Doctors who have long been rankled by the fees they have to pay for certification exams won’t take any comfort from a new analysis that suggests medical specialty boards are profiting by charging those high fees.
Many doctors resent the substantial costs for both board certification and maintenance of certification (MOC), but now a research letter published in JAMA may pour salt into that wound as it finds American Board of Medical Specialties (ABMS) member boards have increased their financial margins by charging doctors those exam fees.
Despite the fact they are nonprofits, the analysis by two doctors found that revenue for most ABMS member boards surpasses their expenses, with a mean annual growth rate of 10.4% between 2003 and 2013, the decade they studied.
"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 FY [fiscal year] 2013," the authors Brian Drolet, M.D., from Vanderbilt University Medical Center in Nashville, Tennessee, and Vickram Tandon, M.D., from the University of Michigan in Ann Arbor, wrote.
However, the ABMS fired back and in a statement, defended the costs of certification and recertification of doctors as “reasonable” and “acceptable.”
Many physicians have objected to certification programs, particularly MOC, citing a lack of clinical relevance and lack of evidence to support their efficacy, as well as high fees, the JAMA authors noted.
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The authors evaluated fees for initial certification and MOC as published on the websites of the 24 member boards in March 2017. To evaluate expenses, they reviewed most recently published tax documents for fiscal year 2013 and tax forms for the past 10 years for each board.
What are doctors paying for those certification exams? In 2017, doctors could have paid as much as an average of $5,600 for initial certification. The mean fee for an initial written exam was $1,846. In addition, 14 boards require an oral exam at a mean cost of $1,649. Nineteen boards offered subspecialty verification (for instance hand surgery within orthopedic or plastic surgery) with a mean cost of $2,060. Mean fees for MOC were $257 annually.
In 2013, member boards reported $263 million in revenue and $239 million in expenses, a difference of $24 million in surplus. Exam fees accounted for 87.7% of revenue and 21.3% of expenditures. Six boards reported no debt, while 18 had assets that substantially exceeded their liabilities, the analysis found.
Overall revenue greatly exceeded expenditures in FY 2013 for most specialty boardshttps://t.co/L4GnnM9vV1
— JAMA (@JAMA_current) August 2, 2017
With more than $860,000 physicians in the U.S. board certified, 2013 member boards’ revenue represents approximately $313 per doctor, the ABMS said. “This is a reasonable amount to support a nationally recognized credentialing program that is both respected and valued by physicians, healthcare providers and institutions, and most importantly, patients and their families,” the board wrote.
It also defended the estimated annual cost of $257 for continuing certification, calling it “an acceptable cost for physicians to demonstrate that they have the current knowledge, judgment and skills to provide the highest level and most up to date care to their patients.”
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In the decade studied, the boards’ net balance, or the difference of assets and liabilities, grew from $237 million to $635 million between 2003 and 2013.
The authors noted that the Internal Revenue Service form 990 they used as the source of their data on the boards did have limits, as it does not provide complete, specific accounting information.