A Certification Board’s Tracking of their Specialty: The American Board of Family Medicine’s Data Collection Strategy

Background: Medical certifying boards’ core mission is assuring the public that Diplomates have the requisite knowledge, skills, and professional character to provide high-quality medical care. By understanding their Diplomates’ workforce and practice environments, Boards ensure that certification is relevant to the profession and accountable to the public. Current and reliable data are key to meeting this function. The objective of this article was to describe American Board of Family Medicine (ABFM) data collection procedures and demonstrate the capacity to compare cohorts by examination year. Methods: We used data from ABFM examination application practice demographic questionnaires from 2013 to 2016. Descriptive and bivariate statistics assessed variation in Diplomate and certification candidate characteristics across examination cohorts. Results: From 2013 to 2016, 55,532 family physicians applied for either initial certification (n = 15,388) or to continue their certification (n = 40,144). Diplomate characteristics varied slightly from year to year with more International Medical Graduates and fewer men in later cohorts but, these differences were not large between cohorts. Initial certification candidates were more likely to be women, and racial or ethnic minorities than Diplomates seeking to continue their certification, and each year’s cohort was characterized by increasing numbers of female and US medical graduates. Discussion: Data collected from Diplomates as part of examination registration have proved invaluable to serving the mission of the ABFM and advancing knowledge about the specialty of family medicine. Continued refinement of data collection to enhance data reliability and usefulness, while reducing collection burden, will continue. The stated purposes of the American Board of Family Medicine (ABFM) include improving the quality of medical care, establishing and maintaining standards of excellence in Family Medicine, improving the standards of medical education in Family Medicine, and determining the fitness of specialists in Family Medicine to hold ABFM certification. For decades, the ABFM has used data to help guide these purposes. Examples include the use of examination performance data to help the Accreditation Council in Graduate Medical Education (ACGME) accredit family medicine residencies; the use of demographic data obtained during the examination application process to determine the readiness of Diplomates to use the internet to begin participation in Maintenance of Certification for Family Physicians (MC-FP) program in 2003; and the collection of race and ethnicity data to test the fairness of examination questions.1 Data collected by the ABFM are largely a byproduct of its business operations. Examination scores and results are obvious examples, but certification activity, residency, and fellowship training, feedback surveys on certification activities, and licensure and disciplinary actions are also collected. For over 30 years, the ABFM has required a practice demographic questionnaire to be completed by Diplomates when they apply for the recertification examination. These data were collected on “bubble sheets” (Online Figure) until the advent of MC-FP in 2003, when the ABFM began collecting these data online. Collection of these data are an important business requirement as the Board of Directors use the data to guide their policy decisions. Beginning in 2008, the ABFM sought to better understand the practice characteristics and scope of practice of its Diplomates by partnering with the Robert Graham Center to conduct secondary research using the data from the practice demographic questionnaire and other administrative data. This collaboration has produced over 50 peer-reviewed publications and has documented a decline in scope of practice of family physicians,2⇓⇓–5 high participation rates in MC-FP,6⇓–8 and growing use of electronic health records.9,10 In 2012, the ABFM launched its own research department to better understand the effectiveness of11,12 and satisfaction with13,14 its certification programs and the practice and person characteristics associated with family physicians delivering high-quality care.15⇓⇓–18 The interval between recertification examinations has changed from 7 to 10 years due to changes in MC-FP requirements and a change to a Continuous Certification program but well-defined cohorts of physicians should apply for the examination at known intervals. In effect, the examination application practice demographic questionnaire constitutes a census of recertifying family physicians for that year. Therefore, the objective of our study was to compare the demographic characteristics of recertifying family physicians over the last few years and to describe ABFM data collection.