Study raises questions about true cost of board certification for docs
Though board certification is not a requirement to practice medicine, certification allows physicians to improve and demonstrate their expertise in their particular specialty.
Physicians have long complained about the hassle and cost of board certification. A new study in JAMA is sure to add fuel to that fire.
Drs. Brian Drolet and Vickram Tandon examined Form 990s filed with the Internal Revenue Service and found that fees collected by specialty boards for certification examinations made up 88% of board revenue in 2013, yet the cost of administering those tests accounted for only 21% of board expenditures.
The analysis of fees for physician certification examinations in the 24 specialties represented by the American Board of Medical Specialties member boards also found they had a total combined surplus of $24 million in fiscal 2013. The findings were published last week in a JAMA research letter.
“If the charges outstrip the costs, then a relatively simple solution would seem to be to cut the charges,” said Drolet, an assistant plastic surgery professor at Vanderbilt University Medical Center who is in the process of testing for board certification. Tandon serves in the department of plastic surgery at the University of Michigan.
The findings are sure to stir up what has already been a contentious topic among some physicians, who have questioned the role of the board-certification system in improving physician quality, and in turn, healthcare outcomes.
Though board certification is not a requirement to practice medicine, certification allows physicians to improve and demonstrate their expertise in their particular specialty. Hospitals seek out board-certified physicians, and many require a physician to have board certification prior to receiving practicing privileges. More than 860,000 physicians in the U.S. are certified by one or more of the member boards of the American Board of Medical Specialties, or ABMS.
The American Medical Association, parent to the publisher of JAMA, and other physician organizations have said the ABMS’ maintenance- of- certification program, or MOC, which replaced periodic physician testing every 10 years with a continuous training process, lacks value.
The ABMS defended the size of the fees as a “reasonable amount to support a nationally recognized credentialing program that is both respected and valued by physicians.”
“ABMS Member Boards are continually reinvesting in program improvements and enhancements to transform their certification and continuing certification programming, including the development of quality improvement and longitudinal assessment programs,” according to a statement.
The study found that from 2003 to 2013, ABMS member boards’ combined net assets rose 167%, from $237 million to $635 million, resulting in an average annual growth rate of 10.4% during the decade studied. Member boards reported $263 million in revenue and $239 million in expenses in fiscal 2013.
The analysis also found the average fee for an initial written examination was $1,846 in 2017. Only one specialty, emergency medicine, had an examination fee under $1,000. In addition, 14 boards required an oral examination for initial certification at an average cost of $1,694. Nineteen boards offered subspecialty verification at an average cost of $2,060. MOC fees averaged $257 a year.