Medical board certification fees are excessive, according to JAMA research letter

A physician who was fed up paying what he thought were exorbitant fees to maintain his specialty certification, decided to see where that money is going, and published his findings in a JAMA research letter.

Study co-author Dr. Brian Drolet, an assistant plastic surgery professor at Vanderbilt University Medical Center who is in the process of testing for board certification, said the several thousand dollars he has had to spend toward becoming board-certified got him asking questions about how the money generated from certification exam fees was being spent, and he doesn't believe it's being spent wisely.

After examining Form 990s filed with the Internal Revenue Service, Drolet 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. "If the charges outstrip the costs, then a relatively simple solution would seem to be to cut the charges," Drolet said.

The analysis of fees for physician certification examinations of 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 are sure to add fuel to 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 of patients.

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.

But critics have complained that the process that many physicians must undertake to get and maintain certification is time-consuming, demanding and expensive.

In particular, 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. "These investments will ensure that ABMS Board Certification continues to be a relevant, valued and important quality indicator for those who hold the credential as well as those who rely upon it for the highest standard of quality care."

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, according to the analysis. Employee compensation and benefits accounted for 42% of expenses, which Drolet said was pretty much in line with other not-for-profit organizations.

It's actually lower than what the AMA itself in fiscal 2013 recorded, which reported compensation and benefits of $133.7 million, or roughly 50% of its expenses of $265 million, according to its 2013 IRS 990, published on GuideStar.

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.

An​ edited​ version​ of​ this​ story​ can​ also​ be​ found​ in​ Modern​ Healthcare's​ Aug.​ 7​ print​ edition.