The American Board of Eye Surgery (ABES) and the Council for Refractive Surgery Quality Assurance (CRSQA), for instance, are two organizations making inroads in the certification/accreditation arena.

ABES introduced its first subspecialty certification program in 1986 with the following mission: "To operate an objective, voluntary, peer-based examination, assessment, and certification process for ophthalmic surgeons to assist them in providing the highest quality ophthalmic surgical care to their patients."

While critics say the ABES designation is nothing more than a marketing tool for cataract and refractive surgeons, others point out the organization's rigorous evaluation of applicants as a sign of its legitimacy. Surgeons pay $2,100 for the initial certification, as well as the expenses of the on-site reviewer who documents the surgery. Maintaining certification requires a commitment to 20 hours of Continuing Medical Education annually. Recertification is required every seven years.

CRSQA, too, evaluates the outcomes of refractive surgeons and brands those who pass muster with a catchy acronym - pronounced "Sirska."Patient advocate Glenn Hagele charges $3,250 for initial certification. Surgeons are required to supply outcomes data on 125 consecutive patients from a specified time period, or to be ABES-certified in refractive surgery. Once certified, surgeons are re-evaluated quarterly and recertified annually.

Certification is not CRSQA's primary focus, according to Hagele. "Providing certification is a means to an end for CRSQA."

What's in it for the surgeons besides a discount on advertising? Public credibility, according to Hagele, is an important asset, even for those whose names are well recognized within their field.

Jack T. Holladay, MD, MSEE, another CRSQA surgeon, said people trust the CRSQA designation because lay people are behind it. "Part of the reason why CRSQA is not in the hands of any medical group is so the public has the trust that comes with knowing that people are the watchdog, and that there's no conflict of interest with physicians trying to protect other physicians,"he said.

CRSQA-certified surgeon Barrie D. Soloway, MD, director of vision correction, New York Eye and Ear Infirmary, said, "In one sense, any layperson can go out and set up an organization similar to what Hagele has done. There is no way to prevent an organization from simply being a rubber stamp, 'Good Housekeeping Seal of Approval©'for payment."

Many are skeptical of the value of any of the certification programs in existence today. The essential problem with the surgical credentialing boards is that they have no standards for surgical skill, said Mark Johnson, MD, Venice, Fla. Holladay acknowledged that there would always be debate between surgeons who see ABES and CRSQA-like credentials as nothing more than marketing tools and those who proudly display the seals of approval as evidence of an elevated level of excellence.

"Comparing ABES to CRSQA is unwieldy,"said Jerre M. Freeman, MD, immediate past president of ABES. "ABES was generated decades ago out of a professional desire to elevate the standards and quality of surgical performance. ABES certification is based upon a review of an audited series of consecutive cases and observation of live surgery with outcomes, which are confirmed by a third party."

ABES certification is no more a marketing tool than American Board of Ophthalmology (ABO) or American College of Surgeons (ACS) certification, said Spencer Thorton, MD, FACS. "These designations communicate to other doctors, not just the public, commitment to higher standards and continued, self imposed, education."