Recertification Exam Performance in General Surgery is Associated With Subsequent Loss of License Actions

Ann Surg. 2020 Dec;272(6):1020-1024. doi: 10.1097/SLA.0000000000003330.


Objectives: To measure associations between first-time performance on the American Board of Surgery (ABS) recertification exam with subsequent state medical licensing board disciplinary actions.

Background: Time-limited board certification has been criticized as unnecessary. Few studies have examined the relationship between recertification exam performance and outcomes.

Methods: Retrospective analysis of loss-of-license action rates for general surgeons who were initially certified by the ABS from 1976 to 2005 and attempted to take a surgery recertification exam. Disciplinary actions from 1976 to 2016 were obtained from the Disciplinary Action Notification System through the American Board of Medical Specialties.

Results: A total of 14,169 general surgeons attempted to pass the surgery recertification exam. The rate of loss-of-license actions was significantly higher for surgeons who failed their first exam attempt [incidence rate 3.41, 95% confidence interval (CI) 2.27-4.56] than those who passed on their first attempt (incidence rate .01, 95% CI 0.87-1.14). A Cox proportional-hazards regression model found that the adjusted hazard rate for loss-of-license actions for surgeons who failed their first recertification exam were significantly higher than those who passed their first attempt after adjusting for multiple surgeon characteristics (adjusted hazard rate 2.98, 95% CI 1.85-4.81).

Conclusions: Failing the first recertification exam attempt was associated with a greater rate of subsequent loss-of-license actions. These results suggest that demonstrating sufficient surgical knowledge is a significant predictor of future loss-of-license actions.

MeSH terms

  • Certification*
  • Clinical Competence / standards*
  • Female
  • General Surgery / education*
  • Humans
  • Licensure, Medical*
  • Male
  • Retrospective Studies
  • United States