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Historical Perspective

There are numerous issues with the Maintenance of Certification process: Age discrimination, the cost, the time involved to prepare for and complete the maintenance of certification process and the clinical relevance/irrelevance. One issue that is of great concern among physicians of course is the cost of the Recertification process. With the rising costs of running one's medical practice, diminishing reimbursements from insurance companies and looming health care reform on the horizon further impacting our livelihood, there is controversy regarding the financial impact that the recertification process has on one's practice. Another big issue is the constantly changing requirements that do not allow physicians to adequately prepare for and understand the examination. One might ask, how did we get to this point? Here is some background information.

The American Board of Medical Specialties (ABMS) “assists 24 approved medical specialty boards in the development and use of standards in the ongoing evaluation and certification of physicians” (ABMS website). The ABMS dictates to each of its boards that Maintenance of Certification (MOC) requires six competencies (patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice) and four components (professional standing, Lifelong learning and self-assessment, cognitive expertise, and practice performance assessment). These guidelines are what each specialty board uses to determine its MOC process.

Currently, MOC requirements are supported by major medical organizations, including the American Medical Association (AMA), American Hospital Association (AHA), National Board of Medical Examiners (NBME), Federation of State Medical Boards (FSMB), Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and the Accreditation Council for Graduate Medical Education (ACGME), among others.

However, the FSMB, ABMS, JCAHO, AHA and other parties are starting to coordinate and use MOC in licensing of physicians, inclusion in insurance plans and as requirements for hospital privileges, thereby essentially making MOC mandatory for all practicing physicians who want to maintain on insurance panels and have hospital privileges. At some point MOC may even be tied to state licensure. Thus the argument that many physicians who have been "grandfathered" from having to endure the maintenance of certification process make about not needing to get involved is false. Soon, we will all be involved in MOC unless we ALL do something about it now.

In response to the ABMS guidelines each specialty board has widely disparate requirements to achieve MOC, whose variations include, but are not limited to the costs associated with the examinations, the locations used, the time required to prepare for and complete the certification, the time allowed between periods of recertification, the timeliness of the material which must be mastered, and the percentage of applicants who qualify for certification.

While the MOC process is intended to improve the quality of healthcare by assessing physician competency, improving patient safety, and ensuring compliance with current standards of practice, there is little or no statistically valid data available to demonstrate that MOC achieves these goals.

While all the boards differ, they are given the six competencies and four components from the American Board of Medical Specialties. Here is an example from the American Board of Internal Medicine. We would love to hear about your board, please click on the Comments tab and let us know what is going on with your recertification process.

As of 2009, from the ABIM website:

Exam Fees:

  • Internal Medicine Certification Exam: $1,280
  • Subspecialty Certification Exams: $2,060 (except for Advanced Heart Failure & Transplant Cardiology, Transplant Hepatology, Cardiovascular Disease, Interventional Cardiology, and Clinical Cardiac Electrophysiology)
  • Subspecialty Certification Exam in Cardiovascular Disease: $2,195
  • Subspecialty Certification Exams: $2,650 for Advanced Heart Failure & Transplant Cardiology, Transplant Hepatology, Interventional Cardiology, and Clinical Cardiac Electrophysiology
  • Late Registration fee for 2009 Certification Exams (non-refundable): $400 ABIM will send candidates an invoice for the examination fee.
  • International Test Center Fee: $500

Total Fee to Enroll in Maintrance of Certification:

Enrollment fees:

  • $1,570 for physicians who only have certificate in Internal Medicine
  • $1,720 for physicians who have held or currently hold a subspecialty certification


  • $725 for each additional exam
  • $500 for International Test Center Fee

Add to these costs the time required to complete all the Self Assessment Medical Knowledge Modules, the Practice Improvement Modules as well as the Peer and Patient Evaluations and then multiply this over the course of a 40 year career, and the costs escalate into the tens of thousands. Also to be considered in the cost are the study materials, review courses and missed days of work for the exam itself.

In fact since 2004, with the inclusion of the Maintenance of Certification program requirements, the fees and time involved to complete the process have significantly increased.

Physicians across the country are in agreement: with the rising costs of running a medical practice, diminishing reimbursements from insurance companies and the cost of maintaining a medical practice with its inherent responsibilities, these Board Recertification requirements are discriminatory, expensive, time consuming and simply not necessary.

Also, who benefits directly from these fees? Where do these costs go?