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Characteristics of Internal Medicine Physicians and Their Practices That Have Differential Impacts on Their Maintenance of Certification

Lipner, Rebecca S. PhD; Brossman, Bradley G. PhD

doi: 10.1097/ACM.0000000000000445
Research Reports

Purpose: One way to ensure quality of health care in the United States is through maintenance of certification (MOC). In this study, the authors explored whether participation in the internal medicine MOC program varies by physician-level characteristics, professional activities, and the size and location of the practice. They also sought to determine which component of MOC was incomplete for physicians who participated but did not complete the program.

Method: The authors used a theoretical realist approach to understand whether participation in the American Board of Internal Medicine MOC program varies according to physician and practice characteristics. The data came from a study sample that consisted of all physicians whose original certification was granted in internal medicine from 1990 through 1999; the study was conducted in 2013. Chi-square tests of indepen dence and a multinomial logistic regression were conducted to determine which physician-level characteristics, professional activities, and practice characteristics were significantly associated with MOC participation.

Results: Results showed that physicians who completed MOC tended to have higher certification exam scores; were younger; were U.S. medical graduates; practiced as subspecialists and in the Midwest; spent more time in patient care, teaching, or administration; worked in nonsolo practices; or were employed in counties with less than 20% of persons in poverty.

Conclusions: As certifying boards evaluate their programs, they need to continuously improve their features to assure the public that physicians maintaining certification are providing high-quality patient care.

Dr. Lipner is senior vice president, Department of Evaluation, Research, and Development, American Board of Internal Medicine, Philadelphia, Pennsylvania.

Dr. Brossman is a psychometrician, Department of Evaluation, Research, and Development, American Board of Internal Medicine, Philadelphia, Pennsylvania.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Physicians who enroll in an ABIM certification program enter into a business agreement that permits the ABIM to use their deidentified data at an aggregate level for research purposes. The ABIM Privacy Policy can be found at The researchers who conducted this study were blinded to the physicians’ identities, and the data were viewed and analyzed in aggregate.

Previous presentations: A very early version of the data from this paper was presented at the American Educational Research Association Annual Meeting, San Francisco, California, April 2013.

Correspondence should be addressed to Dr. Brossman, 510 Walnut St., Suite 1700, Philadelphia, PA 19106-3699; telephone: (215) 399-4249; e-mail:

© 2015 by the Association of American Medical Colleges