Predictors of Attrition From Family Medicine Board Certification

This paper is a good example of "statistical compassion." Its results could be inverted to claim that family physicians overwhelmingly recertify. What nice foundation for diving into further qualitative research asking both sides of the question, "Why did you recertify?" "Why did you not recertify?" There are so many twists and turns in the careers of physicians and so many environmental shifts going on. It is hard to isolate why doctors do what they do, e.g. leave practice, re-enter practice, limit practice. One of the more urgent considerations about certification policy is contending with the individual physician issues vs the practice issues. The professional commitment to excellence must consider changing the practice environment at least as much as it considers changing the physician.

Competing interests: I am on the BOD of the ABFM Foundation and the BOD of the American Board of Medical Specialties

As Dr. Liaw and his co-authors point out, attrition in the number of family physicians participating in the recertification process was low and relatively stable between 1980 and 2000. Current ABFM data show that this attrition rate continues to be relatively low and stable through 2017. While physician certification is part of professional accountability to the public, the ABFM understands that the process also needs to be meaningful to physicians in a manner that promotes lifelong learning. We have listened to feedback and continue to develop new and more adaptive ways of promoting knowledge assessment and acquisition over time and to offer more flexible options to do so. For example, the recently developed and highly rated CKSA (Continuous Knowledge Self-Assessment - available both online and as a smartphone app) and the creation of the Prime Registry are ways we are working to ensure that ongoing, adaptive learning methods are seamlessly integrated into a physician's work day in order to help maintain a high retention rate.

The ABFM has also made a major commitment to collecting and utilizing data in order to better understand current physician practice (e.g. workforce, scope and burden) in order to make data-driven decisions that will help family physicians. These data are helping clarify that an absolute primary care shortage remains a problem, but that the greater risk is continued erosion in scope of practice and the robust primary care models which are shown to reduce costs and improve outcomes. These changes in scope of practice are correlated with increasing employment of physicians, in some cases by organizations that do not understand or support valuable primary care functions including long-term relationships, care across settings (including hospitals), and delivering babies. The impact of these changes in scope of practice on continued participation in ongoing board certification are unknown, and will be tracked over time.

Competing interests: Dr. Baxley currently serves as Chair of the American Board of Family Medicine.