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“Maintenance of Certification”, the process by which the American Board of Medical Specialties supposedly ensures that physicians keep up with the times in terms of medical knowledge has more drama surrounding it than the cast party for a high school musical. Speaking from experience here:

 Is MOC a form of rigorous self-regulation to be emulated across other professions, or a corporate boondoggle, swindling innocent docs out of their hard-earned?

Full disclosure: I am board-certified in Internal Medicine and Nephrology. Every ten years, I have to spend several thousand dollars to take an exam to maintain that certification. Where does all that money go?

After reading this research letter appearing in the Journal of the American Medical Association, I’m not really sure.

Researchers Brian Drolet and Vickram Tandon did the legwork of pulling the fees associated with maintenance of certification for 24 member boards within the ABMS. Then they did something clever. They pulled the IRS form 990 records for each board - these are non-profit organizations after all – to determine just how much money they are making from all of our fees. One caveat – this is all 2013 data.

Overall, the 24 boards brought in 263 million dollars in 2013, and spent 238 million dollars. Examination fees were the bulk of the revenue at 87% but only 21% of the revenue was spent on administering exams, certifying, and verifying diplomates.

The rest was spent on staff compensation. FYI I looked at the 2015 form 990 for the American Board of Internal Medicine to see that the CEO had compensation totaling $850,000.

Alright, I’m not an accountant. I'll let smarter people than me debate the finances of non-profit entities like this. The important question to me is whether the whole process of specialty certification matters – does it improve patient care?

The data here is actually mixed.

I love this study, appearing in JAMA in 2014.

Basically, the researchers took advantage of the fact that individuals who were certified in internal medicine in 1989 never had to recertify, but those who certified in 1991 were subject to the every 10-year recertification process. This is as close to a randomized trial as we’ll get. The bottom line? Maintenance of certification was not associated with a reduction in hospitalizations – you can see these lines basically overlap.

But 1989 was a long time ago. Medicine moves faster now.

We also have good data to suggest that patients really like this stuff. 79% of patients in a 2003 Gallup poll said re-certification is very important.

The medical specialty boards exist to facilitate public trust. But studies like this which raise questions about their financial situation erode the trust of the doctors they are trying to serve. We need some way to ensure that we, as professionals, are keeping up with the rapid evolution in medical science, but we're going to need greater transparency from the ABMS if they want to continue to be our default mechanism.