Association between American Board of Emergency Medicine certification performance and severe state medical licensure actions

Background: Maintaining ABEM certification is associated with fewer state medical board disciplinary actions. To become ABEM-certified, candidates must pass the Qualifying Examination (QE) and then pass the Oral Certification Examination (OCE). The purpose of this study was to examine the relationship between certification examination performance and severe state medical board licensure actions for emergency physicians. Methods: The sample was residency-trained emergency medicine physicians who graduated in 1973 or after and attempted to gain ABEM certification from 1979 to 2016. After excluding physicians who did not take the QE, graduated from non-categorical residency programs, or received a disciplinary action prior to graduation, 35,321 physicians remained. Severe actions were defined as actions that resulted in the denial, revocation, surrender, or suspension of a medical license. Severe actions data from 2021 and earlier were obtained from the NPDB. Analysis included descriptive statistics and Cox proportional hazard regression. Results: Physicians were divided into three groups based on their performance on the QE and OCE. Group 1 physicians (30,058; 85.1 %) passed both examinations on their first attempt; Group 2 (4694; 13.3 %) passed the QE and OCE after multiple attempts on either or both exams; and Group 3 (569; 1.6 %) never passed either the QE or OCE. There were 274 (0.9 %) physicians in Group 1 with severe actions; 96 (2.1 %) in Group 2; and 23 (4.0 %) in Group 3. Physicians in Group 1 had a lower rate of severe actions per 1000 person-years (0.52; 95 % CI, 0.46–0.59) than did physicians in Group 2 (1.02; 95 % CI, 0.81–1.22) or Group 3 (1.88; 95 % CI, 1.11–2.65). Compared to Group 1, Group 2 had a hazard ratio (HR) of 1.81 (95 % CI, 1.44–2.29); and Group 3 had an HR of 3.19 (95 % CI, 2.08–4.89). Compared to Group 2, Group 3 had a HR of 1.86 (95 % CI, 1.18–2.94). Additionally, female physicians were less likely to have severe actions than male physicians (Χ²(1) = 12.7, P < 0.01) when excluding physicians with no reported sex. Conclusion: Difficulty becoming ABEM-certified is associated with severe medical board licensure actions. Never achieving ABEM certification was associated with the highest risk of action.