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.

Modern Healthcare - - NEWS - By Steven Ross John­son

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.

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