Nonprofit medical boards reported a $23 million surplus in 2013, more than triple what was recorded a decade earlier. Most of that revenue comes from charging physicians for certification exams.

In a research letter published in JAMA, plastic surgeons Brian Drolet, MD, of Vanderbilt University Medical Center and Vickram Tandon, MD, of the University of Michigan, examined the most recently published tax documents, from fiscal year 2013, for the 24 members of the American Board of Medical Specialties. They also compiled what fees were charged for initial certification and maintenance of certification (MOC) as of March 2017.

The mean fee for 2017 was $1,846 for an initial written exam and $1,694 for an initial oral exam. 19 boards offered subspecialty verification at the mean cost of $2,060. For MOC fees, the mean cost was $257 annually.

Some of the highest fees within specialties included:

• Allergy and immunology ($3150 application/written exam fee, $150 MOC annual fee).
• Internal medicine ($1,365 written exam fee, $2,200-$2,830 subspecialty fee, $194-$256 MOC annual fee).
• Otolaryngology ($3,580 written exam fee, $$1,800 oral exam fee, $2,485-$4,825 subspecialty fee, $310 MOC annual fee).
• Radiology ($2,560 written exam fee, $3,270 subspecialty fee, $340 MOC annual fee).

The lowest fees were paid by emergency physicians and orthopedic surgeons.

Boards made the bulk of their revenue—88 percent—off these exams and MOC fees. The cost of administering the exams, however, accounts for about 20 percent of their annual expenses, which Drolet and Tandon wrote goes against the “fiduciary responsibility” of these nonprofit organizations to “match revenues and expenditures.”

“Board certification should have value as a meaningful educational and quality improvement process,” they wrote. “Although some evidence suggests board certification may improve performance and outcomes, the costs to physicians are substantial. More research is needed to assess the cost-benefit balance and to demonstrate value in board certification.”