Board certification: what physicians say about the boards and MOC, in their own words

Last updated September 24, 2026.

Read together, the 95 KevinMD posts on board certification say one thing consistently: physicians value passing the boards once and have spent a dozen years arguing that the cycle of recertification that followed, maintenance of certification or MOC, was never shown to make anyone a better doctor. The argument peaked in 2015, when the American Board of Internal Medicine apologized to its diplomates, returned in 2026 with an antitrust lawsuit and a new round of reforms, and has always had defenders who say a profession that will not police itself will be policed by someone else. Posts mentioning MOC appear in 47 percent of the record before 2013 and 86 percent in 2015 and 2016; posts mentioning a lawsuit or antitrust rose to 12 percent since 2023. Both sides are on this page under their own names.

This page is a maintained record of what physicians have written about board certification, recertification, and the specialty boards on KevinMD.com, a physician-authored publication founded in 2004 by Kevin Pho, MD, a board-certified internal medicine physician in Nashua, New Hampshire. It draws on 95 essays and podcast transcripts with board certification, board eligible, recertification, maintenance of certification, the board exams, or a specialty board in the title, published between October 2008 and September 2026 by 51 named contributors, 86 of the posts bylined by physicians. Of the 95, 16 were published from 2023 onward and 9 in 2026 alone. Every claim is attributed to a named author with the month it was published, quoted in the author’s own words, and linked to the original.

This record is about specialty certification. The medical school licensing exams, Step 1 and Step 2, are covered in Medical school: what students and physicians say, in their own words, and board exams during training in Residency: what residents and physicians say, in their own words; state medical boards and discipline are outside it. Officers of the certifying boards and of a rival board are cited and identified as such, because they are parties to the argument. Each section opens with a direct answer, then what named authors have said, in the order they said it. Where authors cite figures, the source is named alongside the author and the figures are theirs as of the date they wrote.

What does board certified mean, and how is it different from board eligible?

Board certified means a physician finished residency in a specialty and passed that specialty board’s exam; board eligible means the training is done and the exam is not, and physicians on KevinMD say the second term has been stretched for years by doctors who never pass. Most of the authors who explain the difference also defend the first certification. Their argument is with what came after it.

Roy Benaroch, MD, a pediatrician, wrote in February 2011 that “In most cases, to call yourself ‘board certified’ requires periodic re-certification,” in “How to become a licensed, board certified doctor.” Christopher Johnson, MD, a pediatric intensivist, wrote in June 2012 that “The terms ‘board certified’ and ‘board eligible’ are confusing to people not in the medical profession,” in “Does it matter if your doctor is board certified or board eligible?” Jennifer Gunter, MD, an obstetrician-gynecologist, wrote in July 2012 that “I would never go to a non-board certified physician,” in “Why I would never go to a non-board certified physician.” Chris Porter, MD, a surgeon, wrote in May 2013 that credentials are not the test: “A safe surgeon does the right operation on the right patient at the right time,” in “Is a board certified surgeon a safer one?” Emmanuel K. Konstantakos, MD, an orthopedic surgeon, wrote in March 2022 that while it is important for physicians to be board-certified “it does not mean that they must only be certified by the ABMS,” in “Stop the ABMS monopoly.” Brian Hudes, MD, a gastroenterologist, wrote in January 2026 that “The phrase ‘board-certified’ once carried a universal meaning,” in “The patchwork era of medical board certification.”

Why did physicians revolt against maintenance of certification?

Physicians on KevinMD describe a promise that changed after they made it: many trained under lifetime certification, then time-limited certificates, then a continuous program of points, modules, and fees. The revolt that followed reached the American Board of Internal Medicine’s apology in February 2015, an American Medical Association policy against mandatory recertification exams in 2016, an alternative board, and state laws in Texas and Michigan. MOC appears in 86 percent of the 2015 and 2016 posts.

Wes Fisher, MD, a cardiologist, wrote in February 2014 that years of experience could be “lost because a doctor refused to perform these unproven MOC exercises,” in “The Goliath of board certification: Does David stand a chance?” Meg Edison, MD, a pediatrician, wrote in July 2014 that “Pediatricians needed to remit $990 and enroll in a continuous MOC program,” in “The mission creep of maintenance of certification.” Richard J. Baron, MD, president and chief executive officer of the ABIM, wrote in February 2015 that “We launched programs that weren’t ready and we didn’t deliver an MOC program that physicians found meaningful,” in “ABIM announces immediate changes to MOC program.” Wes Fisher, MD, a cardiologist, wrote in May 2015 that “The psychological, social, and financial consequences of failure of maintenance of certification are real yet have never been studied,” in “So you failed maintenance of certification. What now?” Meg Edison, MD, a pediatrician, wrote in January 2016 that stripping pediatricians of certification for not paying was “further evidence that MOC is all about the money,” in “Stop MOC: An open letter to the American Board of Pediatrics.” Meg Edison, MD, a pediatrician, wrote in June 2016 that “It is now AMA policy that the AMA opposes mandatory ABMS recertification exams,” in “The AMA calls for an immediate end to MOC.” Karen S. Sibert, MD, an anesthesiologist, wrote in January 2017 that “thousands of board-certified physicians (myself included) have earned two-year NBPAS certificates,” in “The real danger of maintenance of certification and what to do about it.” Carlos J. Cardenas, MD, then president of the Texas Medical Association, wrote in May 2017 that “Texas’ SB 1148 prohibits the state from using MOC as a requirement for state licensure or renewal,” in “Mandating MOC to practice medicine is an appalling overstep of nonexistent authority.” Paul Teirstein, MD, a cardiologist and president of the National Board of Physicians and Surgeons, an alternative board, wrote in January 2019 of a national commission’s draft report that “The report provides clear evidence validating the recent physician uprising against MOC,” in “MOC harms physicians in surprising ways.” Meg Edison, MD, a pediatrician, wrote in May 2019 that “Six years after I started down the very slow process to end forced MOC in my state, it happened,” in “The inspiring story of how a physician fought MOC against all odds.”

Does MOC improve patient care? What physicians say about the evidence.

The evidence question is where the two sides stay furthest apart. Critics on KevinMD cite studies in which patients of recertifying physicians did no better and argue that initial certification, not recertification, is what tracks with quality; the ABIM’s own leaders cite a body of research linking certification to outcomes. In 2026 a geriatrician objected to the research itself. Evidence or outcomes appears in 21 to 62 percent of posts in every period.

Christine K. Cassel, MD, then president and chief executive officer of the ABIM, wrote in May 2010 that “Physician skill and knowledge alone will not determine quality of patient care,” in “ABIM: Quality medical care needs more than strong systems.” Kevin Pho, MD, wrote in December 2014 citing two JAMA studies that “patients’ medical outcomes were no better and overall costs were only marginally lower in the recertifying group,” in “How to fix maintenance of certification: Here’s what I’d do.” Karen S. Sibert, MD, an anesthesiologist, wrote in January 2017 that “Initial board certification is associated with higher-quality practice, but recertification with MOC programs is not,” in “The real danger of maintenance of certification and what to do about it.” Emily Gibson, MD, a family physician, wrote in May 2017 that “Somehow the high stakes MOC exam survives without evidence of benefit,” in “This family physician is deeply disappointed in maintenance of certification.” Rajeev Jain, MD, a gastroenterologist and chair of the ABIM board of directors, wrote in August 2023 that “there is a substantial body of research that supports how ABIM’s MOC programs lead to better patient outcomes,” in “The case for ABIM’s maintenance of certification program.” Brian Hudes, MD, a gastroenterologist, wrote in February 2026 that after years of research there is “little solid evidence that MOC participation, testing, or point accumulation improves how we practice,” in “MOC patient outcomes: Why recertification doesn’t guarantee quality.” James Rudolph, MD, a geriatrician, wrote in April 2026 that most internists do not realize “their exam performance has been linked to federal Medicare claims data and used in research, without their knowledge or consent,” in “Why ABIM’s use of Medicare claims data violates physician autonomy.”

Who pays, and who profits? What physicians say about the money.

Physicians on KevinMD count MOC in fees, exam charges, and hours, and they count the boards’ revenue and salaries against it; the boards’ defenders answer that fees are the only way the boards can fund themselves. Fees or cost appears in 29 to 81 percent of posts in every period.

Edwin Leap, MD, an emergency physician, wrote in January 2012 asking of board director salaries in the $200,000 to $800,000 range “is there a potential hint of conflict of interest,” in “It’s time to look critically at the concept of board certification.” Robert Wachter, MD, an internist, wrote in July 2015 after a decade on the ABIM’s boards that with fees from diplomates as the only funding “there was a constant underlying tension about how to keep fees reasonable,” in “Dr. Robert Wachter: In defense of the ABIM.” Tara F. Bishop, MD, MPH, an internist, wrote in August 2015 that “The MOC program was significantly expanded in 2014 and required doctors to get 100 MOC points every 5 years,” in “The real cost of MOC is stunning.” Physician on FIRE, an anesthesiologist writing under a pen name, wrote in March 2017 that before his board changed the rules “Diplomates were encouraged and incentivized to take the $2,100 exam early in the three-year eligibility window,” in “A physician’s MOC debacle: Nevermind that $2,100 exam he just passed.” Carlos J. Cardenas, MD, then president of the Texas Medical Association, wrote in May 2017 that “ABIM reports $58 million in revenue for 2015, nearly $27 million of which came from MOC fees,” in “Mandating MOC to practice medicine is an appalling overstep of nonexistent authority.” Torie S. Sepah, MD, a psychiatrist, wrote in June 2020 of having to “pay an annual fee of around $500 to maintain the certification that I already earned,” in “How MOC is contributing to the demise of physicians.” Ronald L. Lindsay, MD, a retired developmental-behavioral pediatrician, wrote in July 2026 that “Recertification functions as a revenue model, not a quality model,” in “Physician recertification is a revenue model, not quality.”

What do physicians say about the board exams themselves?

The exam posts on KevinMD are practical and personal: how to study, what the pass rate means, an oral board that tested composure more than facts, a nursing mother’s six-hour testing day, and a radiology board whose questions repeated from year to year. The certifying boards’ position is that the exams test judgment, not recall.

Christine K. Cassel, MD, then president and chief executive officer of the ABIM, wrote in March 2011 that “recall of facts is not what Maintenance of Certification (MOC) exams are designed to test,” in “ABIM: Maintenance of Certification (MOC) exams assess clinical judgment.” Kevin Pho, MD, wrote in January 2012 that “Apparently, half of the questions on their certification exam were the same from year to year,” in “Radiologists who cheat on their board exams: Who’s to blame?” Felicity Billings, MD, an anesthesiologist, wrote in October 2012 that the year after residency and the written exam “you need to pass an oral board examination,” in “Oral board exams: A window into how you behave in the operating room.” John Schumann, MD, an internist, wrote in July 2013 that “the board exam is for a doctor what the bar exam is for a lawyer,” in “Declining board exam pass rates: Blame millennial doctors?” Niran S. Al-Agba, MD, a pediatrician, wrote in July 2016 of “the testing day experience, which was one of the most humiliating of my entire life,” in “The humiliation a nursing physician faced during her board exam.” A hospitalist writing anonymously wrote in February 2023 of a partner who had paid $2,900 to sit for a new hospital medicine exam that “she did not qualify to take the exam because her clinical time was diminished,” in “3 hospitalists’ struggles with board certification: a tale of ineligibility, cancelled tests, and unfair fees.” Farzana Hoque, MD, a hospitalist, wrote in June 2023 that “I passed the ABIM Board Certification Exam without any review course,” in “Master the ABIM Certification exam with effective strategies: insider tips for success.”

Where does the fight stand now? The 2024 reforms and the ABIM lawsuit.

Since 2023 the argument on KevinMD has moved from petitions to courts and program design. The ABIM replaced its ten-year exam with an optional longitudinal assessment and, in late 2024, dropped its two-year point checkpoint; critics answer that the exemption for physicians certified before 1990 was never touched and that the antitrust suits over MOC are still in the appeals courts. Grandfathered or lifetime certification appears in 38 percent of posts since 2023.

Rajeev Jain, MD, chair of the ABIM board of directors, wrote in August 2023 of the Longitudinal Knowledge Assessment that “participants spend less than two minutes per question, or about four hours a year for each discipline they are maintaining,” in “The case for ABIM’s maintenance of certification program.” Brian Hudes, MD, a gastroenterologist, wrote in January 2026 that “Thousands of physicians certified before 1990 remain permanently credentialed, exempt from MOC entirely,” in “Did ABIM MOC reform actually fix the problem for physicians?” Brian Hudes, MD, a gastroenterologist, wrote in February 2026 of the antitrust suits that “ABIM counters that participation in MOC is voluntary,” in “The American Board of Internal Medicine maintenance of certification lawsuit: What physicians need to know.” Brian Hudes, MD, a gastroenterologist, wrote in March 2026 citing a 2024 Medscape survey that “one in five mid-career physicians cited MOC or other certification mandates as a contributing factor to early retirement,” in “How board certification fuels the physician shortage crisis.” Bernard Leo Remakus, MD, an internist, wrote in March 2026 at 77 that the ABIM label for grandfathered physicians who do not participate is “misleading and potentially harmful to the reputations of physicians so designated,” in “The controversy over Maintenance of Certification for grandfathered physicians.”

What do physicians disagree about?

On whether MOC should exist at all, Robert Centor, MD, an internist, wrote in March 2015 that “MOC, in my mind, is necessary because CME is generally a failure,” in “Why is MOC necessary?” David Troxel, MD, a pathologist and medical director of a malpractice insurer, wrote in May 2015 as a former trustee of the American Board of Pathology that “I support the concept of MOC,” in “3 changes that can improve maintenance of certification.” Robert Wachter, MD, an internist, wrote in July 2015 that “If we prove ourselves incapable of self-governance, we are violating this trust,” in “Dr. Robert Wachter: In defense of the ABIM.” On the other side, Meg Edison, MD, called it mission creep and Ronald L. Lindsay, MD, called it a revenue model. On the evidence, Rajeev Jain, MD, and Brian Hudes, MD, read the same literature and reach opposite conclusions. On alternative boards, Emmanuel K. Konstantakos, MD, wants hospitals to accept them and the ABIM’s defenders say one national standard is the point. The record does not resolve these; it dates them.

What would fix it? What physicians propose.

Asked what would fix board certification, physicians on KevinMD propose keeping the initial exam and replacing recertification with continuing education physicians choose, taking MOC out of licensure, credentialing, and insurance contracts, letting boards compete, and proving benefit before requiring anything.

Andrea Paul, MD, chief medical officer of BoardVitals, a board review company, wrote in April 2016 that “It’s time to start proposing alternate solutions that work for the public as well as for doctors,” in “Want to fix MOC? This is one idea to do it.” Sarah Hiam, DO, a family physician, wrote in December 2016 that “Board study is a poor use of CME time,” in “It’s time to stop mandating board exams for family physicians.” Karen S. Sibert, MD, an anesthesiologist, wrote in July 2017 that “If other professional societies stand up against mandatory MOC, there may still be a chance of saving our profession,” in “None of us should have to choose between MOC and DRexit.” Ronald L. Lindsay, MD, a retired developmental-behavioral pediatrician, wrote in July 2026 that “Medicine earns trust through relationships, not through a testing center,” in “Physician recertification is a revenue model, not quality.”

How has the board certification conversation changed since 2008?

The record starts with explanations of what board certification means and with defenses of the ABIM by its own leaders from 2010 to 2012. The 2013 and 2014 posts are the first organized objections to MOC. The 2015 and 2016 posts are the revolt itself: petitions, an apology, the AMA, and the alternative board. From 2017 to 2022 the argument moves to state legislatures and to alternative boards’ fight for hospital recognition. Since 2023 it is the ABIM’s new assessment, the lawsuit, and the grandfathered physicians. Kevin Pho’s short early commentaries, 2 of them, are counted here but not cited.

Two things did not change. The ABIM is named in 25 to 75 percent of posts in every period. And the physicians who object to recertification almost all say they are glad they passed the boards the first time.

Term 2008 to 2012 (17 posts) 2013 to 2014 (14 posts) 2015 to 2016 (28 posts) 2017 to 2022 (20 posts) 2023 to 2026 (16 posts)
MOC or maintenance of certification 47 percent 71 percent 86 percent 75 percent 56 percent
Recertification 35 percent 50 percent 50 percent 30 percent 62 percent
ABIM 59 percent 50 percent 68 percent 25 percent 75 percent
Fees or cost 29 percent 64 percent 61 percent 60 percent 81 percent
Evidence or outcomes 29 percent 50 percent 21 percent 60 percent 62 percent
NBPAS or alternative board 0 percent 0 percent 29 percent 35 percent 25 percent
Lawsuit or antitrust 6 percent 7 percent 4 percent 10 percent 12 percent
Burnout 0 percent 0 percent 4 percent 10 percent 31 percent
Grandfathered or lifetime 12 percent 21 percent 21 percent 35 percent 38 percent

Term frequencies are the share of posts in each period whose text contains the term at least once, computed on the September 24, 2026 corpus of 95 posts with one stored expression per term.

The KevinMD board certification corpus by the numbers

These figures describe the set of KevinMD posts this page draws on. They are counts of what KevinMD has published, not a survey of physician opinion.

Measure Value
Posts in the corpus 95
Published 2023 or later 16
Published in 2026 (through September) 9
Named contributors 51
Posts bylined by physicians (MD or DO) 86
Podcast episodes with transcripts 2
Written anonymously 3
Kevin Pho’s early commentaries, counted but not cited 2
Posts not indexed, counted but not cited 5
Most frequent contributors Kevin Pho, MD (8); Wes Fisher, MD (7); Meg Edison, MD (7); Brian Hudes, MD (7); Robert Wachter, MD (3)
Title matches excluded 18 with the subject thin in the text; state medical boards, licensing discipline, and boards of directors were excluded at the title search

How this page was built and how it is updated

The corpus was assembled from title searches for board certified, board certification, board eligible, recertification, maintenance of certification, MOC, board exams, board review, oral and written boards, the ABIM, the ABMS, the ABFM, and the National Board of Physicians and Surgeons. Titles about state medical boards, licensing complaints, institutional review boards, and boards of directors were excluded, and posts whose text mentioned the subject fewer than four times were excluded. Term frequencies were computed against the full text of each post. Posts are counted whether or not they are indexed; citations on this page are limited to posts that are indexed and can be verified at the link. 5 posts in the corpus are not indexed; they are counted but not cited. Quotations are taken verbatim from the original posts and were checked against the source text by script. Author credentials are as they appeared in the byline at publication; where the byline gave none, the credential is the one the post itself states. Officers of the boards are identified where they are cited: Christine Cassel, MD, and Richard J. Baron, MD, led the ABIM; Rajeev Jain, MD, chaired its board of directors; Robert Wachter, MD, wrote after a decade on its boards; Paul Teirstein, MD, is president of the National Board of Physicians and Surgeons, a rival board; Andrea Paul, MD, is chief medical officer of BoardVitals, which sells board review. Every source is linked in the sentence that cites it, and the full list appears at the end of the page. No board certification tag exists on KevinMD; the closest archive is the Physician category. Related records: Residency: what residents and physicians say, in their own words, Medical school: what students and physicians say, in their own words, Physicians and administrators: what physicians say about who runs medicine, in their own words, Physician burnout: what physicians say, in their own words, and Physician careers: what physicians say about jobs, contracts, and leaving clinical practice, in their own words.

This page is updated as new essays on board certification are published on KevinMD. When it is updated, the date at the top changes, the counts in the tables are recomputed, and new named claims are added to the relevant section. Nothing is removed unless the original post is removed. An author who believes a quotation on this page misrepresents them can write to Kevin Pho and the page will be corrected.

To cite this page: Pho K. Board certification: what physicians say about the boards and MOC, in their own words. KevinMD.com. Updated September 24, 2026. https://kevinmd.com/board-certification

The 44 KevinMD posts cited on this page, in order of publication