In recent years, the health care industry has undergone significant changes. Some of these, such as the acquisition of new or updated medical knowledge and treatment tools, are undoubtedly beneficial. Other changes have been of less specific benefit. The relatively unregulated and often for-profit evolution of subspecialty recertifications is one of the latter.
The reasons why periodic recertification is a good idea are obvious. It’s a good idea to ensure that doctors are keeping up with rapidly advancing medical knowledge and technology, and that they still remember skills they may have last formally studied decades ago.
But who is ensuring that the methods and standards used for recertification improve patient outcomes? There’s a right way and a wrong way to do everything. When the motive is primarily profit driven, there’s often an incentive to structure rules and operations in a way that optimizes profit rather than human outcomes.
The process of recertification as it exists today requires physicians to demonstrate their continued competency through ongoing education and regular exams. Doctors who fail to recertify may face penalties from their state medical board and insurance companies and a loss of patient confidence. But these exams and ongoing education credits are often administered by for-profit entities that charge high fees for both their educational materials and their exams. This creates an apparent conflict of interest because the more continuing education required for recertification or the more frequently the exams are required, the more money these companies stand to make. This raises concerns about the monopolization of the recertification process and the insufficient reinvestment of revenue into improving the certification system itself.
Topping this off is a troubling fact: There is no direct incentive for these companies to improve patient outcomes. While some of their educational materials may sharpen doctors’ practical skills, this is not how their success is typically measured.
So how does this affect doctors and patients? I found myself confronted by this question this year, when my pain medicine subspecialty board certification was up for renewal.
I have worked in physiatry, of which pain medicine is a key component, for over 30 years. I am fellowship trained and have continued to publish medical papers and books regarding my subspecialty of pain medicine.
However, to meet the current requirements for recertification, I’d have to pay a $1,500 exam fee and provide proof that I have completed 150 hours of CME. A single hour of CME credit in my subspecialty costs a minimum of about $100. In my case, I had to invest in multiple $1,200 weekend seminars to meet my needs. The financial strain of these costs is alarming, especially in a system that aims to lower costs.
And here’s the kicker: I’m approaching retirement age and was recently diagnosed with cancer. As I eyed the obstacle course ahead of me, I wondered if renewing my pain medicine subspecialty board was even worth it. I likely wouldn’t use it for the full term required before retiring. What if I just retired here and now — not because I wanted to stop caring for my patients, but because I wasn’t sure I could handle completing the requirements to recertify on top of the requirements of practice?
I am not the only physician who has faced this decision.
As physicians age, priorities often shift. Many take work-life balance more seriously and evaluate the toll their careers have taken. The additional pressure of recertification can push some to reconsider long-term plans. Instead of viewing retirement as a distant milestone, they may see it as a way to escape the cycle of exams and education requirements. This can exacerbate the trend of early retirement among physicians, who may feel that certification demands add unnecessary burdens to already taxing schedules. Early retirement among experienced physicians can significantly impact patient care by reducing expertise and continuity.
Moreover, the landscape of medicine has evolved, leading to frustration among practitioners. Changes in reimbursement models have increased administrative responsibilities, and the advent of EHRs has made practicing medicine even more challenging. Combined with rigorous recertification, these factors contribute to disillusionment or exhaustion. Physicians may question whether their sacrifices justify working in a system that increasingly restricts both patients and doctors, prompting them to consider leaving early to seek fulfillment or reclaim time.
Financial considerations also play a role. Many physicians are financially prepared to retire earlier than planned due to years of stable income and savings. The increasing costs of certification and CME can weigh heavily on their decision-making.
The controversy over recertification has become so intense that the term “recertification” is sometimes replaced by the more benign “maintenance of certification.” In 20 states, physician-led legal battles have been mounted to prevent medical boards from penalizing doctors who don’t recertify. In response, the American Board of Medical Specialties announced a five-year plan in 2019 to make recertification more convenient, affordable, and feasible. It remains unclear whether these changes have kept pace with the inflation of requirements demanded by for-profit entities.
In conclusion, while physician recertification is essential for ensuring competency, the current system comes at a high cost — and may not prioritize quality care. The combination of personal pressures, professional development, and financial burdens creates a complex dynamic that influences career decisions. Addressing these concerns is essential to retaining experienced physicians and ensuring quality patient care. Potential solutions include flexible recertification timelines, financial support, and emphasis on work-life balance.
How do we improve this situation? I have a few suggestions:
1) Remove recertification from private, for-profit entities. State-run boards could use public health data rather than profit margins to inform their curriculum design.
2) Ensure curricula align with actual practice. As a physiatrist running an adult musculoskeletal practice, I probably don’t need to answer questions about pediatric or cancer pain management.
3) Ensure the required credit hours align with state licensure requirements. If the investment of time is sufficient for licensure, it should also be sufficient for subspecialty certification.
When the mental, physical, and financial health of doctors suffers due to administrative burdens, patients ultimately feel the impact. Adopting practical, independent, and patient-focused approaches to continuing education benefits both physicians and the broader medical community.
How should recertification evolve to keep physicians in practice without compromising patient care? Share in the comments.
Dr. Francisco M. Torres is an interventional physiatrist specializing in diagnosing and treating patients with spine-related pain syndromes and general musculoskeletal disorders. He is certified by the American Board of Physical Medicine and Rehabilitation and the American Board of Pain Medicine. In his free time, he enjoys working out, playing the violin, and spending time with his five grandchildren. He was a 2024–2025 Doximity Op-Med Fellow, and continues as a 2025–2026 Doximity Op-Med Fellow.
Image by Moor Studio / Getty Images
