In a new study, researchers have found that among family physicians originally certified through the American Board of Family Medicine (ABFM) between 1980 and 2000, around 5.6% never tried to get recertified. The researchers report their findings, which have implications for the growing primary care shortage and burnout, in the Annals of Family Medicine.

Compared with the 1990-1995 group, physicians certifying in 1996-2000 had 16% higher odds of not attempting to recertify whereas diplomates who certified before 1990 had 78% higher odds. In addition, the number not trying to recertify went up with each failed attempt at initial certification, hitting 24% for those who failed at least three times.

Certification attrition is a transitional step between burnout and leaving the primary care workforce although future studies should elucidate the relationship. Understanding why some physicians leave the certification process is also important because board certification has been associated with benefits, such as improved clinical knowledge, higher quality care, and less disciplinary action, the authors said.

Groups who were more likely not to attempt to recertify included men (7.2% vs 5.1% for women), international medical graduates (8.5% vs 5.1% for US medical graduates), and physicians practising in the South. Regional variations ranged from 4.7% in the Midwest to 6.4% in the South. The ABFM began its maintenance of certification (MOC) program in 2003. As of 2011, diplomates must meet certain requirements every 3 years and pass an exam every 10 years to recertify.

Perceptions that MOC is too costly, time-consuming, or unnecessary have given rise to other start-up boards. The researchers included all diplomats who live in the United States and were certified between 1980 and 2000. They classified diplomates as either successfully recertifying or not attempting to recertify by December 31, 2015. The study excluded those who tried but failed to get recertified.

These estimates differ from other reports. For example, of all diplomates successfully recertifying in 2003, 23% did not maintain certification, indicating that diplomates eligible to recertify for the second, third, or fourth times are less likely to do so, the researchers explain. Reasons for that included not completing MOC requirements, failing the exam, and retiring.

The authors said that ABFM is trying several things to lower the attrition rate. One is a promotion of the PRIME Registry, a tool to improve population health and clinician performance by turning electronic health record data into reportable measures. It has the potential to simplify reporting for certification and payment of fees.

ABFM is also partnering with the American Academy of Family Physicians to assess for burnout and provide resources for those at risk. In addition, certification activities are being incorporated into residents' training to better introduce them to MOC practices. It is possible the findings may follow different patterns in recent years, the researchers said.