Does Performance on the American Board of Physical Medicine and Rehabilitation Initial Certification Examinations Predict Future Physician Disciplinary Actions?

Abstract

Objective The aim of the study was to determine the relationship between performance on the American Board of Physical Medicine and Rehabilitation primary certification examinations and the risk of subsequent disciplinary actions by state medical boards over a physician's career. The hypothesis is that physicians who do not pass either or both of the two initial specialty certification examinations are at higher risk of disciplinary action from a state medical licensing board. Design This is a retrospective cohort study that analyzed board certification examination data from all physicians who completed physical medicine and rehabilitation residency between 1968 and 2017. Results Matching examination and license data were available for 9889 physical medicine and rehabilitation physicians, who received a total of 547 disciplinary action reports through the Federation of State Medical Boards. The results showed a significant correlation between failing an American Board of Physical Medicine and Rehabilitation certification examination and the risk of subsequent disciplinary action by a state medical board. Failure to pass either the written (Part I) or oral (Part II) examination increased the risk of subsequent disciplinary action by 5.77-fold (P < 0.0001, 95% confidence interval = 4.07–8.18). Conclusions Physicians in physical medicine and rehabilitation who do not pass initial certification examinations and become board certified are at higher risk of disciplinary action from a state medical licensing board throughout their careers.

Characteristics, Predictors and Reasons for Regulatory Body Disciplinary Action in Health Care: A Scoping Review

“…20 Scores on certi cation exams were associated with discipline risk, with lower scores having a higher risk of future disciplinary action. 66,67,75,85 Board-certi ed physicians also were less likely to receive a severe penalty and more likely to receive a less severe penalty. 33,67,73,75,89 One study found that higher scores on the board certi cation exam reduced the likelihood of disciplinary action for both domestic and international graduates, but that it was more protective against disciplinary action for domestic graduates than for international graduates.…”

“…Research on whether being an international graduate increases risk of future disciplinary action is con icting. Nine studies 15,16,24,35,62,66,69,109,112 and two review articles 33,91 found that international graduates were at higher risk of disciplinary action than domestic graduates, and one found an increased odds ratio for discipline with overseas training but it was not statistically signi cant. 90 Another study found that international graduates were more likely to receive high impact decisions in every stage of the disciplinary process and were more likely to be suspended or have their license revoked.…”

“…Of physical medicine and rehabilitation physicians, the highest disciplinary risk was seen in those who had a subspecialty in pain. 66 Among internal medicine physicians, highest risk was seen among general internal medicine, then cardiology, and less risk with rheumatology, endocrinology, respirology, gastroenterology, hematology, and medical oncology. 74 Among nurses, those in medical-surgical nursing were disciplined the most, with other higher risk specialties including geriatrics and long-term care, anesthesia, critical care, and emergency.…”

“…28,33,62,69,80 Studies also found that those who passed the certi cation exam on the rst attempt had lower risk of discipline than those who required multiple attempts. 59,66,75,83,85 Risk was also lower for those whose certi cation never lapsed, while those who let their certi cation expire before recertifying had a higher risk of discipline. 67,75,83,89 Those who had been in practice for a longer duration since completing their mandatory specialist training also had a higher risk of discipline.…”

“…Seven studies found that most discipline cases involved multiple violations or repeated charges. 24,33,40,66,80,87,92 Previously disciplined physicians were more likely to be subject to future discipline than physicians who have never been disciplined, 47 and one study found higher risk of license revocation with two or more previous actions compared to one previous action. 26 Seven papers reported on the rate of discipline for physicians in general or certain predictors of discipline.…”