BOX 6-4 Certification by the American Board of Medical Genetics

The ABMG was incorporated in 1980 at the request of the American Society of Human Genetics to provide accreditation of training programs and certification of individuals in the United States who provide medical genetics service. Until 1992, certification was available for the following subspecialties: clinical geneticist, Ph.D. medical geneticist, genetic counselor, clinical biochemical geneticist, and clinical cytogeneticist. Four exam cycles have occurred: 1981, 1984, 1987, and 1990. During the 1990 cycle, dual certification as a clinical biochemical/molecular geneticist was available; independent certification as a clinical molecular geneticist has been available since 1993.

Eligibility to sit for ABMG examinations requires application and credential review. Eligibility criteria include, but are not limited to, training in a required set of clinical experiences and verification of training in an ABMG-accredited clinical genetics training program. For the subspecialties of M.D. clinical geneticist, Ph.D. medical geneticist, clinical biochemical geneticist, clinical cytogeneticist, and clinical molecular geneticist, a minimum of two years of postdoctoral training experience through appropriate ABMG-accredited training programs is required. The genetic counselor subspecialty requires at least one year of clinical experience in one or more ABMG-accredited genetic counseling training sites, although the master's-level genetic counseling programs per se are not accredited by ABMG as they are for other subspecialties.

In Canada, an equivalent certifying body to the U.S. ABMG, the Canadian College of Medical Geneticists, also provides certification in clinical genetics, Ph.D. medical genetics, cytogenetics, biochemical genetics, and molecular genetics, but not for genetic counselors.

The status of certification changed in 1992 when the American Board of Medical Specialties (ABMS) agreed to admit the American Board of Medical Genetics to its ranks, the first such admission since 1979. ABMS has never admitted a board that certifies non-doctoral-level individuals and had, to this date, only admitted one other board that certified doctoral-level specialists who were not physicians. In order to gain admission, the ABMG had to agree not to certify master's-level genetic counselors in the 1993 examination.

Acceptance of both M.D.'s and Ph.D.'s in the ABMS was considered a victory by some, as was the admission to ABMS, which had previously not recognized medical genetics as a bona fide medical specialty. This precedent also paves the way for the newly formed American College of Medical Genetics (ACMG) to seek recognition by the American Medical Association (AMA) and to be granted a seat in the AMA House of Delegates, which is essential for the development of additional current procedural terminology (CPT) codes for genetic procedures (used in billing and insurance reimbursement policy)(see Chapter 7). Others are concerned that this medical subspecialization may further isolate medical genetics



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