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fter 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.”

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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.”

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  • I was a Navy Doctor for 29 yrs, Int Med for 4 yrs, then GI board certified since 91, became Department Head for a decade, program director for 4. I scored very high on the recertifying exam, then MS hit me hard, developed aseptic necrosis from all the steroids, so I left the Navy, had my shoulder replaced and rehabbed. I worked per diem at two clinics with electronic medical records, Kaiser and Sharp. When 2011 came, I was told I wasn’t eligible because I didn’t meet the meaning use criteria. So I am no longer as Gastroenterogist but I am permanently boarded in Internal Medicine. Could I take and pass the Internal Boards–no, could I pass the GI boards, yes. Do people who graduated 2 years earlier know more, I doubt it. This is a big money making scam by the ABIM
    William Schindler D.O., FACP, FACG

  • Seems like the vast majority of Docs on this site agree: We are being abusively gouged by a few greedy, but well-organized docs to take meaningless tests and MOC.

    The problem is we aren’t doing anything about it!!

    We need a well organized, well funded organization to take on the legal, regulatory, economic and political issues. If the AMA won’t defend us, then screw them. (sorry to all the AMA reps who I offend, my dad foremost)

    With kids at home, and a busy, but time-consuming solo practice, It was a huge effort just to find the “extra” time for my recent board prep. I don’t have the background or resources to start and run an organization like the one we need. I just passed my 2nd recert, and I’d like to forget about it for another decade, and focus on my family and practice. I suspect that’s how most of us feel. It’s hard enough to keep up with all the pressures in our lives. We’re all good students, so its easier to just study for the tests than to spend time and effort on a “repeal” that may never come. I’m as guilty of this as anyone. Dermatology mounted an effort that was stymied when we realized the MOC was inserted into the Obamacare regulation so we cant get paid by Medicare if we don’t play along( this is thanks to some shady dealings by the ABIM…I love my friends who are internists, but your board seems to be the leading edge of our problems)

    I hope there’s some MD/JD type out there who listens to my rant and can help us…We aren’t allowed to unionize and gain the power that federal or labor unions enjoy. We need our own version of the NRA(Hate them or love them, you have to admire their effectiveness at getting legislature to support the focus of their members against well organized regulators) So we’re easy to control by a very few privileged individuals.

    I think most docs in my shoes will at least donate to an organization we form if the goals are stated clearly and it can produce results. This is what the boards fear, yet they count on us being too busy with our noses to the grindstone or too fearful to rise up against them.

    • I was originally ABMS board certified. Unfortunately I was not able to recertify because I was not actively practicing at the 8 to 10 year mark. I transferred doing a fellowship in addiction medicine. Unfortunately despite its board certification, is a sub specialty.
      So each year I have to pay about $1,100 to be a member of the addiction society and to the addiction boards in total. This is very unfortunate because the addiction boards are not being accepted for over 25% of us since we do not have our primary ABMS boards. Commercial insurance will not credential me because they consider me non boarded because my primary boards are not recertified and addiction boards are not accepted. However I pay a fee every year and have to do the MOC.
      What makes it even worse is the addiction Society supports only 8 hours of training for any doctor to prescribe buprenorphine to addicts with no other required training. Thus turning pain pill and heroin addicts into buprenorphine dependent people across the country. What kind of Behavior is that?
      The best part is any primary boarded doctor now takes an 8-hour course is credentialed by insurance companies and can treat these patients despite my fellowship training and knowledge in the field still can’t take the insurance where I can properly treat these patients. So why bother doing the MOC or paying $1,100 a year? 25% of the Addiction Medicine Board!

  • Chicomba is correct. When are the U.S. physicians going to put on their adult trousers and stand up to the Practice/hospital CEO’s, Board Certifications and maintenance fees and the State Medical Boards that charge you excessive rates for license renewals. What about DEA license fees! You should pay them! You are already paying Federal Income taxes… where do they go? You think the attorneys would tolerate this? Are the states, the Feds, the CEO’s or anyone coming to your defense when there are problems with factitious charges or acquisitions, or are you hung out to dry?

  • Total rip off. Day time stealing. 4 years medical training, 3 to 6 residency training, sometimes 1 or 2 years of fellowship. That should be enough. Scrap off Board certification as it has no bearing on outcome. Need only CME. Multiple choice questions and few questions on the oral don’t make one a good physician or surgeon. Greediness and clearly scams. Scrap of the Board certification system. The training is enough. Keep CME courses only.

  • The ABMS and its MOC program are a total rip off. I have paid them for 6 specialty exams over the years, and won’t be paying anymore or participating in the MOC. Physicians are being exploited by this organization and the AMA. The National Board of Physicians and Surgeons is a much less draconian organization and allows certification based on training and annual CME at a fraction of the price and none of the hassle (no closing your clinic doors for the day for exams, and no bullying). We need to throw off organisations that do not serve our profession, but only themselves. They party in lavish hotels, literally, at our expense.

  • After I passed the ABoIM Boards, I got a letter that demanded that I pay the Board $600.00 per year for maintenance fees, or I would lose–not clear what, but it seemed rather threatening. After reading their letter, it dawned on me that they would refuse to keep me on their website if I don’t pay them. Since I have my own private practice, patients come to me for my niche and reputation, not whether the Board has me on their website. It felt like blackmail and bullying, and I didn’t want to be a part of that kind of organization. So, I didn’t pay them. It has not affected my practice at all. I passed the test, and that’s what matters. I don’t care if the Board refuses to keep me on their website, if I don’t pay them. I think they’re unreasonable and greedy, and I won’t agree to that kind of treatment.

  • They want to keep DOCTORS on a leach!
    The old establishment/Academicians wants to stay in control! They grandfather themselves in & then then put demands & push Insurance & Hospitals to require it!
    They can’t let go! It makes them feel important & in control! Shameful!
    If you’re good enough to go through rigorous Medical School, Residency, Fellowship & on going CME, what’s the point? On wonders if DOCS. are stupid, dum, demented, retarded & idiots to to go through this nonsense! Plus everyone is demanding more & more being, Insurance, Managed Care, MED&MED daily!
    Rules & Regulations, plus daily interference in every step of the way!
    Is like ” no longer DOCTOR knows best “!
    EMR, HIPPA, OSHA! On & on & on!!
    One wonders why go through Med. School when NP’s, PA’s, PT’s & others, so called HEALTH CARE PROVIDERS are being treated & paid almost equally!!
    The sad part is that most Health Care Organizations & Organized Medicine have failed miserably! I belong to many & worked on Medical Legislative issues. I remember before meeting our Legislators, we’ve always been told & reminded not to appear be self servants!! OK!!
    So we’re serving the community each & every day with or without pay!!
    Payers not paying for 7-8 months in the name of audit & moving at a snail pace!
    Every body is loading rules in our way!
    I’ve been in practice for 30 years & I’ve seen it & done it all! None of those Organizations is on Top of their game, they keep hicking premiums & they keep spending the money on same old crap! The lousy Journal that no has time to read! The inauguration of the new President gala! On & on & then they ask for contribution for PAC!
    It’s like they froze in time & they are so BRAINWASHED & trained to keep doing the same old stuff, without rocking the boat! By the way, “I’m a NEUROLOGIST”!
    NOW, anyone is wandering as to the causes of ” PHYSICIANS BURNOUT “??
    The ACADEMY OF NEUROLOGY is conducting a study ? ??
    All they need to do is ask the members who are paying their BILLS??
    You don’t need to respond or feel sorry for me! I’m fine ?
    I’m proud to be a PRACTICING PHYSICIAN in the USA ??
    THE BEST MEDICINE IN THE WORLD ?
    But it doesn’t have to be this way!
    Too many cooks burn the food!
    GOD BLESS ALL & GOD BLESS THE USA ?? ??

    • STRONGLY AGREE – Oh wait that’s not the correct answer on my MOC ABIM board 10 y recertification exam – ohhh you mean after 15 years of medical practice – we have learned that you cannot Protocal medicine 100% – and these mutilple choice questions I am currently choking down to earn my credits in order to take this costly board certification – where I will need to close my office hours – in order to prep and take the test -a Test that hardly reflects the real world. Who out there has said ” no ..the guidelines say a 50 yo high risk smoker , obese , concerned about heart disease , does not need any work up – not an ECG ever – at all ”
      This was the correct answer – unbelievable – and of course explained away by saying , in real practice of factors may account for proceeding with a work up , ( disclaimer) ” but since our test was made up for the purpose of funding the organization and not really educating or providing any value at all – it’s the best we could do ” sighh – there was a time when I could take any test whether or not I had any familiarity with the subject – it was required of me to be a test taking expert – to analyze what the test wanted me to answer . I am far removed from this trying to keep my patients alive in a dying health care system where I have to individually for each patient go through layers and layers of paperwork to find which type of insulin is ” covered” each year – ITS INSULIN – are you kidding me ? Let the games begin – our system at be failing – but my medical skills are not and as I continue to separate myself and my practice from any governing bodies so that when it fails I can still provide a modicum of affordable health – ( No not through an ACO either ) God bless us all – we will need it , but I do have faith that good will prevail in medicine . Be damned the talking heads :0

    • Absolutely on target and correct and on target. I retired 5 years ago and it is frightening how the exploitation of physicians has increased. If you physicians don’t fight back you are going to lose it all. This is really serious. Time for the docs to respond seroiusly.!

  • You should do a follow up article on dental boards. In order to get a dental license in the US, dental students have to find their own patients with qualifying lesions (cavities), which can be very difficult since they have to be the perfect size and in the right location. Students not only have to pay several thousands of dollars for the licensure exam (written, simulated and live patient portions), but many have to pay the actual patients to incentivize them to take a day off to get a filling/cleaning (even though the procedure is free); additionally, dental schools have to shut down and prepare the clinics for these tests, a significant and unnecessary financial burden. Then, if the patient doesn’t show, the student is responsible, fails the exam, and has to pay thousands of more dollars to take it again (often having to pay to travel to take it in another state). Or, any number of arbitrary reasons can be used to justify failure on testing technicalities, even if the student was competent in treatment. Not only is it unethical to subject patients to this kind of exam which can be entirely standardized in a simulation lab, but there is substantial financial incentive on behalf of the numerous dental boards to fail a percentage of students in order to recoup even more fees from retests (students almost always pass the second time around).

    When an orthopedic surgeon graduates residency, he/she doesn’t have to perform a hip replacement in front of a review board. But graduating dentists have to demonstrate arbitrary, subjective “competence” even though they’ve been practicing clinical dentistry for 2-3 years at that point. Now, a handful of states permit residency completion in lieu of licensure exams, but other states with more conservative boards will never let that happen without outside influence.

  • I recently took the ABEM ten year recertification exam for emergency medicine. The test was horrendous. The majority of questions were ambiguous, poorly-constructed, of questionable relevance to emergency medicine, or arcane to the point of absurdity. It was abundantly clear that the people writing and choosing these questions had little concern for an accurate assessment of the knowledge base of the persons being tested.

    The industry of “board test prep” is much larger than the revenues from exam fees. My understanding is that those who profit from test prep courses overlap substantially with those who compose and choose the test questions. Several people who took these courses informed me that some of the most irrelevant and abstruse questions on the exam had mysteriously appeared in their prep sessions previously. The stink here is redolent.

    The entire concept of a multiple choice test for a medical board certification is ridiculous. When the patient is being wheeled into the resuscitation room, there is no time to sign up for a prep course. What matters is what you know and how you apply it in that moment. The test I took doesn’t even begin to address assessing that capability.

    • So are there groups or individuals addressing this problem? I would like to get involved but don’t know how.

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