Today's radiologist workforce will spend nearly $984M on certification

Today’s diagnostic radiologist workforce will spend nearly $984 million on certification over the course of a career, according to new research. 

The figure includes about $208.5 million for initial board certification and another $775.3 million for maintaining the designation over a 35-year career. Researchers offered these figures in an analysis published Nov. 19 by the American Journal of Medicine [1]. 

Those involved also looked at other American Board of Medical Specialties members, with about 90% of U.S. physicians currently board certified. ABMS board certification will cost impacted physicians nearly $3 billion for initial certification and $9 billion for MOC over the course of their career. Member boards hold a net surplus of $839 million in funds, which has climbed by 31% since 2014. 

“With the increasing number of board-certified physicians, these numbers are only expected to grow,” Alan H. Daniels, MD, with the Department of Orthopedics at Brown University, Providence, Rhode Island, and co-authors concluded. “Physicians also spend a substantial amount of time and effort preparing for and meeting the initial and continuing certification requirements. Given the $12 billion burden to the healthcare industry, further research is needed to evaluate the utility of the board certification process as a measure of professional competence and its association with patient outcomes.”

Daniels and colleagues gathered data on active diplomates from published ABMS reports. Revenue, expenditures, liabilities and assets for each member board came from IRS forms. Between 2016 to 2023, the number of physicians with active certification increased by 14% while continuing certification jumped 33%. 

Initial certification exams across all specialties had an average of 300 questions over 6 hours, an 89% pass rate and cost of $2,942. In diagnostic radiology, the two initial written exams cost a total of $3,200 including $1,920 for the first and $1,280 for the second. The first exam has 615 questions spread over 11.5 hours and split into multiple sections. The second has 298 more questions over 5.7 hours and split into multiple sections. The initial radiology exam has a 95% pass rate and the second’s is 86%. Radiology is 1 of only 15 specialties that have more than one exam and one of three with a second multiple-choice test, the authors noted. 

Across all specialties, continuing certification exams had an average of 49 questions with four minutes per query, a 93% pass rate and $263 annual cost. In radiology, the MOC exam has 260 questions and a 13-hour timeframe to take the test. Radiologists have every five years to complete their defined requirements, which include earning CME credits (125 for radiology every 5 years), and completing self-assessments. Members of the specialty also must pay $340 annually to maintain their certification. 

For the 2022 tax year, the certification process generated about $47 million in surplus and yielded an $839 million net balance across all ABMS member boards. In diagnostic imaging, the American Board of Radiology earns total revenue of about $18.4 million, with 95.7% (or $17.6 million) coming from fees. The ABR has total expenses of about $18.4 million of which 62.5% (or $11.5 million) went to employee compensation. About 1.6% or $300,000 went to expenses for administering the exams. ABR holds liabilities of approximately $3.7 million and total assets of $43 million for a net balance of $39.3 million, which has increased 26.5% since 2014. The ABR has certified 65,151 individuals, the authors estimated. 

Physicians have previously questioned the value of maintaining certification, contending it’s too costly and offers no scientifically proven benefit. A Tennessee physician even sued ABR a few years ago, claiming the board has forced tens of thousands of radiologists to pay for “worthless” professional development products. However, a judge tossed the complaint in 2021. ABMS did not immediately respond to a Radiology Business request for comment on the study Tuesday, while ABR could not provide a response in time for our deadline. 

“This system warrants ongoing investigation as to whether this process effectively filters out unqualified physicians or provides sufficient ongoing education to ensure high-quality care,” Daniels and co-authors wrote in their study. “It has been suggested that these funds may be better allocated towards individual physician self-regulation, which may promote the delivery of evidence-based care. Furthermore, funds could also be allocated toward improving the physician work environment or enhancing overall wellness, thus promoting peak physician performance.”

Read more about the results, including potential study limitations, at the link below.