After the grueling slog of medical school, residency, and fellowship, Dr. Brian Drolet was ready to start paying down his debt. Then the hand surgeon faced another $5,660 in board certification fees.
It didn’t seem right, considering what he got in return.
“Let’s say you finished journalism school, went through another five years of training, and had to pay over $5,000 to take tests to be a certified journalist,” said Drolet, an assistant plastic surgery professor at Vanderbilt University Medical Center. “You’d be curious why it was necessary at the end of all that training.”
A new study published Tuesday in the Journal of the American Medical Association raises still more questions about those exam fees. Boards representing medical specialties are nonprofits, yet they’re building up substantial assets.
Members of the American Board of Medical Specialties reported a combined surplus of $24 million in fiscal year 2013, the most recent year studied in the report. What’s more, the boards’ net balance more than tripled between 2003 and 2013.
Most of that money comes from exams, which account for 88 percent of the boards’ revenues. By contrast, administering the exams accounts for only about a fifth of their overall expenses.
Physicians typically get board certified hoping to hone their skills and increase their standing in a specialty. In some cases, medical institutions require it for employment.
The study found that doctors in two dozen specialties spend an average of $5,600 for the exam, which often includes a written test, an oral test, and subspecialty verification. Those who paid the highest member board fees included allergists, dermatologists, otolaryngologists, and radiologists. Emergency doctors and orthopedic surgeons paid the lowest member board fees. It costs between $110 and $610 a year to renew certification.
“Although some evidence suggests board certification may improve performance and outcomes, the costs to physicians are substantial,” the study concluded.
“There are a lot of mandatory hoops to jump through as a physician,” said University of Michigan, Ann Arbor, plastic surgery resident Dr. Vickram Tandon. He and Drolet co-authored the study. Many doctors, he added, feel like the value isn’t commensurate with the cost.
The authors call for further study of the specialty board system. Drolet believes opportunities exist to fold the board certification into residency programs. Tandon, for his part, would ultimately like to see the process lead to better health outcomes for patients.
“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,” said Tandon. “Is it going to improve patient care? If the answer is no, let’s consider that.”