Although medical specialty boards — as nonprofit organizations funded by physicians —have been entrusted to match revenue and expenditures, most boards exhibited revenues that significantly exceeded their expenditures in 2013, according to a research letter that recently appeared in JAMA.
“The process of board certification has a central role in the self-regulation of physician quality standards,” Brian C. Drolet, MD, of the department of plastic surgery, Vanderbilt University and Vickram J. Tandon, MD, of the department of plastic surgery, University of Michigan, wrote. “However, many physicians have objected to programs by the American Board of Medical Specialties, particularly maintenance of certification, citing a lack of clinical relevance and evidence to support efficacy as well as high fees to participants.”
To examine physician fees against medical specialty board finances, Drolet and Tandon gathered fee structures for physicians’ first certification and maintenance of this certification for two dozen American Board of Medical Specialties member boards. The researchers also obtained IRS Form 990 from fiscal year 2003 to 2013, then calculated the change in net balance for each of those years.
Drolet and Tandon stated that average maintenance of certification (MOC) fees were $257 per year. In addition, between 2003 and 2013, the member boards’ net balance — the difference of assets and liabilities — increased from $237 million to $635 million. In fiscal year 2013 alone, member boards indicated $263 million in revenue and $239 million in expenses. Examination fees were responsible for 21% of expenditures and 88% of revenues.
“Board certification should have value as a meaningful educational and quality improvement process. Although some evidence suggests board certification may improve performance and outcomes, the costs to physicians are substantial,” Drolet and Tandon wrote. “More research is needed to assess the cost-benefit balance and to demonstrate value in board certification.”
In a 2015 AMA Journal of Ethics article more than 19,000 physicians signed a petition between March 2014 and March 2015 demanding that the only requirement for AMA’s American Board of Internal Medicine be an exam taken every 10 years. The AMA wanted physicians to finish a MOC activity every 2 years, obtain a specific number of points for MOC activities every 5 years, complete patient voice and patient safety modules every 5 years and passing the MOC exam every 10 years.
In the AMA article, David B. Waisel, MD, also wrote that the AMA responded to the petition by pointing out its $200 to $400 annual fee for MOC provided members self-evaluation products that physicians could use to earn CME credits and provided a likely discount on the initial 10-year exam cost. AMA added that though the MOC requirements take 5 to 20 hours annually to complete in nontest years, members who took them found them “valuable.”
“Both views have validity,” Waisel wrote.– by Janel Miller
Waisel DB. AMA J Ethics. 2015; doi: 10.1001/journalofethics.2015.17.3.spec1-1503.
http://journalofethics.ama-assn.org/2015/03/spec1-1503.html. Accessed July 28, 2017.
Drolet and Tandon report no relevant financial disclosures.