The American Board of Medical Specialties: Certification and the Need for Antitrust Enforcement

Abstract

Certification functions as medicine’s gatekeeper. Certifying organizations ensure that their physicians meet the appropriate professional standards. Traditionally, numerous organizations have provided certification services, which often involve costly testing and exams. Competition among these organizations drove innovation and lowered healthcare costs. The domination of the American Board of Medical Specialists (ABMS) over certification is dramatically raising certification costs and indirectly accreditation costs throughout medicine, decreasing access to physicians, increasing already exploding medical budgets, and reducing healthcare innovation. Leveraging its dominant market position in certification, ABMS and its member boards are now extracting even more revenue from physicians by requiring not simply periodic recertification exams to maintain board membership but continuous participation in maintenance of certification (MOC) programs. ABMS’ growing power is spreading beyond certification. Its influence has appeared to lead to hospitals only granting privileges to, and even insurance companies only reimbursing, ABMS-certified physicians. State boards of medicine, under ABMS’ sway, are adopting policies only favoring ABMS-certified physicians. Cementing the ABMS-monopoly will only drive up healthcare costs, as physicians pass on the cost of their certification testing to patients and the government. The number of physicians will also decline, exacerbating access problems particularly in rural America.