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Family physicians now have a new pathway to renew their board certification — a “longitudinal” assessment versus the high-stakes, one-day exam.

Fam Pract Manag. 2022;29(5):6-11

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Author disclosure: no relevant financial relationships.

This year marks an important milestone for family medicine physicians who have been involved in the maintenance of their board certification. Both MDs and DOs can now elect to forgo the high-stakes, one-day recertification exam and instead participate in a longitudinal assessment pathway. This pathway is offered by the American Board of Family Medicine (ABFM), which first piloted it in 2019, and the American Osteopathic Board of Family Physicians (AOBFP). This article will explore the evolution of maintenance of certification and review the requirements to successfully navigate this new pathway.


  • Physician recertification requirements have evolved over the years, with most boards requiring some sort of maintenance of certification and an exam.

  • Starting in 2022, family physicians seeking recertification with the ABFM or AOBFP can forego the high-stakes, one-day exam and instead take a “longitudinal” exam.

  • Despite its costs and hassles, board certification is a worthwhile pursuit for most physicians because of employer requirements, payer requirements, and expectations among the patient population served.


To formalize a set of standards across specialties, physicians established the American Board of Medical Specialties (ABMS) in 1933 and the American Osteopathic Association Bureau of Osteopathic Specialists (AOA BOS) in 1939. Diplomates were issued lifetime certificates after passing their certification examinations. Another organization, the American Board of Physician Specialties (ABPS) was established in 1952 by a group of osteopathic surgeons who completed allopathic residencies and were not allowed to be board certified through the ABMS (because they were DOs) or the AOA (because they did not complete an osteopathic residency). Thus, they created their own certifying body and became the first organization to board certify both DOs and MDs in 1960.1

These organizations gave way to specialty specific certifying bodies, including the ABFM in 1969 and the AOBFP in 1972.

Medical knowledge in today’s world is far different than it was when the first board organizations were established. It is estimated that the doubling time of medical knowledge in 1950 was 50 years, and by 2020 it was just 73 days.2 As patients and payers became concerned about doctors keeping up with the rapid changes in medicine, most boards transitioned from lifetime certification to time-limited certification. Time-limited certification eventually became accompanied by continuous assessment programs called maintenance of certification (MOC). The ABFM’s MOC requirements began in 2004.

Developing these MOC programs became a challenging process that also came with controversy. Beyond being expected to possess a satisfactory fund of medical knowledge, physicians were now being asked to complete practice modules, earn CME credits, and submit practice improvement data. These newer requirements had additional expenses and hassles, which were compounded by the fact that physicians were still required to take and pass recertification examinations as well. This frustrated many physicians and became a rallying point for approximately 20,000 internal medicine physicians who signed a petition of protest in 2014 against the American Board of Internal Medicine (ABIM). This led to the establishment of the National Board of Physicians and Surgeons (NBPAS) in 2014, which would provide an alternative recertification pathway. The NBPAS criteria for recertification do not involve a recertification exam or continuous assessment. Its requirements include previous ABMS or AOA certification, earning a minimum of 50 CME credits within 24 months of recertifying, a valid and current medical license, and (if applicable) possession of hospital or outpatient facility privileges and maintenance of medical staff appointment/membership for at least 24 months.3

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