What Does Double Board-Certified Mean (& Is It Right For You?)

June 24, 2024
In the complex and ever-changing world of healthcare, patients often look for the most qualified physicians to address their medical concerns. One of the indicators of your expertise as a physician is board certification. You can expect most practicing doctors in the U.S. to be board-certified, but what does it mean when a physician is double (or dual) board-certified? 
This post will dive into the concept of dual board certification, its significance, the process of obtaining it, and the benefits of it for both physicians and patients. There’s even an excerpt from my colleague who is a double board-certified practitioner as well, in which she explains why she chose to become dual certified, what she can do as a result, and why it may not be for everyone. Let’s jump in!

What does it mean to be “board-certified?”

A board-certified physician is a medical doctor who has undergone the proper training and assessment to showcase competency and expertise in their specialty. 

After completing medical school and a residency program, the physician must pass comprehensive exams administered by a recognized medical board, such as the American Board of Internal Medicine (ABIM) or the American Board of Surgery (ABS). 

The certification process as a whole ensures the physician meets high standards of knowledge, skill, and clinical competence, and it often involves continuing medical education (CME) to stay current with advancements in their field. Certification serves as a gold standard, signaling to patients and peers the physician is qualified to practice medicine and treat patients in their specialty. 

Of course, becoming board-certified isn’t an easy task. Just take a look at the certification requirements for internal medicine, which dictates physicians must: 

  1. Graduate from an accredited medical school or medical institution.
  2. Complete a residency program in internal medicine that’s recognized by the Accreditation Council for Graduate Medical Education (ACGME) or its equivalent. 
  3. Complete the national exams and obtain an unrestricted medical license to practice medicine. 
  4. Pass the Internal Medicine Certification Examination, an exam administered by the ABIM. This exam is comprehensive, testing knowledge in all areas of internal medicine using multiple-choice questions that cover a broad range of topics such cardiology, gastroenterology, endocrinology, infectious diseases, pulmonary and critical care, nephrology, and hematology/oncology.
  5. Demonstrate adherence to professional and ethical standards, as candidates must exhibit professionalism and a commitment to continuous learning and improvement. This includes providing references and evaluations from residency program directors and peers.
  6. Engage in continuing medical education (CME) and maintenance of certification (MOC), which are ongoing learning and assessment activities. Once certified, physicians must complete CME credits, periodic knowledge assessments, and demonstrate practice improvement activities. The MOC process ensures that certified physicians stay current with evolving medical knowledge and practices.

As you can see, obtaining one certification is a laborious process, so getting two is a real challenge.

Now let’s take a look at double certification, so you can get a sense of whether it might be the right move for you. 

What does it mean to be double board-certified? 

This occurs when a physician becomes certified in two distinct medical specialties. For instance, a physician might be certified in both internal medicine and cardiology, or in pediatrics and pediatric oncology. 

The second board certification usually comes after completing a fellowship in an area of focus chosen by the physician. This is more demanding than single board certification, requiring additional training, education, and examination.

How do you become double board-certified?

The journey to double board certification is extensive and involves several key steps after completing school and obtaining your primary certification. 

In order to receive the second board certification, physicians must first complete medical school, which typically takes four years. This is followed by residency programs in their chosen specialties. For double board certification, this means completing residencies in both fields.

If you’re thinking about becoming double board-certified, keep in mind you may need the following:

1. Fellowship Training 

Depending on the specialties, additional fellowship training may be required. For example, a physician aiming to be certified in both internal medicine and cardiology would complete a residency in internal medicine followed by a fellowship in cardiology.

2. Examinations and Assessments 

After completing the necessary training, physicians must pass rigorous board examinations for each specialty. These exams assess their knowledge, skills, and competence in the respective fields.

Let’s look at an example to see what it takes to become dual board-certified. Some IM physicians who enjoy geriatric medicine, which focuses on promoting health and preventing and treating chronic diseases and disabilities in older adults, will seek additional board certifications. 

To become certified in the subspecialty of geriatric medicine, an already board-certified IM physician must:

  1. At the time of application, be previously certified in internal medicine by the ABIM.
  2. Satisfactorily complete the requisite graduate medical education fellowship training in the field of geriatrics. (The geriatric medicine fellowship training must be accredited by the ACGME.) 
  3. Demonstrate clinical competence and ethical behavior in the clinical setting.
  4. Hold a valid, unrestricted and unchallenged license to practice medicine.;
  5. Pass the Geriatric Medicine Board Certification Examination, which is developed by the ABIM and the American Board of Family Medicine (ABFM). The examination is administered to candidates from both boards at the same time in the same testing centers.
  6. Maintain necessary CMEs and MOCs for both IM and geriatric medicine.

Be aware that, no credit will be granted toward certification in a subspecialty for training completed outside of an accredited U.S. or Canadian program. Additionally, candidates for certification in the subspecialties must meet the ABIM’s requirements for the duration of training, as well as the minimum duration of full-time clinical training. Clinical training requirements vary by speciality but typically include factors such as the total months of training required, inpatient and outpatient cases managed, and requisite procedures performed. 

Candidates are required to provide documentation that demonstrates competency in: (1) patient care and procedural skills, (2) medical knowledge, (3) practice-based learning and improvement, (4) interpersonal and communication skills, (5) professionalism, and (6) systems-based practice. All fellows must receive satisfactory ratings of overall clinical competence. In addition, fellows must receive satisfactory ratings in each of the six ACGME/ABMS competencies and the requisite procedures during the year(s) of required training. 

What are the benefits of being double board-certified?

So, why spend this extra time doing all of this extra work? 

Just as each physician will have their own personal reason for choosing a particular medical speciality, each dual board-certified diplomate may have personal and/or professional reasons behind their choice for dual certification. 

The reason may be as simple as wanting to have an extra specialization because of a particular interest, or perhaps circumstances came together and allowed them to seize the unique opportunity to become dual board-certified. I know of a colleague who was initially fellowship trained in wound care, and then his faculty and academic mentor (also dual board-certified) convinced him to join his pain medicine fellowship program as well. 

Regardless of the motives, dual board certification offers numerous benefits to practicing physicians , including: 

1. A Unique Skill Set 

Dual certification allows physicians to develop a broad and deep understanding of not one but two medical specialties, enhancing their ability to diagnose and treat a wider range of conditions. 

2. Academic and Research Opportunities 

Physicians with dual expertise are well-positioned for academic roles and research opportunities, and can use their advanced training to contribute to further medical knowledge. 

3. Increasing Demand 

In most urban healthcare systems, there is a high demand for physicians with dual specialties, offering better job opportunities and career stability. 

4. Enhanced Reputation 

If a single board certification is a mark of excellence and dedication, then being dual board-certified can further enhance a physician’s professional reputation among peers, patients, and the medical community, helping to bring higher professional recognition and credibility.

5. Increased Earnings 

Physicians with dual board certification often have higher earning potential due to their specialized skills and ability to offer a wider range of services.

6. Diverse Career Paths 

Dual certification provides flexibility to work in different settings and roles, whether in clinical practice, administration, research, or education.

7. Adaptability 

Physicians can adapt to changes in healthcare demands and trends, ensuring long-term career viability.

8. Specialized Expertise and Knowledge 

Physicians with dual board certification often possess a deeper understanding of multiple medical specialties, allowing them to offer specialized care to patients. 

In summary, double board certification is a way for a physician to distinguish themselves, satiate medical curiosity, engage in lifelong learning, increase earnings, and care for patients in a way that others cannot. By doing so, dual-boarded docs can adapt to market changes in the healthcare industry and lead the way in their respective fields.

What’s it like to work as a double board-certified physician?

Case Study: Dr. Wang

I am fortunate enough to work with my colleague Dr. Wang, who is dual boarded. She’s certified by the American Board of Family Medicine (ABFM) and has completed fellowship training in both wound care and geriatric medicine. 

She believes that being dual boarded “expands the kind of patients I’m able to care for, but also helps me focus my care.”

In her family medicine clinic, she not only sees regular family medicine patients from kids to adults, she also is able to specialize her care towards the elderly population, thus practicing full scope. She’s very happy with her work and enjoys caring for entire families. Right now, she’s also working to get a wound care clinic up and running on site as well. 

Her reason for choosing the two fellowships of geriatric medicine and wound care is because she knew she wanted to work in an academic setting. She realized that large institutions recognize extra training, and you can negotiate for more if you market yourself to be more competitive by being dual boarded. She admits, however, that “Although wound care is often not technically ACGME accredited and not “board-certified,” you still receive the fellowship training as well as wound care certification, which holds a lot of weight.” 

(To clarify, ABFM considers geriatrics a certificate of additional qualification (CAQ), whereas ABIM considers geriatrics a secondary certification.) 

Dr. Wang advised on pursuing dual board certification “Depending on which fields you plan to work in. It has to make sense for your personal or professional life, because there is a downside, which is more training and that can be lengthy.” Another disadvantage Dr. Wang mentioned is that you must also “Maintain the status of your certification. If you are dual boarded, then that’s twice the work to stay up to date.”

Case Study: Dr. Smith

Let’s consider another scenario, Dr. Smith, who is certified in both internal medicine and endocrinology. Her dual certification allows her to manage complex cases involving diabetes and thyroid disorders with a holistic approach, addressing both primary and specialized care needs. Patients benefit from her integrated knowledge, leading to more effective treatment plans and likely better health outcomes. 

These examples illustrate how double board-certified physicians bring added value to patient care, using their extensive training to tackle multifaceted health issues.

Finding a double board-certified physician can be crucial for specialized medical care. Resources such as the American Board of Medical Specialties (ABMS) provide directories where patients can verify the certification status of physicians and learn more about the process of being double boarded. 

Who should consider double board-certification?

Applying for dual board certification is a significant undertaking that requires extensive training, dedication, time, and effort. Those who undergo this rigorous task should have a clear understanding of what they’re in for and a vision for their career as a dual board physician. 

Consider becoming double board-certified if you: 

  1. Aim to practice in a niche or highly specialized area of medicine where expertise in two related fields is advantageous. For example, if you’re interested in both internal medicine and cardiology, or general surgery and trauma surgery. 
  2. Aspire to hold leadership positions, such as being a department head or in a certain academic role, where being double board-certified can enhance your credentials and professional standing.
  3. Work in environments where multidisciplinary expertise is valuable, such as complex care settings, teaching hospitals, specialized clinics, or you’re interested in conducting research that spans multiple specialties.

Final Thoughts

Realize that physicians who become double board-certified have undergone rigorous training and assessment, equipping them with the skills to provide exceptional care across multiple specialties. But it’s not for everyone. In fact, it’s not for the majority of physicians, given the substantial time and effort required. 

However, for those with specific career aspirations or a passion for multidisciplinary expertise, getting dual boards can be a highly rewarding path. It offers significant professional advantages, including career opportunities, recognition, and a higher income ceiling. If becoming double board-certified would help you attain your professional goals, it may be the right thing for you. Good luck on your professional journey, whichever path you choose!

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By Mike Ren, MD

Categories: MD/DO ,


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