Major Finding: Just over 87% of medical school graduates have attained specialty board certification, and factors such as their age, gender, race/ethnicity, debt, and test scores were predictors of certification.
Data Source: A retrospective cohort study of ABMS certification in 42,440 physicians who graduated from U.S. medical schools in 1997-2000 and were followed through 2009.
Disclosures: This study was supported by the National Institute of General Medical Sciences, one of the National Institutes of Health. No financial conflicts of interest were reported.
Age at graduation, gender, race, and test scores were found to predict whether a physician would attain board certification in any of eight specialty categories, according a retrospective analysis.
“ABMS [American Board of Medical Specialties] member board certification is currently among the criteria used by HMOs, hospitals, and health insurance plans in evaluating physicians who wish to obtain privileges or join provider organizations, by medical school promotion committees in evaluating physician faculty members for promotion and tenure, and by the Accreditation Council for Graduate Medical Education as criteria for selection of physicians to serve as GME program directors and residency review committee members,” according to Donna B. Jeffe, Ph.D., and Dr. Dorothy A. Andriole of Washington University, St. Louis.
“Thus, ABMS member board certification is emerging as a de facto requirement for the full participation of physicians in the U.S. health care system, and non–board-certified physicians compose an increasingly marginalized group,” they noted.
To identify factors associated with achieving specialty certification, Dr. Jeffe and Dr. Andriole constructed a database with “deidentified” records for all medical students who graduated 1997-2000 and followed them for at least 8 years; a total of 42,440 graduates were included. These data were linked to testing records from the National Board of Medical Examiners as well as data from the Association of American Medical Colleges and the American Medical Association Physician Masterfile to track specialty certification.
The specialty categories included internal medicine, family medicine, pediatrics, emergency medicine, radiology, surgery (including several surgical subspecialties), ob.gyn., and a composite category comprising allergy/immunology, anesthesiology, dermatology, neurology, genetics, nuclear medicine, ophthalmology, pathology, and psychiatry.
Overall, 87.3% of the sample were board certified, the investigators said (JAMA 2011;306:961-70).
Physicians who were 28 years or older at medical school graduation were less likely to become certified, which is perhaps related to the fact that older graduates also were more likely to have failed an initial attempt at certification.
“Our findings suggest that older graduates may experience greater difficulties, regardless of specialty choice, in timely advancement along the GME continuum toward board certification,” Dr. Jeffe and Dr. Andriole said.
Women physicians were less likely than men to be board certified in three specialty categories, notably in obstetrics/gynecology, which is currently the category with the largest proportion of women physicians (79%).
Members of minority groups were less likely than white physicians to be board certified in every specialty except family medicine, “raising concerns about ongoing efforts by U.S. medical schools to increase the racial/ethnic diversity of the physician workforce,” they noted.
Physicians who had higher scores on Step 1 and Step 2 Clinical Knowledge tests on the U.S. Medical Licensing Examination were more likely than those with lower scores to become board certified. This finding “provides support for program directors' use of first-attempt licensing examination results among criteria for evaluating applicants in a range of specialties,” the researchers said.