Board certification is ultimately a necessity when practicing within certain specialties, and can ensure that your employment potential is secure for the course of your career. Board certification is important to make sure there is no issue with eligibility to receive coverage of specialty services, you may not be able to participate in some payor programs without it (e.g., a health system’s IPA for a specialty service at higher negotiated rates), it may impact the type of staff privileges you are granted by a hospital or surgical center (or whether you are granted them at all), and it could affect coverage by malpractice carriers for the specialty service. Board certification is not needed to actually practice in a specialty, contrary to popular belief, but proof of training and competency has a direct impact on malpractice cases.
The good news is that you merely need to be eligible to take a Board, rather than actually certified in order to start a job, get staff privileges or maintain certain payer participation or insurance coverage. Note that most contracts, including employment agreements, include a warranty that you are already Board certified, so make sure to clear that up and indicate that you are merely eligible if that is still the case. Some employers will require you to become Board certified within a certain period of time. Typically, this time period is two (2) years, but some contracts indicate one (1) year. Be sure to ask to extend it to 2 years if that is the case, to be safe. You might also want to make sure that you can take time off to study before the Boards and after starting, which should be coordinated with their human resources at the outset, particularly if time off is based on accrual over time rather than having the right to take extended time off at the outset from starting. Some employers will incentivize passing by increasing your base compensation only after you do so. The agreement may also allow them to terminate you immediately without notice if you do not meet the certification deadline.
So what happens if you fail every time you take the Boards and you have used up all of your tries? You may actually be required to report back to specialty training with a hospital, including for a number of years. This could be limited to a one (1) year period if the right program is willing to sponsor you. Do you have trouble taking tests generally? Look into whether you have an underlying learning disability that can qualify you for special concessions before taking the Boards. This will require formal application for “disability” through proper channels, and must be accompanied by a proper report from a healthcare professional, among other application materials. Proper diagnosis can qualify you for extra time and other concessions when you take the Boards. If you have not done this already and failed all of the allotted tries, then you may be allowed an extra try on the Boards if you subsequently apply through the same channels.
