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Table 1.  
Examination Fees Among 24 American Board of Medical Specialties Member Boards, as of March 2017
Examination Fees Among 24 American Board of Medical Specialties Member Boards, as of March 2017
Table 2.  
Revenue and Expenditures (in Millions) Among 24 American Board of Medical Specialties Member Boards, Tax Year 2014a
Revenue and Expenditures (in Millions) Among 24 American Board of Medical Specialties Member Boards, Tax Year 2014a
1.
Bauchner  H, Fontanarosa  PB, Thompson  AE.  Professionalism, governance, and self-regulation of medicine.  JAMA. 2015;313(18):1831-1836.PubMedGoogle ScholarCrossref
2.
Nora  LM, Wynia  MK, Granatir  T.  Of the profession, by the profession, and for patients, families, and communities: ABMS board certification and medicine’s professional self-regulation.  JAMA. 2015;313(18):1805-1806.PubMedGoogle ScholarCrossref
3.
Teirstein  PS.  Boarded to death—why maintenance of certification is bad for doctors and patients.  N Engl J Med. 2015;372(2):106-108.PubMedGoogle ScholarCrossref
4.
Gray  BM, Vandergrift  JL, Johnston  MM,  et al.  Association between imposition of a maintenance of certification requirement and ambulatory care-sensitive hospitalizations and health care costs.  JAMA. 2014;312(22):2348-2357.PubMedGoogle ScholarCrossref
5.
Holmboe  ES, Wang  Y, Meehan  TP,  et al.  Association between maintenance of certification examination scores and quality of care for Medicare beneficiaries.  Arch Intern Med. 2008;168(13):1396-1403.PubMedGoogle ScholarCrossref
6.
Brennan  TA, Horwitz  RI, Duffy  FD, Cassel  CK, Goode  LD, Lipner  RS.  The role of physician specialty board certification status in the quality movement.  JAMA. 2004;292(9):1038-1043.PubMedGoogle ScholarCrossref
Research Letter
August 1, 2017

Fees for Certification and Finances of Medical Specialty Boards

Author Affiliations
  • 1Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
  • 2Department of Plastic Surgery, University of Michigan, Ann Arbor
JAMA. 2017;318(5):477-479. doi:10.1001/jama.2017.7464

The process of board certification has a central role in the self-regulation of physician quality standards.1,2 However, many physicians have objected to programs by the American Board of Medical Specialties (ABMS), particularly maintenance of certification (MOC), citing a lack of clinical relevance and evidence to support efficacy as well as high fees to participants. We investigated fees charged to physicians for certification examinations and finances of the ABMS member boards.

Methods

We compiled the fee structures for initial certification and MOC through the published websites of the 24 ABMS member boards as of March 2017. Each board uses a different fee structure for MOC (eg, annual vs triennial), and for comparative purposes MOC fees were annualized by averaging costs (ie, annual dues, examination, and certification fees) over a 10-year period, which is the standard time interval for recertification by the ABMS. We also obtained the most recently published tax documents (tax year [TY] 2014 Internal Revenue Service [IRS] Form 990) and tax forms from 10 years prior (TY 2004) for each board. For TY 2014, we extracted the amount and sources of revenue and expenditures, as well as liabilities and assets for each board. The change in net balance (assets − liabilities) was calculated for TYs 2004 through 2014. All financial information was extracted and reported exactly as it was denoted in the Form 990 documents. Form 990 line items that did not account for greater than 10% of total revenue or expenditures (such as conventions, office expenses, and information technology) were excluded from the analysis, as they did not contribute significantly to the sums.

Results

In 2017, the mean fee for an initial written examination was $1863. In addition, 14 boards required an oral examination for initial certification at a mean cost of $1695. Nineteen boards offered subspecialty verification (eg, hand surgery within orthopedic or plastic surgery) with a mean cost of $2104. Mean fees for MOC were $262 annually (Table 1).

In TY 2014, member boards reported $264 million in revenue and $239 million in expenses; a difference of $25 million in surplus (Table 2). Examination fees accounted for 87.9% of revenue and 21.3% of expenditures, whereas officer and employee compensation and benefits accounted for 42.3% of expenses.

In total, the boards reported $704 million in assets and $62 million in liabilities (difference, $642 million) (Table 2). Six boards reported no debt; and the remaining 18 held reported assets that substantially exceeded liabilities. Between 2004 and 2014, the change in net balance (ie, difference of assets and liabilities) of the ABMS member boards grew from $237 million to $642 million.

Discussion

As nonprofit 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 TY 2014. As a result of such margins, the member boards saw a mean annual growth rate of 10.5% during the decade studied.

This study is limited primarily by the data source. Although IRS Form 990 includes major sources and amounts of revenue, expenses, liabilities, and assets, it does not contain complete and specific financial accounting for the ABMS member boards. Also, board subsidiaries and foundations were not included.

Board certification should have value as a meaningful educational and quality improvement process. Although some evidence suggests board certification may improve performance and outcomes,3-5 the costs to physicians are substantial. More research is needed to assess the cost-benefit balance and to demonstrate value in board certification.

Section Editor: Jody W. Zylke, MD, Deputy Editor.
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Article Information

Accepted for Publication: May 25, 2017.

Correction: This article was corrected for data errors in the text and Tables on November 28, 2017.

Corresponding Author: Brian C. Drolet, MD, Department of Plastic Surgery, Vanderbilt University Medical Center, Medical Center N, D-4219, Nashville, TN 37232 (brian.c.drolet@gmail.com).

Author Contributions: Dr Drolet had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Drolet.

Administrative, technical, or material support: All authors.

Supervision: Drolet.

Conflict of Interest Disclosures: Both authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

References
1.
Bauchner  H, Fontanarosa  PB, Thompson  AE.  Professionalism, governance, and self-regulation of medicine.  JAMA. 2015;313(18):1831-1836.PubMedGoogle ScholarCrossref
2.
Nora  LM, Wynia  MK, Granatir  T.  Of the profession, by the profession, and for patients, families, and communities: ABMS board certification and medicine’s professional self-regulation.  JAMA. 2015;313(18):1805-1806.PubMedGoogle ScholarCrossref
3.
Teirstein  PS.  Boarded to death—why maintenance of certification is bad for doctors and patients.  N Engl J Med. 2015;372(2):106-108.PubMedGoogle ScholarCrossref
4.
Gray  BM, Vandergrift  JL, Johnston  MM,  et al.  Association between imposition of a maintenance of certification requirement and ambulatory care-sensitive hospitalizations and health care costs.  JAMA. 2014;312(22):2348-2357.PubMedGoogle ScholarCrossref
5.
Holmboe  ES, Wang  Y, Meehan  TP,  et al.  Association between maintenance of certification examination scores and quality of care for Medicare beneficiaries.  Arch Intern Med. 2008;168(13):1396-1403.PubMedGoogle ScholarCrossref
6.
Brennan  TA, Horwitz  RI, Duffy  FD, Cassel  CK, Goode  LD, Lipner  RS.  The role of physician specialty board certification status in the quality movement.  JAMA. 2004;292(9):1038-1043.PubMedGoogle ScholarCrossref
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