Demographic, educational factors associated with medical specialty board certification identified in new study

"Specialty-board certification by an American Board of Medical Specialties (ABMS) member board is an increasingly important credential for physicians engaged in clinical practice. Although lack of ABMS board certification does not necessarily mean that a physician is not well qualified, its presence is associated with the quality of medical care that physicians deliver to their patients. Better patient outcomes have been observed for patients under the care of board-certified physicians compared with those under the care of non-board-certified physicians," according to background information in the article.

Donna B. Jeffe, Ph.D., and Dorothy A. Andriole, M.D., of the Washington University School of Medicine, St. Louis, conducted a study to identify demographic, medical school, and graduate medical education (GME) variables associated with ABMS member board certification among a national cohort of 1997-2000 U.S. medical school graduates, grouped by specialty choice at graduation and followed up through March 2009. Analysis was conducted for each specialty category to determine factors associated with ABMS member board certification. There were eight specialty categories included in the study: internal medicine, family medicine, pediatrics, emergency medicine, radiology, surgery/surgical specialties, obstetrics/gynecology, and other nongeneralist specialties.

Overall, of the 42,440 graduates in the study sample, 87.3 percent (37,054) were board certified. The researchers found that graduation year, race/ethnicity, age at graduation, U.S. Medical Licensing Examination Step 1 and Step 2 Clinical Knowledge results, leave of absence during GME, and withdrawal/dismissal during GME were associated with board certification in all 8 specialty categories. In all eight adjusted models, older graduates and graduates who had withdrawn/were dismissed from a GME program were less likely to become board certified.

"In the family medicine category, graduates with higher levels of debt were more likely to be board certified. However, in the obstetrics/gynecology category, graduates with higher levels of debt were less likely to be board certified. Compared with whites, underrepresented minorities in all specialty categories except family medicine were less likely to be board certified, as were Asians/Pacific Islanders in the surgery/surgical specialties category. Women in the obstetrics/gynecology, surgery/surgical specialties, and other nongeneralist specialties categories were less likely to be board certified," the authors write.

Graduates in all specialty categories with first-attempt passing scores in the highest tertile (vs. first-attempt failing scores) on U.S. Medical Licensing Examination Step 2 Clinical Knowledge were more likely to be board certified.

Regarding the findings on the association between race/ethnicity and board certification, the researchers write that because they "observed these differences in a sample that included only graduates who reported specialty board certification intentions at graduation, there may be factors after graduation that disproportionately and negatively affect non-white -- particularly underrepresented minority -- medical school graduates' timely advancement along the postgraduation medical education continuum to board certification. Further research is warranted to identify factors after graduation that are associated with board certification and amenable to intervention so that these observed disparities in board certification can be eliminated."

The authors conclude that their "findings can inform an understanding of factors contributing to U.S. medical school graduates' advancement along the medical education continuum to board certification, an outcome of interest for medical school graduates, their patients, and the relevant professional organizations involved in undergraduate medical education, GME, and board certification."