While the intention behind maintenance of certification (MOC) requirements from member boards of the American Board of Medical Specialties (ABMS) is to ensure that physicians stay current in their specialty in order to provide the best care to their patients, physicians are voicing concerns about the potential value of the certification examinations, as well as the significant cost of the tests themselves.

To assess the economic impact of examination fees on both physicians and ABMS member boards, researchers investigated the fees charged to physicians for certification examinations, as well as the revenue and expenditures reported by the boards.  As described in a research letter published in JAMA, the authors gathered fee structures for initial certification and MOC via published websites of the 24 ABMS member boards. 

MOC fees were compared by averaging the costs over a 10-year period, coinciding with the usual time period required for recertification by the ABMS.  Recent Internal Revenue Services (IRS) tax documents, as well as those from the prior 10 years, were obtained for each board obtained.

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Results show that an average $1846 (95% CI, $1586-$2106) was spent on the initial written examination in 2017; an average $1694 (95% CI, $1528-$1860) was spent for oral examinations required for initial certification by 14 boards. An average $2060 (95% CI, $1787-$2333) was spent on subspecialty verification exams for the 19 boards that offered them, and the average annual MOC fee was $257 (95% CI, $205-$309).

During the 2013 fiscal year (FY), member boards earned approximately $263 million (95% CI, $212 million-$249 million) and spent approximately $239 million (95% CI, $218 million-$258 million). Approximately 87.7% (95% CI, 82.4%-93.0%) of the revenue and 21.3% (95% CI, 17.0%-25.6%) of expenses were attributed to examination fees;  42.2% (95% CI, 36.9%-47.5%) of expenses were attributed to officer and employee compensation and benefits. The boards reported approximately $701 million (95% CI, $644 million-$758 million) in assets and $65.6 million (95% CI, $60 million-$71 million) in liabilities.

The authors of the study found that the overall revenue of ABMS member boards significantly exceeded their expenditures in FY 2013 resulting in an average annual growth rate of 10.4% over the 10 years assessed by this study. As board certification exams pose a significant financial burden to physicians, more research would help to ascertain their contribution to meaningful quality improvement processes and for regulating physician quality standards.


Drolet BC, Tandon VJ. Fees for certification and finances of medical specialty boards. JAMA. 2017;318(5):477-479.

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