data obtained from ABCN was that the largest number of applicants deemed eligible for the exam, failed to begin the exam (34%). Of the 66% of applicants remaining, 33% obtain the credential and 33% do not. As a result, ABCN has credentialed just 19% of newly trained psychologists since 1992 who likely have the requisite training & experience to sit for the exam (see Figs. 1 & 2 for details). This has remained relatively stable for 15 yrs. Rohling - INS Convention Portland

5. Similar data, regarding applicants deemed eligible for the exam but who never started the process, were not available from ABPN. Therefore, it was impossible to determine if the same phenomenon has been occurring for this board. Personal communication with board members from ABPN suggests that this is a common occurrence for ABPN as well. Furthermore, across 9 years of data, ABPN has started just 32% as many people in the exam process as has ABCN. Also, ABPN has passed just 32% as many clinicians as has ABCN. This appears to be a constant across this period. Finally, there are nearly 3 times as many total diplomates within ABCN as there are in ABPN. These results are in contrast to that which has been found in medicine, where 90% of physicians are board certified. Furthermore, less than 3% of physicians drop out of the process for any reason. Finally, over the past 15 years, there has been an increase in the percentage of certified physicians, going from 72% to 90% (see Fig. 1 for details). Rohling - INS Convention Portland

6. Table 1: American Board of Clinical Neuropsychology (ABCN) Cumulative data across 11 Years Rohling - INS Convention Portland

7. Table 2: American Board of Professional Neuropsychology (ABPN) Cumulative data across 9 Years Rohling - INS Convention Portland

8. ABCN Annual Total of Diplomas Awarded Per Year: 1990-2006 ABPN Annual Total of Diplomas Awarded Per Year: 1990-2006 Rohling - INS Convention Portland

9. Fig. 2: Percent of NPs Who Are Certified Annually by ABCN Relatively Flat Fig. 1: Number of NPs Who Are Certified Annually by ABCN Increasing Rohling - INS Convention Portland

10. Fig. 3: Annual Percentage of Practitioners Who Are Board Certified by ABMS or ABPP MDs Certified within ABMS Boarded Psychologists Certified by ABPP Rohling - INS Convention Portland

11. Fig. 5: The “BIGGER” PictureEst. of All U.S. Licensed Psychologists Included Fig. 4: What Boards & Academies Have PresentedABPP Totals/Yr: 1990-2006 Rohling - INS Convention Portland

12. Fig. 6: THE “BIGGER” PICTUREEst. of All U.S. Licensed Psychologists Included (1990-2005 growth/prior membership size) Note. Deceased and Retired members excluded. *ABCH was excluded as it did not begin exams until 1992. Rohling - INS Convention Portland

13. What Boards & Academies Have PresentedAACN Membership Growth THE “BIGGER” PICTUREEstimates of Total Number of practicing NPs Included AACN Membership Total Neuropsychologists in Practice Rohling - INS Convention Portland

14. Conclusions Board certification in clinical neuropsychology has been contentious. Much debate has occurred as to which of the boards is "the better board." In fact, any attempt to address this question would require significant time, energy, and cooperation from professionals who currently see themselves as competitors. As a result, we do not foresee empirical evidence ever being available to answer this question with much certainty. In medicine, which has conducted far more research on the certification process, reliability and validity results have been modest at best (Grosch, 2006; Sharp et al., 2002; Sierles et al., 2001). Without reliability and validity data for the two boards, no conclusions can be reached as to which of the two are the “better board.” Besides that, it is not clear what is meant when one uses the word “better.” Rohling - INS Convention Portland

15. An additional concern is the rate at which the percentage of NP practitioners are obtaining board certification. Based on estimates of the annual rate of newly trained NPs and the percentage of those who go on to obtain ABCN certification, it will take at least 51 years to reach the percentage of board certified practitioners that currently exists in medicine (see Fig. 4, 5 & 6 for details). However, this is a conservative estimate, as it is based on the assumption that no one retires nor stops practice once certified. Estimates of attrition are difficult to generate, but surely it will take longer than 51 yrs before NP reaches the 90% estimate of medicine. Finally, even if all of the individuals who were “competently” trained were automatically awarded board certification, it is estimated that it will take 27 yrs before we would reach the same percentage as medicine. However, this estimate is also conservative, as it does not take into account individuals who retire or discontinue their practice. Again, it would likely take longer than 27 yrs to reach the 90% estimate in medicine under this scenario. Rohling - INS Convention Portland

16. Additional Results • One of our original goals in comparing the three boards was to be able to provide comprehensive information about how the applicants into each process could expect to fare, as demonstrated in the following tables. Unfortunately, the data are not available to completely fill out the cells; however, those data that are available point of interesting observations. For example, it is estimated that of those individuals who annually have obtained the requisite training & experience to be eligible to sit for the ABCN exam. • 41% of the average annually trained new clinical neuropsychologists either never apply for the credential or fail to demonstrate that they had the requisite training to sit for the exam. Rohling - INS Convention Portland

17. 20% of the remaining newly trained individuals are admitted to the ABCN examination, but fail to initiate the examination process. • 9% do not complete the process because they failed to enter the next step after successfully completing a stage. • 18% failed to retake the exam stage that they most recently failed. • Of those whose applications were accepted by ABCN, only 33% successfully complete the process. • Of those applicants who remain engaged in the process until they are no longer eligible due to failures, 97% are certified by ABCN and 100% are certified by ABPN. Rohling - INS Convention Portland

18. The final successful completion rates of the two Clinical Neuropsychology boards are far more similar than they are different. • Of those whose applications are accepted into the ABCN process, 64% voluntarily discontinue the process prior to achieving board certification. In contrast, an estimated 3% of physician candidates to the American Board of Psychiatry and Neurology – Neurology (ABPN-neuro) voluntarily discontinue their participation in the certification process. Rohling - INS Convention Portland

19. 1) The most striking difference between the performance of the board certification processes in neuropsychology and that of ABMS is applicant persistence: whereas less than 5% of physicians voluntarily discontinue their participation in their board certification process, nearly 80% of psychologist applicants do so, most of whom have not failed a stage in the process. 2) To its credit, the Neuropsychology community is pursuing the goal of board certification more enthusiastically than any other group in psychology. However, even with this enthusiasm, the problem of applicant persistence has left the percentage of board-certified professionals in Neuropsychology far below that found in medicine, and this appears likely to remain so for the foreseeable future. 3) There appear to be no meaningful differences in the pass rates of ABCN and ABPN. Rohling - INS Convention Portland

20. THE “BIGGER” PICTUREEstimates of Newly Lic. Psychologists Included What Boards & Academies Have PresentedABPP Enrollment Per Year: 1990-2006 Rohling - INS Convention Portland

21. References Grosch, E. N. (2006). Does specialty board certification influence clinical outcomes? Journal of Evaluation of Clinical Practice, 12, 473-481. Rohling, M. L., Lees-Haley, P., Langhinrichsen-Rohling, J., & Williamson, D. J. (2003). A statistical analysis of board certification in neuropsychology. Archives of Clinical Neuropsychology, 18, 331-352. Sharp, L. K., Bashook, P. G., Lipsky, M. S., Horowitz, S. D., Miller, S. H. (2002). Specialty board certification and clinical outcomes: The missing link. Academic Medicine, 77, 534-542. Sierles, F. S., Daghestani, A., Weiner, C. L., deVito, R., Fichtner, C. G., Garfield, D. A. S. (2001). Psychometric properties of ABPN-style oral examinations administered jointly by two psychiatry residency programs. Academic Psychiatry, 25, 214-222. Sweet, J. (2006). The president’s annual state of the academy. The Clinical Neuropsychologist, 21, 1-6. Rohling - INS Convention Portland