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Original Investigation
March 18, 2020

Association Between American Board of Surgery Initial Certification and Risk of Receiving Severe Disciplinary Actions Against Medical Licenses

Author Affiliations
  • 1American Board of Surgery, Philadelphia, Pennsylvania
  • 2Federation of State Medical Boards, Euless, Texas
  • 3Inova Medical Group, Falls Church, Virginia
JAMA Surg. Published online March 18, 2020. doi:10.1001/jamasurg.2020.0093
Key Points

Question  What is the association of initial certification by the American Board of Surgery and examination performance with future risk of severe disciplinary actions against medical licenses?

Findings  In this study of 44 290 surgeons, board certification and examination performance were associated with lower rates of severe disciplinary actions against medical licenses.

Meaning  This study provides evidence that supports board certification as a marker of surgeon quality and professionalism.


Importance  Board certification is used as a marker of surgeon quality and professionalism. Although some research has linked certification in surgery to outcomes, more research is needed.

Objective  To measure associations between surgeons obtaining American Board of Surgery (ABS) certification and examination performance with receiving future severe disciplinary actions against their medical licenses.

Design, Setting, and Participants  Retrospective analysis of severe license action rates for surgeons who attempted ABS certification based on certification status and examination performance. Surgeons who attempted to become certified were classified as certified or failing to obtain certification. Additionally, groups were further categorized based on whether the surgeon had to repeat examinations and whether they ultimately passed. The study included surgeons who initially attempted certification between 1976 and 2017 (n = 44 290). Severe license actions from 1976 to 2018 were obtained from the Federation of State Medical Boards, and certification data were obtained from the ABS database. Data were analyzed between 1978 and 2008.

Main Outcomes and Measures  Severe license action rates were analyzed across certified surgeons and those failing to obtain certification, as well as across examination performance groups.

Results  The final dataset included 36 197 men (81.7%) and 8093 women (18.3%). The incidence of severe license actions was significantly greater for surgeons who attempted and failed to obtain certification (incidence rate per 1000 person-years = 2.49; 95% CI, 2.13-2.85) than surgeons who were certified (incidence rate per 1000 person years = 0.77; 95% CI, 0.71-0.83). Adjusting for sex and international medical graduate status, the risk of receiving a severe license action across time was also significantly greater for surgeons who failed to obtain certification. Surgeons who progressed further in the certification examination sequence and had fewer repeated examinations had a lower incidence and less risk over time of receiving severe license actions.

Conclusions and Relevance  Obtaining board certification was associated with a lower rate of receiving severe license actions from a state medical board. Passing examinations in the certification examination process on the first attempt was also associated with lower severe license action rates. This study provides supporting evidence that board certification is 1 marker of surgeon quality and professionalism.

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