Many doctors are not aware that there are actually (at least) three board certifying organizations for physicians in this country. Today we're going to talk about each of them, as well as which employers prefer and how to keep your expensive certification in place. Before we get into that, let's discuss board certification in general.
What Does Board Certified Mean?
“Board-certified” means some sort of external organization has looked at your knowledge, skills, and experience and deemed them adequate for the safe and effective practice of medicine. It demonstrates to patients, peers, and hospital credentialing committees that you are a “good doctor”. Whether it should or not is debatable, but that is certainly the way board certification is used these days. For that reason the answer to “Do I really need board certification?” is almost always going to be yes.
How to Be Board Certified
As you will learn below, there are a number of ways to get board certified. It usually requires some level of education, some level of training, and some degree of experience. There is usually a written and perhaps an oral test you must pass.
Can You Practice Medicine Without Being Board Certified?
In order to practice, a physician simply must be licensed to practice by their state. But in reality, most employers expect you to be board certified eventually. Nearly every hospital requires it.
There are actually at least three boards that certify physicians in the United States. You've probably only heard of one of them, ABMS.
American Board of Medical Specialties (ABMS) Board Certification
The first and most popular is the American Board of Medical Specialties (ABMS). If you are board-certified, it is likely your certification comes from this board. ABMS includes boards such as:
- American Board of Dermatology
- American Board of Obstetrics and Gynecology
- American Board of Orthopaedic Surgery
- American Board of Pediatrics
- American Board of Radiology
- American Board of Internal Medicine
- American Board of Surgery
- American Board of Anesthesiology
- American Board of Family Medicine
- American Board of Emergency Medicine
There are 24 total member boards under the ABMS umbrella, and they certify 40 specialties and 85 subspecialties. ABMS was founded in 1933. As of 2018, approximately 880,000 physicians in the US are board-certified by ABMS.
Other Board Certification Organizations for Physicians
American Osteopathic Association (AOA)
Some osteopathic physicians are board-certified by the American Osteopathic Association (AOA), which certifies in 29 specialties and 77 subspecialties. This board certification began in 1897. Approximately 30,000 physicians in the US are board-certified by AOA.
American Board of Physician Specialties (ABPS)
A lesser-known board certifying organization is the American Board of Physician Specialties (ABPS). It began in 1952 certifying DOs, and then started certifying MDs in 1984. Although I was not able to find the current numbers of doctors certified by ABPS, it was approximately 5,000 in 2010.
A Surgeon’s Perspective on the American Board of Physician Specialties
I had an academic surgeon reach out to me not long ago who was initially very complimentary toward my work asking me to promote ABPS board certification (“Monopolies are bad!”). I told him that was a controversial topic, but I would probably take a guest post on it that was formatted as a Pro/Con post. He seemed unaware of any cons to ABPS certification, so I informed him of the main one I was aware of (discussed later in the post) and even offered to take the Con side myself if he preferred. He subsequently became very upset with me and sent me this email:
“Given the questionable levels of competence of most EM doctors (most likely ABEM certified) that we as orthopedic surgeons continue to face on a routine basis, the ABPS has done you a huge favor by certifying family practice and other primary care fields to enter emergency medicine. Newsflash: It's no wonder why only medical students in the middle to bottom half of their class end up matching in EM! It makes total sense now. Thanks for clarifying things. Your idea of a ‘pro and con' article with nearly every slimy life & disability insurance company in the country advertising on your blog (not to mention you wanting to be the con-guy with having the final incorrect editorial say on your blog) ain't gonna happen bro.”
And actually continued to send me hate mail for months afterward saying things like:
“All of the surgeons (myself included) in our surgery lounge want to thank you for providing us with great laughter and amusement of the articles you keep writing as our online ‘financial guru'. Clearly, you are a disgruntled ER doc who must be certified by the ABEM.”
“Everyone thinks you're crazy and delusional as hell. Don't forget, you're just an ER doc. Trying to come across as someone that's condescending in your articles just makes you look like more of a fool than you already are. And before I forget, do yourself a favor and modify your psych meds that you're taking (if you're not seeing a psychiatrist, please do so). But most importantly, do us ALL a favor and stop writing. That is, unless you want us to continue laughing at you!”
Needless to say, I decided to write the post anyway. And in case anyone is wondering, EM is considered a moderately competitive specialty, more competitive than primary care, anesthesia and radiology, and less competitive than OB/GYN, Ortho, Derm, Plastics, and Neurosurgery, thus making it pretty unlikely that “only medical students in the middle to bottom half of their class end up matching in EM.”
The EM Perspective on The American Board of Physician Specialties
The ABPS website advertises that it offers a “higher standard” for board certification.
It was unclear whether they were comparing to someone without board certification or to someone with ABMS certification, but, if the latter, I found it somewhat ironic. You see, Emergency Medicine (EM) has a bit of a unique relationship with ABPS. EM is a relatively young field. Obviously, when a new medical specialty appears on the scene, none of its practitioners are trained in its residencies. They trained in something else and then specialized through their clinical experience. However, after a few years, the expectation in any medical specialty is that if you want to practice the specialty, you should actually get some training in that specialty. In medicine, we call that training residency (+/- a fellowship), and it lasts for 3-7 years. It's a big deal, and there is little way to replicate its intensive experience in any other way. So it is reasonable that, after some period of time of existence of a specialty, anybody who wants to call themselves a specialist in that specialty should plan to complete a residency in that specialty.
The first EM residency began in Cincinnati in 1970. EM became recognized as a specialty by ABMS in 1979 and got its own board. Board certification at the time had a relatively liberal grandfathering clause, that is, if you were practicing EM (8,000 hours before 1988) you could be grandfathered in to EM board certification simply by passing the test even if you never completed a residency. As the years went by, the percentage of board-certified emergency physicians who never completed an EM residency became smaller and smaller and is now a minuscule portion of practicing emergency doctors, all of whom are in their 60s and 70s. ABPS and its associates have been suing ABMS in an attempt to keep that back door into Emergency Medicine open for the last three decades, arguing that board eligibility should not require residency training.
Indeed, ABPS is still (50 years after the establishment of the first residency program) offering board certification in EM to people who have not completed a residency in EM. Their requirements? Well, you have to do one of the following:
- Complete an EM residency OR
- Complete a FP, IM, Peds, or Surgery residency AND a 12 month EM fellowship OR
- Complete a FP, IM, Peds, or Surgery residency AND work for 7,000 hours over 5 years in an ED.
Imagine you're an orthopedist and your board certification organization allowed someone who completed an FP residency and a one-year fellowship in ortho to call themselves board-certified. Or an OB/GYN who hung out a shingle and practiced obstetrics for 5 years. It's nonsensical. If you want to be board certified, go to residency. Every other specialty is allowed to restrict its specialists to those who did specialized training, why would it be any different for EM? How is that “a higher standard”?
So emergency physicians, at least those who bothered going to residency, haven't been super fond of ABPS for years. It's not just because they charge more, although they do that. It's because they cheapen the value of our residency training on the open market.
How to Maintain Your Expensive Board Certification: MOC Requirements
Over the last decade, a lot of physicians have become very frustrated at the board certification process and especially the newer Maintenance of Certification (MOC) requirements. The expenses in both time and money are not insignificant. In some specialties (perhaps most notably Internal Medicine) the doctors have gathered torches and pitchforks and attempted to storm the castle. Most ABMS boards have taken the criticism to heart at least somewhat and attempted to make the requirements less onerous.
It used to be that you would just become certified once. You would finish your residency and then pass a test and you were board certified for life. After a while, they implemented recertification exams, so you had to take the test again after a decade. That might require a few months of studying in the evenings to make sure you passed. Then, when annual MOC requirements were added on, the time and expenses started to seem ridiculous to a lot of doctors. Some even made movements in their groups and medical staffs to eliminate the requirement for board certification at all. In addition, other doctors started looking at other, less expensive and/or less onerous ways to be able to claim board certification, and thus interest in ABPS board certification grew.
The expenses of maintaining certification are not insignificant. Consider the current costs of acquiring and maintaining board certification with the American Board of Emergency Medicine.
- Application Fee: $420
- Qualifying Exam (written): $960
- Oral Certification Exam: $1,255
- Recertification Exam (every 10 years): $1,400
- Lifelong Learning and Self Assessment Exams (annual): $0 (used to be $105)
So all in, it's $2,635 to get certified initially and then averages $140 a year. Not terrible, but it really adds up when you consider licensing, DEA, and medical staff fees. You can see why doctors might start getting interested in cheaper alternatives. Along comes the ABPS. Fees for a ABPS board certification in Emergency Medicine are:
- Application fee: $500
- Written Exam: $1,100
- Oral Exam: $1,540
- Annual Fee: $895
So all in, it's $3,140 to get certified and then you pay $895 per year. That's right, 19% more to get certified and 539% more to stay certified. To make matters worse, you have to recertify every 8 years instead of every 10 years with ABPS. And this doctor didn't think there were any Cons to ABPS certification and that anyone who thought so just loved monopolies?
Is Board Certification Necessary for Employers?
Board certification is not required for licensure, but employers and hospital medical staffs often want their doctors to already be board certified or at least expecting to become so soon. Thus it becomes a de facto employment requirement. Why take a doctor that isn't board eligible/board certified (BE/BC) when you have so many applying that are?
I know my group would not take a doctor in this day and age who did not train in Emergency Medicine. We probably would not be very impressed with someone who only had an ABPS certification, either. In EM, that tells us that they're either
stupid ignorant (because they're paying 19-539% more for their board certification), and we don't want to work with someone stupid ignorant, or they are trying to get around the residency requirement (and we don't want to hire someone in this day and age who didn't bother going to an EM residency). However, I don't know that my group's experience or even my specialty's experience is universal. So I asked you guys what you thought, and this is how you responded:
And in the WCI Facebook Group:
As you can see, a minority of people don't care which certification you get, but when people do care, they are far more likely to demand or at least prefer ABMS certification.
Recertifying Through the National Board of Physicians and Surgeons
In addition to these three organizations, there is another one that offers board recertification only. It is called the National Board of Physicians and Surgeons (NBPAS). The idea is that you have to be ABMS certified initially, but when it comes time to recertify, these guys will recertify you without making you take another test or do any MOC activities. Again, I'm skeptical that a lot of employers who require board certification will accept this (it turns out only around 60 hospitals do), but I guess it does allow you to say you're “board-certified” in many states, and maybe nobody is looking too closely. Maybe you can talk your hospital into it. It's certainly a lot cheaper, $169-189 initially and $145-165 to renew. If you are a fan of getting ABMS certified after completing residency but think any sort of recertification exam or MOC is dumb, this may be your organization to support.
Which Board Certification Organization Should You Pick? The Choice Is Yours
The doctor emailing me wanted residents to know they have a choice when it comes to board certifying organizations. That is true; you have a choice. Keep in mind that if you're in California, New York, or one of several other states, you can't call yourself “board-certified” if you are only ABPS certified (and that probably applies to NBPAS certification, too). So before you choose to go through the door that apparently fewer than 1% of physicians choose, you'd better check with your future employers, partners, hospitals, and state medical boards to make sure they don't care who certifies you. Might want to double-check the prices, too. Nobody likes to shell out thousands for board certification, but, in at least one field, ABMS is not only more widely recognized, but is significantly cheaper than ABPS certification.
What do you think? Are you ABMS or ABPS board certified? Would you get ABPS certified as a new residency graduate? Why or why not? Should we just throw out the whole board certification idea altogether? Comment below!