Full disclosure. I have 4 board certifications and dutifully do all of the required reading, continuing medical education (CME) and recertification exams to maintain my status (I am board certified in OB/GYN in both the US and Canada as well as board certified in pain medicine by both the American Board of Pain Medicine, ABPM, and the American Board of Physical Medicine and Rehabilitation).

I would never go to a non board certified physician. Ever. When I hear about OB/GYNs doing plastic surgery, I cringe. I want the doctor who not only did a residency or fellowship in the kind of care I need, but also had to pass some kind of standard testing, not the rogue one who, you know, “knows better.”

Now many doctors have been practicing since before some of the specialities even existed. I am one of those dinosaurs. When I found myself practicing more pain medicine than OB/GYN I decided I needed to legitimize myself somehow. There was no fellowship to do, so I contacted the pain medicine boards and filled out a lot of paperwork to prove I’d been practicing as a pain medicine doctor, did A LOT of continuing education, and then proved my knowledge by passing their exams. I learned A LOT studying for those exams (and doing the CME). I also learned A LOT when I recently did my ABPM recertification exam. And when I do the annual recertification for OB/GYN I learn A LOT. I believe learning things helps to make me a better doctor.

Maintaining certification (or MOC), which is doing a minimum amount of continuing medical education and exams, is required for pretty much every medical specialty (someone correct me if I’m wrong). Studies tell us that MOC tends to improve knowledge of clinical guidelines, because the practice of medicine changes over time. A LOT. There are medications and imaging techniques today that did not exist when I finished residency in 1995.

But the American Medical Association doesn’t think doctors without board certification or those who haven’t maintained their certification over time with the required reading/course work/exams should be prevented from practicing medicine. In fact they are working to find ways to keep the 22% of allopathic and 60% of osteopathic doctors who are not board certified in practice.

I disagree.

Let me tell you, the OB/GYN board exams in the US are a joke. The exam in Canada that I took to complete my residency (because you can’t call yourself an OB/GYN in Canada or actually finish your residency until you pass the exam) was infinitely harder than what I had to do to be a board certified OB/GYN in the US. After both the written and then the oral 2 years later I was left thinking, that’s it????

Keep in mind that board certifications are not a super high benchmark, to quote my recent congratulations letter from the ABPM, they are the “minimal requirements.”

So, I’m sorry. If you have completed your residency and you can’t pass the exam, meaning you can’t meet the minimal requirements, there’s a problem. And if the claim is exam anxiety, I submit managing a shoulder dystocia or heart attack or gunshot wound to the chest is WAY more stressful than any exam. There are also ways to manage acute situational anxiety. Biofeedback or a beta blocker come to mind.

But there are probably reasons besides failing to pass the exams that keep doctors from being board certified. Some refuse to take the test as a “statement” of some kind (lost on me, sorry), others choose not to recertify when the time comes (i’m not sure why, perhaps the medicine they practice doesn’t change with new research or maybe they are pissed off they have to do it?), and I suppose some cite cost. It’s about $200 a year to maintain my OB/GYN boards and the ABPM exam was a pricy $1700 (but that’s every 10 years). My Canadian recertification cost is covered by the $600 or so I pay a year for the privilege of being a Member of the Royal College of Surgeons of Canada. No sarcasm there, I am proud I completed a challenging 5 year residency and passed that exam.

I’ll be the first to admit that board certification in no way guarantees you are seeing a good doctor, just like a drivers license doesn’t guarantee you are a good driver. However, because certification in many cases is actually a pretty low benchmark, if a doctor has been unable or unwilling to pass the requirements I think that’s an issue.

If you trained before your specialty existed, get grandfathered in. That’s what I did. And I learned A LOT in the process. The AMA should be encouraging board certification and perhaps even working on improving the standards for certification, not trying to find ways for doctors to continue to practice without meeting the “minimal requirements.”


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  1. I respectfully disagree. Maintenance of certification in OBGYN is a joke. Flat out stupid, requiring no thinking, and in no way improves anyone’s knowledge base. It is just a hoop to jump through to say you did it. It means nothing. It gives a false impression that being BC’d is something more than it is–a charade. That’s why doctors think the process is a joke.

  2. Disagree! This is why comradery is so poor amongst physicians. Board certified vs Board-Eligible, oh please! Come off of it! First of all, it is another standardized way to keep minorities out of high positions in medicine. Second of all, no one test should be used to validate someone overall competency to practice medicine. Third of all, if someone gets to the point they are taking specialty boards, they have endured 100’s of test already. Fourth, some residency programs have an unfair advantage. Fifth, boards get money for failures along with test taking centers, hotels, taxis, board prep courses, etc. Sixth, hospitals and insurance companies run the boards now, because just recently they have decreased the time in which doctors are board eligible. So, the hospitals wont have to deal with getting sued and just lay the blame on the supposedly board certified physician. If they really cared about the doctors taking the boards they would have programs to help with remediation, but instead they use an axe to cut off people who spent just as much time and sacrifice and money as someone who got board certified. Hell they even spent more money and time, because they got to retake the test. Good doctors are getting cut out from practicing from this board certification process, but I guess you and other arrogant people get off on such titles because you were on the otherside of the curve. If there is truly an incompetent doctor serving patients, let the lawyers and hospital staff weed them out. if recertification is such a big deal how come people in practice for 20-30 years don’t have to recertify. They are the ones with the huge practices, see boat loads of patients. Even an older doctor told me, they got over being grandfathered in. The system is trash covered with self-righteous icing and this is one of the reasons why the profession is losing respect.

    1. 1) The above poster must have failed the boards. The questions and answers don’t depend on what color your skin is. Stop blaming the test, and STUDY!

      2) i have a problem with people who support non ABMS boards. There is no end to organizations that will take money from MD’s so they can frame a board certificate in their office. The patients think it’s the real thing. I think it’s fraud.I am especially dumbfounded by people with real boards adding these others, because it is supporting something that is deceptive. If it were just a benign trade organization to share CME etc, they wouldn’t use the word “board” in their certificate. Everyone knows the game, and it stinks to high heaven.

      1. I’m still waiting for the well designed study that shows that board certified physicians that have been residency trained in a specialty, are better than non boarded docs that have also been trained in like residencies. Controlled for times or dates of residency and or age. I’m not impressed by someone who is boarded vs someone who has taken and passed the written test or not even bothered with that. Sometimes I’ve seen the certified doc be the worst of the bunch. To me, the whole board system is mostly a scam rather than all of the “other” boards or certifications you mentioned Bob. The “accepted” boards are deceptive because they are used to claim a “more qualified” physician for employment or privileges when it just isn’t true. Those who go through it and pass, then join the masses that use it as bragging rights or to “prove” their qualifications when it does no such thing but since they are already through that door they and you, are perfectly satisfied in ignoring or even supporting the freezing out of non boarded physicians, who may be better physicians than them or you!!!

  3. Thoughtful commentary ! I loved the insight ! Does anyone know if I can get access to a sample IRS 1120 – Schedule G form to fill in ?

  4. After reading this article I felt like I should join the fray, though it appears I am 2 years too late. I am a BC Internist practicing as a hospitalist, and have been for the past 5 years. I tend to disagree with the author, as appears to be the case with many of the comments written above. I, likely similar to all of us providers, have gone through a residency where some of our fellow residents we wouldn’t let come near us with a stethoscope. In my residency class, two were released from the program for failing to perform adequately as was the case in classes before and after me. I would suggest that the “minimum standard” would be the ability to pass residency, given that every day you are scrutinized for actual patient care and knowledge by practicing physicians in that specialty. This is the legal minimum to be licensed in that speciality, especially given that in order to finish an ACGME approved residency also has to successfully pass their Step exams. There have been no studies to date that suggest board certified physicians provide superior care over their non-board certified colleagues. I believe we all have anecdotal experiences with good providers that were not BC, and bad experiences with providers that are. One of our chief residents and arguably one of the best/smartest providers I have ever met, is not BC. Additionally, our “faculty of the year” two years running (including the year I was was a faculty attending) failed his board exam. I don’t suppose to know the reasons behind their certification status, nor do I care. I would have them take care of myself and my family members without hesitation.

    Simply put, board certification based on an exam tells us nothing about a physician’s ability to provide adequate care for a patient. Passing a rigorous 3 or 4 years of high standard residency should be adequate (and legally is!) with minimum CE standardized to attempt to keep us up to date. I am still undecided whether I will subject myself to re-certification in another 5 years as often times hospitals erroneously use BC status as necessary for employment. I hope that the landscape will be different in that time.

    Dr. W

  5. They may be out there but I haven’t been able to find the studies that show that Board Certification results in improved care. Back when Residencies were being formed Residency training itself was supposed to do what board certification claims to do now. I would much rather depend on residency training than a test set. Board certification does satisfy those who have no other reference to gauge proficiency in some ways but spending 4 or more years actually doing the things that you are being trained to do is obviously much more important.
    If board certification is to be required then I believe it should be part of the residency. One shouldn’t pass the residency until certified. Case lists can be compiled and reviewed at a later date or on a scheduled bases not just once in ones career.
    I finished residency later in life than most and have a large family. It took a while for me to find my niche financially so the costs and time away from practice to take the boards were actually a barrier for me at first. I studied for 2 weeks prior to my one and only sitting for the Oral Board exam in Ob/Gyn, about 6 years after residency, which was not nearly enough. Why? Because many of the questions were truly Not what I did on a daily basis. Also the issue of test anxiety that is so blithely written off by the author is a real entity. There is a big difference in taking care of emergent situations calmly and proficiently and what I would simply refer to as “stage fright”. When asked a question that I obviously know the answer to but blanking out under the “spot light” doesn’t mean that I don’t think very well on my feet and use that very information correctly in practice. The author obviously doesn’t suffer from the problem and has no point of reference to be able to understand it.
    At one point in my career I was the only non boarded Ob/Gyn for a large area which included several hospitals but I was known for my laparoscopic surgical ability which, I was told, surpassed the majority of these “Board Certified” Ob/Gyns by those who were familiar with both myself and these others. I know that is subjective but these were not my own observations or statements. I was aware that I was taking on much more complex and difficult cases however and doing well.
    I now work as a Hospitalist and have no trouble at all in comparing my skills, my outcomes, and actually my lower C-section rate to the other providers. I am respected for my abilities and knowledge. I don’t think I’m better than my Board Certified colleagues but easily on par.
    I honestly would like to see the comparison studies of Board Certified vs Non Board Certified providers with everything else being equal. If someone has the reference I would appreciate it.

  6. Finished your residency in 1995, your “hardly” a dinosaur. That means you were probably board certified in your specialties over the next few years. There is no practicality in making a highly experienced physician who is 65 take 3 or 4 board certifications. You should write back when you truly are a dinosaur and the restrictions, certifications, requirements and the associated costs take a toll on your willingness to continue in this profession.

  7. I could not disagree more with the content of the article, nor the facts. Only 1 in 4 boarded physicians were participating in MOC, per Managed Care Magazine, 2010. May be a bit higher now, but I surmise, not by much. And that does not include the something like 30% of physicians who chose to never board. This does not support your contention that physicians find this helpful or are supportive of it. And of the ones doing it, most say they have been forced to do it against their will, not that they find it helpful or a mark of excellence.

    Additionally, your cost estimates are extremely off base. Board certification exam, including study materials, time away from practice/family, travel, taking practice course (which MANY do) including travel/hotel, etc puts the cost at over 5 figures. Not EVERYONE spends that much but MANY do. That is a tenth of the BEFORE TAX income of many physicians. It is no longer tenable. No longer tenable. Especially in light of the educational costs and lowered incomes being experienced by new graduates. No longer tenable.

    Additionally, I am perplexed at this hearty effort by a corporation who makes MONEY off doing this thing which has never been shown to demonstrate an excellence in medicine, when a much more concerning quality issue is midlevels of varying quality (some excellent, some very, very concerning) moving into the bread and butter of medical practice. One midlevel just this week told me that with an RN degree and 6 to 9 months, VERY little supervision and clinical rotations where they were seeing 2 to 3 patients per day, are now going to be the primary care providers. I worked recently with a midlevel, newly minted, who clearly did not have the ability to see even the most basic of cases. These are not isolated incidents, they are becoming more the norm. I feel very sad for midlevels trained in the past who had stringent training and experience. Things have changed here, too. VERY concerning.

    You have stated right here that board certification/MOC/MOL is not indicative of quality, so why in the world would you support a private company, who has made literally billions on this, to continue to ratchet up their profit at the cost of patients, physicians and their families? It makes no sense whatsoever when placed in the context of our current system. It makes no sense to patient safety. It makes no sense to public costs. And it does not, whatsoever, address the issues of quality which it purports to do. I, also, have had multiple boards but have chosen to no longer participate in this con game.

    It is time for physicians to stand up for patients, for the system and for real quality. I have no issue with taking a test at the end of residency to assure the standard. There are MANY other ways to ensure up to date physicians besides this. It is time for physicians to gain the courage to move away from these “money changers” who have destroyed medicine over the last decades.

    1. Your prerogative to disagree. However, we need some kind of standardization to prove doctors have the qualifications they profess. I wont to know that my doctors have at least passed a minimum standard and if I had my way I’d make certification and re-certification harder. In Canada if you don’t pass the exam you don’t get to call yourself a specialist nor practice like one.

      1. Isn’t passing the Residency while being evaluated by your instructors a form of “passing the minimum standard”?
        My request would be to make certification a part of the residency if that is going to be the case. Claiming that taking a certification exam set is equal in evaluating ones skills and performance as having people watching you perform on a daily basis just doesn’t seem right to me. It isn’t logical. Maybe residency should include a one year observational period where the candidate is out in “real world” practice followed by the “exam” or put the exam as the “Final Exam” at the end of the residency. That way tailoring the teaching to pass the exam would be much more likely.

  8. I have seen docs kept on staff despite horrible outcomes because they were board certified. Turned my stomach. So I decided to not sit for the boards and be the best doc I could be. 30 years later, I’ve have done well without the boards. They keep extending board eligible ad nauseum. The latest iteration is that I have to pass by 2019. Please. I really think I’ll put my extra time into learning more Spanish to serve my patients. When I finally reach the point where I absolutely have to be board certified or quit, well – I’m sorry I ever started. Let those with a shadow of my experience and talent take the helm. As the talent pool grow shallow, let them cling to letters and certificates rather that ability and great outcomes. Good for them. Agnostic fools. In some ways I envy them. They will pass from this life not knowing what they tossed away. Hope and change.

  9. I strongly disagree with the post.

    I graduated from a very good residency program. I am very good with analytical and descriptive answers but not good at MCQs with single best choice.

    I have best recommendation letters and graduated from one of the best fellowship program. I could not pass ABIM boards and started doing subspecialty practice without board certification. I contacted board to allow me to appear for board exam for my subspecialty but they want me to appear for IM exam first which I am no longer practicing for more than 6 years. I tried IM exam when I am not even practising IM and I failed, I can not appear for subspecialty exam without passing IM boards.

    I am praised by all my patients. There are 4 other subspecialists of same field in the town where I practise they are all board certified but I have the busiest practice because I deliver good care.

    Patients are not fool. They analyze time spent with them as well as results we are giving them. I have seen many other non certified as well as board certified docs who deliver good care.

    Board exams are nothing but the art of taking exam. Some of questions are outright foolish which you would never encounter in your practice.

    Board certification does not mean good doctor and lack of board certification does not mean that doctor does not have even minimal standards.

    Folks who subscribe to this notion may be loosing out on a number of good docs. Best way to find a good doc is ask around your friends and family and you will find one.

    1. One of the expectations of a US residency is to pass the exam. So, when you sign up for a US residency you accept the exam is part of it. In Canada when I trained passing the exam was a requirement, so you could not practice without passing.

      While exams do test the ability to take a test, many specialities now have an oral exam component (OB/GYN for example) which takes the “I’m a good/bad test taker” out of the equation.

      However, you needed to pass exams to get through undergrad, into med school (MCAT), and to get through med school so I don’t understand why it should be ok to not pass the final exam.

      1. You must pass the written exam to sit for the ABOG orals. The “good/bad” test taker is still very much part of the equation.

      2. Interestingly stated. I personally do very well with written tests and have passed the written OB/GYN test on 3 occasions over the years. I have a much more difficult time with oral exams. I had a hard time in undergrad and in this case as well when ever an oral test was done. I can do essay written testing and complex multiple choice but oral just shuts me down for some reason.

    2. Have you ever checked the number of your patients who have died and those you convinced they are hospice. Compare it with another physician and see where you stand. Everyphysician gives himself praise and even NPs believe they are better. They spend more time with patients and examine patient more with perfect documentation but their patients are always in the hospital very ill. A good physician cannot have patients in the hospital all the time.

  10. As a doctor I spend a lot of time behind the curtain and must attest that picking one doctor over another based on board certification is a fool’s game. Board certification does not guarantee competence, compassion, or a good outcome. Nor do the Boards claim as much. BC means that the doctor has done a residency and taken a test. He may be a hazard clinically, but he has a certificate.

    I am trained in internal medicine but I run a general practice and have done so for 30 years. I haven’t taken the boards and do not plan to — I am booked 3 months out and sadly have to turn new patients away daily. I am on staff in good standing at a major regional medical center, and have never been turned down by an insurance company for accreditation.

    In 2007 94% of doctors who took the IM boards passed the first time they took it. The ABIM was ashamed — they were handing out certificates in exchange for credit card numbers or so it seemed, now they have cut the pass rate to 84% for first timers.

    I lost respect for the boards when I saw case after case of poor patient treatment at the hands of board certified physicians, doctors who had their jobs because they were board certified, obviously not because they were good for patients. I complained to the appropriate directors, they sympathized but nothing ever changed, the docs were board certified after all.

    A metaphor I like to use is this: Would you drink milk that is beyond it’s expiration date? What if it looks, smells, and tastes fine? Now, would you drink milk that is in date but is curdled, stinks, and is sour? Why not? It is in date, isn’t it?

    Would you go to a doc who gives great care and terrific outcomes and has stats to prove it who is not certified? How about one who is certified but, well, he’s certified after all. . .

    Best of all nurse practioners can now graduate in 18 months and become “Board Certified”. No pre-med, med school, residency or fellowship. Just a bachelors in anything and 18 months training, no nursing experience required. Some are good, many are not, but they are all “Board Certified”. Sure, it is a different board than docs, but in 18 states they can work independently and trust me, the public has no idea how one BC differs from the other.

    Fool’s game.

  11. Hi, My name is Dr. Julio Cesar Novoa. I am a practicing OB/GYN and cosmetic surgeon from El Paso, Texas.

    Although I can appreciate the need for standardization and minimal requirements in regards to training and experience, I have to strongly disagree with Dr. Gunter.

    If you review each of the Board requirements for the 24 specialties certified by the American Board of Medical Specialties, you will become very aware of a recurrent loop-hole regarding true confirmation of sustained proficiency and expertise in each practice specialty. There is NONE. That is to say, that once you pass your Board certification, you are under no obligation, nor are you required or even monitored to confirm that you are practicing in the manner which allowed you to get your Board-certification.

    As an example. The American Board of Obstetrics and Gynecology (ABOG) specifically states on it website the following “THE ABOG DOES NOT LICENSE MEDICAL DOCTORS. LICENSING OF MEDICAL DOCTORS IS DONE BY THE RESPECTIVE JURISDICTIONS IN WHICH SUCH DOCTORS PRACTICE.


    What this amounts to is that the ABOG and other Boards do not routinely monitor the practice patterns of its member doctors to confirm that they are maintaining even a “minimal level of competency, proficiency or ethics”

    The tragedy of this situation can best be demonstrated by the current extraordinarily high level of unnecessary Cesarean Section (C/S) being performed by Board-certified OB/GYNs in the United States.

    In 1967, the rate of C/S was only 5%, today it is 33%. Despite this embarrassingly high rate of C/S, we have not seen any documented benefits in the literature when comparing the risks vs. benefits to either the baby or the mother with having such a high rate of C/S as compared to the rate during the 1970s.

    It is estimated that 500,000 C/S per year are unnecessary with greater than 90% of them being performed by Board-certified OB/GYN doctors.

    In comparison, the risks of complications associated with non-board certified OB/GYN doctors, certified mid-wives and family practice OB/GYNs are much when comparing both low and high risk patients.

    The Center for Disease Control (CDC), the World Health Organization (WHO), and Healthy People 2010 have all shown the benefits of keeping a rate of C/S at or below 15%.

    This reasons for all this are obvious. Doctors are practicing defensive medicine and for the convenience of the doctor over the needs of the patient. This includes both non-boarded and Board-certified doctors. However, with greater than 90% of OB/GYN doctors being boarded, the problems with obstetrics in today’s society is overwhelming due to the behavior of Board-certified OB/GYNs.

    Now, after decades of seeing what has been going on, year after year, the American Congress of Obstetrics and Gynecology has finally starting to comment that there is a problem. However, this is still too little, too late.

    What needs to happen with all the Boards, is that doctors claiming proficiency and expertise based on being board-certified should be required to post monthly stats for the general public to review in order to confirm this level of proficiency on a day to day basis. Until this happens, all being board-certified means is that you passed a written test and passed an oral exam stating what should be done, but not necessarily agreeing to practice that way in order to maintain your board-certification.

    Until this happens, I refuse to be board-certified by the ABOG. However, I practice what I preach and I post my delivery stats online every month for the general public to review. Despite delivering between 300-500 babies per year and specializing in Vaginal Birth After Cesarean Section (VBAC), I have a primary C/S rate of less than 7%.

    As far as CME, I am required to have 24 per year to keep my Texas Medical License. I, however, have earned over 1000 in the past 3 years.

    So, for my colleagues that are Board-certified, please help do something about the problem and stop pretending that Board-certification has the merits that you are bestowing upon it. We all know of Board-certified doctors that routinely practice below the recommended standards and are ethically challenged. We all know that Board-certification doesn’t keep any doctor from practicing the way they want to practice. We all know that an overwhelming number of Boarded doctors are practicing defensive medicine (which is unethical). We all know that very few times, if ever, does a Board-certifying body make one its Fellows produce statistics regarding their practices.

    Until a Board-certified doctor is required to prove that not only can they pass a test, but that they practice every day the way they stated when they became Boarded, the American public is better off evaluating both Boarded and non-Boarded doctors on a case by case basis.


    Dr. Julio C. Novoa, M.D.

    1. Wow! I couldn’t have said this better. I am a Board Certified Psychiatrist which will expire in 6 years and the total cost and time involved in getting this renewed is daunting. Three chart reviews complete with peer review and patient feedback on EACH module. That is 30 forms that are needed in this process. Plus, Self Assessment courses that are $200-$300 dollars each that are on top of 150 CME. Then there is the actual price of the RECERTIFICATION exam $700 application and then $800 fee. Just to do this again in 10 years if I even live that long is ridiculous. Good luck. Patients will be able by word of mouth to figure it out.

  12. Thanks for this! I really had no idea how board cert worked. (Lawyer here, so, limited knowledge outside atty licensing.)

  13. I’m troubled by your vociferous, loquacious and dogmatic approach to qualifications. First, are you really board certified in 4 disciplines? I mean really, anybody good at test taking can accomplish this. Did you take all 4 residencies? I think not. I don’t disagree with your premise, iI just have an issue with your aggrandizing your qualifications. How can you become a PMNR specialist from examining vagina’s?

    1. Did you read the post? You know, the part about there not being a recognized fellowship so doing the due diligence to get grandfathered in by taking required CME and exams? And to be board certified in pain by ABPMR does actually not require you be a physiatrist because it’s a sub specialty. There is a difference between specialty and sub specialty boards.

      The point about having 4 board certifications is that OBViOUSLY I believe in the system so I’m ADMITTING my BIAS up front.

      1. Thanks for the feedback. What I meant by my comment, was in order to be really BOARD CERTIFIED it entails more than just passing a test. To designate that you are BC means you have been trained and are facile in the discipline, not just pass a test. I applaud you for your talents, but when I represent myself to someone as BC they assume I completed the training. If the above were true for all then I could say I passed five boards, like Step 1-3 and specialist are all board tests. I know you appreciate the difference. Maybe I missed your point, maybe you were saying, “look I am not trained in 3 of these fields and look how easy it was for me to get board certified.” And of course I follow you no matter what, man you must be a pistol!

  14. I very much agree with your point and your reasoning, but I’m a bit skeptical of the stat that states that 60% of osteopathic physicians are not board certified. This number is far from what I have seen before. I have found that there are often misleading numbers because when searching for board certification, most people only search for ACGME/MD certification. Most DOs who do osteopathic (AOA) residency programs are certified within an AOA system. For instance in OB Gyn, MDs and DOs who do MD residencies can be board certified by ACOG. However, DOs who do AOA residency are board certified by an entirely different board (the ACOOG) which does not appear in many searches when looking for board certification numbers. This is definitely an important bit of information for people searching for board certification information for their physicians.

    It may also be helpful to find out if your local hospital requires physicians to be board certified in order to have privileges. Many do and these policies often provide the additonal incentive for physicians to be board certified in their specialties.

    1. **sorry it is the ABOG for ACGME residency (part of the Am Board of Medical Specialties) and AOBOG for AOA residencies (part of the AOA board of osteopathic specialties). Not the ACOG/ACOOG.. I get so used to referring to the professional affiliations I throw their names all over!

  15. Your post was very educational for me, a non-doctor. I zeroed in on your assertion that board certification “in no way guarantees that you’re seeing a good doctor.” It also brings up an perplexing issue for me, as a patient: how do I select a doctor that is actually good? Most people will tell you that personal referrals are best. This gives me a pool of people as uninformed as I am on which to base this decision. The only other means at my disposal is to use my insurance’s physical selector, which gives me no insight on the skill level of the doctor. Since I live in a town with an osteopathic medical school, and hence a large number of DOs, I can eliminate them for their lesser education, but what else, other than board certification do I have?

    1. You are being very short sighted and pretty much just downright ridiculous in entirely writing off the entirety of the “large number of DOs” in a teaching town for their “lesser” education. I would not just assume that someone is the best doctor for me just because they went to Harvard and would not discount a foreign medical graduate or a DO because of where they went to school years ago. FMGs often are often full on doctors in their original countries and become doubly trained in a full residency/fellowship here. Many have actually been some of the smartest physicians I have worked with. Likewise, DO stigma is often unfounded- currently they take the exact same courses as their MD counterparts, same clinical structure often at the same training hospitals, and often complete the same residency programs. I am not starting or wanting to participate in a battle of MDvDOvFMG, but only want to point out that good doctors aren’t made in the classroom, they are made in real world training and practice. It is certainly a complicated decision process and there are many factors, but focusing so narrowly on where a doctor learned biochemistry is probably not the most informative way to make such decisions. And it may even keep you from finding the best physician for yourself.

      1. Part of my problem with osteopaths is their refusal do denounce their root philosophy – that all disease stems from misalignment of the bones. No amount of like education can overcome that. Osteopaths also enjoy more lax admission standards. I liken it to the difference between a community college and a 4-year university. You can probably get calculus I at either school, but the more rigorous one will certainly be found at the university.

        To be sure, I have been treated by osteopaths in the past. Some of these experiences were beneficial, others, not so much. It’s because of an osteopath that I have only limited use of my right thumb. It was injured in a fall, likely severing the tendon which allows me to flex it. Had I been taken to an actual hospital instead of osteopathic hospital, I would likely have gotten it repaired. Nor did the “doctor” have any ethical dilemma about withholding the local anesthesia so that I could be sutured with the added pain of feeling every single stick and stitch.

        When I’ve been directed to pursue quackery, it’s always been by an osteopath. I have had them recommend fish oil, herbal preparations, and homeopathic remedies. No MD has ever done this, only DOs.

        So yeah, I hear your point about the “same education”. It just seems impluasible based upon my experience.

  16. I am so grateful for this post. You illuminate the importance of board certification and break the issue down in such a way that future patients can understand why board certification is so important. A priceless piece. Thank you so much for sharing your thoughts.

  17. I agree and wonder if anyone is aware of any peer reviewed studies comparing the rates of adverse outcomes with lack of board certification?
    As an experienced medical malpractice attorney, I have certainly seen my share of the docs who had multiple attempts at passing the board certification exam, but always failed. Dr. Gunter is right. They frequently claim “test anxiety” or some similar nonsense.
    I have elicited testimony from experts who have agreed that the residency programs teach with the expectation that the resident will be able to successfully pass the board certification exams on the first try. So, why wouldn’t board certification be the minimum standard?

    Thanks for writing this blog post Dr. Gunter.

    1. Dr. Gunter – thank you for your blog post. I am a board certified psychiatrist, and while I acknowledge that being board certified is desirable and carries its privileges, I dislike the current system for a number of reasons. If board certification is to represent a “minimum” standard, then in my opinion the questions on the exam should actually represent what practically any physician in the field is likely to need to know in order to practice safely and effectively. The problem is that such a common sense point seems lost on the exam writers, who repeatedly write questions about minutiae that realistically do not impact patient care whether a physician knows those facts or not. For instance, as a psychiatrist, I do not need to know which chromosome that the gene for Huntington’s Disease is on, or what MPTP does (it is used in animal studies, never prescribed by us), but those are commonly tested facts on our boards.

      Another issue I have with the psych boards specifically is the high failure rate, which according to multiple sources I have read is around 65-70%. Perhaps the exam writers, or more importantly those who set the pass/fail cutoff, need to reevaluate why they are failing about a third of examinees. It’s possible, of course, that money is a deciding factor since the exam costs a whopping $2700 to attempt, one of the most expensive medical board exams around.

      Up to this point I have not expressed disagreement with any of your points, but I will say that I think your post takes test anxiety a bit lightly. I’m gathering this from reading between the lines, not so much from what you’ve overtly said – though your tone is pretty obvious. Yes, beta blockers and biofeedback are both useful modalities. And yes, test takers who suffer from such anxiety do need to find a way to overcome it, so I’m not disagreeing with those points. I do acknowledge your point that managing traumatic/acute scenarios could perhaps be more stressful than an exam, in the moment, but I actually think it’s possible that a doctor taking his/her first certification exam may find that exam just as stressful as a seasoned ER physician would find chest pain that he/she has been encountering and managing for decades. One of my residency colleagues, arguably one of the best clinicians among all the residents, did suffer from a high level of test anxiety and it affected her performance on MC tests, but she did pass her exams thus far, her patient outcomes were excellent, her research flourished and she is likely headed for tenure track. On the other hand, I had another colleague who bested others on standardized exams, but whose care of patients was nothing outstanding and many of this person’s peers recognized it.

      My point is that – at least in psychiatry, where the failure rate is ridiculous – a number of good clinicians are probably being prevented from certification on the basis of 1) not being able to read super fast, 2) not knowing some useless minutiae, or 3) yes, test anxiety. I think the psych board needs to reevaluate why so many examinees fail, and include only questions that really matter for the practice of the specialty.

      1. Dear Doctor
        I am currently board certified, in Psychiatry, and child and adolescent. But with busy practice/ life’s commitments/ i have not been able to accumulate the moc requirements. I do really good job with my patients, and get referrals through word of mouth.
        Is there a remedy for those who fail to meet MOC requirements. I really want to keep my Hospital privileges, to continue current practice.
        All I care is another 10 yrs of Practice before I retire( if I am lucky) or done with life ( i am in mid 50’s with IDDM)
        please reply if you know of any one in my predicament.

    2. Test anxiety isn’t “nonsense,” Kvanmey. Yeah doctors need to pass their exams, but don’t go around calling a legitimate phenomenon illegitimate.

      1. Agreed. kvanwey’s comment revealed a true lack of understanding of anxiety phenomenon. But what do I know… I’m a non-board certified psychiatrist.

        I disagree with with the blog author’s opinion. There are many reasons one would not want to subject him or herself to all the regulations of board certification. It does not indicate his or her appropriateness to practice medicine. At the end of the day, all the doctor’s degrees, awards, and pedigree medical school name do not equate to being a better doctor.

  18. Agreed, the certification needs to be at least the minimum standard. Maybe the reason the AMA does not push the certification as a requirement is the certification exams are prepared by other professional organizations other than the AMA. Another is that maybe they think the AMA work in interning and residency for new physicians is the real training the physician needs. Ok, I am just guessing but sometimes I see the AMA as being a group that protects what is within. Anything outside must be thoroughly explored by the AMA before it becomes accepted.

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