Certification Status of Family Physicians in the Initial Cohort Entering Maintenance of Certification

• Certification
• Health Policy

When the American Board of Medical Specialties approved and mandated the adoption of Maintenance of Certification (MOC) for all its 24 member boards in 2000, resistance by board-certified physicians to engage in the process suggested that the potential of MOC to improve the quality of care might not be realized.^1,2 However, after the American Board of Family Medicine (ABFM) introduced MOC for family physicians (MC-FP) in 2003, participation by family physicians was robust, and by 2010 the ABFM became the first American Board of Medical Specialties member board to have transitioned all its more than 80,000 diplomates into the process.^3⇓–5 In this brief we report on the initial group of family physicians who entered and have now completed their first cycle of MC-FP.

Of the 11,260 diplomates in the first 10-year MC-FP cycle, 8,589 successfully completed the first 2 stages of MC-FP and earned 3-year extensions of their certificates; of the remaining 2,671 diplomates, 1,335 successfully completed requirements to sit for the MC-FP examination on the 7-year pathway, but only 1,148 maintained certification by passing.⁴ By the end of 2013, 7474 of the diplomates on the 10-year pathway passed the examination. Therefore, 8,622 of the 11,260 diplomates (76.6%) who entered MC-FP in 2003 maintained their certification, consistent with historical rates before MC-FP (see Figure 1).

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Figure 1.

Participation in MC-FP by the 2003 cohort.

Of the 2638 diplomates who did not maintain certification, 1662 did not complete their MC-FP requirements, 729 met requirements to sit for the examination but failed, 159 indicated that they were retired, and 88 were deceased. Of note, 575 have applied for the 2014 MC-FP examination in an effort to regain certification. The average age of those not maintaining certification was 59.1 years, and 1306 diplomates were older than the age of 60.

After completion of the first full cycle of MC-FP, it seems that family physicians remain invested in this new paradigm at levels consistent with historical recertification rates. Specifically, for any given examination cohort, 75% to 80% of those successfully passing the examination will be maintaining their certification before their certificates expire. It seems that the majority of those not maintaining their certification have approached or are approaching retirement age, although an exploration of retirement and other factors leading to the decision not to participate in MC-FP merits further investigation.

• Received for publication March 21, 2014.
• Revision received July 9, 2014.
• Accepted for publication July 11, 2014.