Physicians must pay substantial costs to meet maintenance of certification (MOC), and the organizations overseeing the process appear to be profiting from those payments, according to a study published Tuesday in JAMA.
According to Medscape, "Board certification is thought to play an important part in maintaining quality standards." But many physicians have opposed American Board of Medical Specialties (ABMS) programs—particularly MOC—citing a lack of support evidence and clinical relevance, as well as the programs' high fees.
For the study, researchers looked at fees for initial certification and MOC on websites for 24 ABMS member boards in March 2017. The researchers calculated the average costs charged, such as annual dues, examination fees, and certification fees for 2003 through 2013.
The researchers then calculated the expenses of the boards based on the most recently published tax documents for fiscal year 2013 and tax forms for the prior 10 years.
The costs to maintain certification, the researchers found, are substantial. The mean cost of an initial written exam in 2017 was $1,846. For the 14 boards that required doctors to complete an oral examination, the mean cost was $1,694 for initial certification. Nineteen boards had subspecialty exams, at a mean fee of $2,060. Overall, MOC cost an average of $257 annually.
All of those fees add up—and they appear to exceed the expenses of providing MOC-related services. In 2013, boards brought in $263 million in revenue and $239 million in expenses, leaving a surplus of $24 million.
The authors wrote, "As [not-for-profit] organizations funded primarily by physician members, the ABMS member boards have a fiduciary responsibility to match revenue and expenditures. However, this is not the case for most boards, with overall revenue greatly exceeding expenditures in FY 2013."
The authors concluded, "Although some evidence suggests board certification may improve performance and outcomes, the costs to physicians are substantial. More research is needed to assess the cost-benefit balance and to demonstrate value in board certification."
Vickram Tandon, a plastic surgery resident at the University of Michigan and study co-author, said, "There are a lot of mandatory hoops to jump through as a physician." He added, "I would like individual physicians to have not just their voice heard but a sense of autonomy in a field that pushes you through gates—to stop and question why we're doing things" (Hackenthal, Medscape, 8/1; Blau, STAT News, 8/1; Healio, 8/1).
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