According to a report in the September 7 issue of JAMA, a medical education theme issue, the likelihood of a medical school graduate becoming board certified is linked with certain factors, such as race/ethnicity, age at graduation and level of debt.

The authors wrote, as background information:

“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.”

Donna B. Jeffe, Ph.D., and Dorothy A. Andriole, M.D., of the Washington University School of Medicine, St. Louis, led an investigation in order to identify demographic, medical school, and graduate medical education (GME) variables linked with ABMA member board certification among a national cohort of U.S. medical school graduates between the years 1997 to 2000.

The graduates were grouped by specialty choice at graduation and followed up through March 2009. Eight specialty categories were each examined to find out which factors might have an impact on ABMS member board certification. These categories were: internal medicine, family medicine, pediatrics, emergency medicine, radiology, surgery/surgical specialties, obstetrics/gynecology and other non-generalist specialties.

Overall, 87.3% (37,054) of graduates out of 42,440 in the investigation sample were board certified. They discovered 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 graduate medical education were linked in all eight specialty categories with board certification.

In all eight categories, older medical graduates and those who had withdrawn or who were dismissed from a graduate medical education were not as likely to become board certified.

The researchers write:

“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 non-generalist specialties categories were less likely to be board certified.”

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

Regarding the discoveries on the connection between race/ethnicity and board certification, the authors explain 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.”

They concluded:

“(our) 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.”

Written by Grace Rattue