Board Certification: A Dose of Competition


In 2014, internists went into open revolt in response to the American Board of Internal Medicine’s (ABIM) new maintenance of certification (MOC) program (a model of measuring continuous learning). The ABIM required physicians to undergo an assessment every two years and a “high stakes” re-certification exam every ten. Internists balked, questioning this new and costly requirement.

Subsequently, internists and other physicians began to question the long-held dogma that board certification promotes higher-quality, safer care, and they began to examine the private monopoly of the American Board of Medical Specialties (ABMS). Three years later, significant effort and research has revealed the imbalance between certification requirements that impose costly entry barriers for physicians and the limited quality benefits and information for consumers that result.

A two-sided market, board certification provides independent attestations of specialized training to both physicians and consumers of physician services. Hospitals frequently require board certification for granting specialty-specific privileges, thus forcing physicians to purchase not only certification, but also MOC and re-certification from a near-monopoly market as a means of access to continued employment. Patients face increased costs and limited offsetting benefits typical of monopoly markets—recent health care services research has demonstrated no incremental quality gains from MOC and re-certification.


Read the full article at Health Affairs.

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