While the U.S. contends with a projected shortage of 86,000 physicians by 2036, the American Board of Medical Specialties contributes to the bottleneck of physicians into the workforce, Paul Teirstein, MD, claims in a viewpoint published in the Wall Street Journal Oct. 19.
Here are 10 takeaways from the article:
1. According to Dr. Teirstein, ABMS is a private, nonprofit entity that “operates like a regulator.” It provides physicians with “board certification,” which has become essential in medical practice. Nearly 95% of physicians hold board certification, and many hospitals or insurers require it for employment. Certain states, including California, Florida and Texas, fine physicians who call themselves “board certified” without an actual ABMS credential.
2. In the past, physicians would complete residency, pass a certification exam and practice medicine. However, Dr. Teirstein writes, ABMS turned the certification milestone into a “hamster wheel” 20 years ago.
“Doctors must pay into ABMS’s ‘Maintenance of Certification’ program, which is an endless cycle of fees, paperwork and testing,” Dr. Teirstein said, “Miss a deadline, and your credential is revoked. While requirements differ across ABMS member boards, most physicians pay hundreds of dollars annually for exams, online modules, and other ‘maintenance’ tasks — costs that add up to thousands when factoring in time lost from patient care.”
3. He details the human element at play in this certification process, telling the story of a cardiologist who was grieving the loss of his mother and missed his renewal window. ABMS revoked his certification, jeopardizing his ability to see patients as the certification status can take one to five years.
4. The problem lies within the fact that initial board certification “is the strongest marker of a physician’s career-long competence,” yet ABMS has total control over the credentialing process and can revoke it unless physicians buy into the maintenance program, Dr. Teirstein writes. He claims it is “extraordinarily difficult” to practice medicine or regain certification status once it is stripped.
5. He also claims that ABMS sells certification status data to hospitals, payers and credential companies who use it to make employment decisions. This means that the maintenance requirements are essentially embedded into employment contracts, hospital bylaws and insurance networks, giving a private organization excessive control over physicians’ ability to practice medicine.
6. Dr. Teirstein lays out the alleged financial incentives for this practice. In 2023, ABMS’s largest member board, the American Board of Internal Medicine, posted $224 million in assets. That year, the ABIM took in $105 million in revenue — $62 million of which was from maintenance fees — and paid its chief executive more than $1.3 million, according to Dr. Teirstein. Across ABMS’s other 23 specialty boards, maintenance fees bring in more revenue than initial certification exams, which Dr. Teirstein calais is a “glaring conflict of interest.”
7. ABMS has pointed to its history of setting industry standards in defense of these practices, which Dr. Teirstein claims were created by its own partners. The Accreditation Council for Graduate Medical Education mandates “current” certification for teaching physicians, tying federal funding to participation in the ABMS maintenance system. This is the case for other nonprofit partners of ABMS.
8. Certain exceptions exist in the ABMS system. Physicians certified before 1990 were permanently exempted from ABMS’s testing and fees, and many grandfathered physicians sit in senior positions of hospitals. Dr. Teirstein says that these leaders often push younger physicians to “take on a professional burden they never had to bear.”
9. Dr. Teirstein details his founding of the National Board of Physicians and Surgeons, which he created to offer a “competitive, evidence-based alternative. NBPAS provides a transparent, clinically relevant path to demonstrate ongoing education through verified continuing medical education credits in their specialty…Costs are minimal, largely because leadership is unpaid,” he writes.
ABMS allegedly responded by distributing a “disparaging ‘tool kit,’ Dr. Teirstein said, aimed at blocking NBPAS’ acceptance. In 2023, NBPAS filed a whitepaper with the Federal Trade Commission claiming that ABMS had a monopoly and was abusing its power.
10. He urges Congress and other regulators to act by stopping federal subsidies to hospital or insurers that require participation in the maintenance program, writing that the bipartisan Resident Physician Shortage Reduction Act of 2025 should include this provision.
