Why Are So Many Younger Doctors Failing Their Boards?

Why Are So Many Younger Doctors Failing Their Boards?


An interesting conversation recently took place among residency program directors in my field of Internal Medicine.

At issue was the declining pass rate of first-time test takers of the ABIM Certification Exam.

It’s a mouthful to say, but the ABIM exam is the ultimate accolade for internists; one is only eligible to take the exam after having successfully completed a three-year residency training period (the part that includes “internship,” right after medical school).

An easy analogy is to say that the board exam is for a doctor what the bar exam is for a lawyer. The difference is that a doctor can still practice if s/he does not pass–they might be excluded from certain jobs or hospital staffs; but certification, while important, is a bit of gilding the lily. [Licensure to practice comes from a different set of exams.]

There’s no doubt it’s a hard test. I was tremendously relieved to have passed it on my first try. Over the last few years, the pass rate for first time takers has fallen from ~90% to a low of 84%.

It may not seem significant, but for 7300 annual test takers, the difference in pass rates affects about 365 people–or one additional non-passing doctor for every day of the year.

In any event, we program directors have taken note. And the falling pass rate has raised questions:

  • Has the test increased in difficulty? No, says the ABIM.
  • Are the study habits of millennials not up to the level of Baby Boomers and Gen X’ers? Now you may be on to something.

One concern that has a ring of truth to it is that young doctors have become great “looker-uppers,” and have lost the sense of what it’s like to actually read and study medicine. While doctors enter the profession with a commitment to lifelong learning, some of us fear that the young folk only go far enough to commit to lifelong googling.

Another key point: in today’s era of restricted work hours, something has to give. Too often, when residents must complete the same amount of work in a limited amount of time, what’s sacrificed is the didactic portion of the education: the stuff we do by running through case after case, discussing subtleties and action plans. When time is limited, the work’s simply gotta get done.

There’s even a term that describes this phenomenon: Work compression.

John H. Schumann, MD is a general internist and medical educator at the University of Oklahoma School of Community Medicine in Tulsa, OK . He is also author of the blog,GlassHospital (@GlassHospital), where this post originally appeared.

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18 Comments on "Why Are So Many Younger Doctors Failing Their Boards?"

Jan 24, 2015

So many well developed comments about a flawed process. Unfortunately, the whole system is being controlled by IT geeks that are also physicians and IT specialists. This brings a whole plethora of new methods for qualifying tests and particular questions. Bottom Line: From the start they left out the most important test of this new system before going live. That is test it to break it. We are dealing with the aftermath of their having failed to do this test. The test taking physicians are the guinea pigs that should have come before going live.

Lastly, a plea. I have to take this thing myself this year, even though in most other areas of medicine I should have been grandfathered in as my initial board had no reference what soever to a limitation.
Help me find the best board prep course. Please.

Thank you.

Jan 23, 2015

If a school faculty had a high failure rate in his class, he will be warned by the school and subsequently fired. When would you realize that Board Certifications are overrated? This is a disguise under which an evil business model runs. Make Boards fair, nondiscriminatory, ethical and moral and true TESTS of knowledge, skills and competency and not just a moneymaking conglomerate!!!

Jan 23, 2015

An easy analogy is to say that the board exam is for a doctor what the bar exam is for a lawyer.

This totally absurd. Doctors practice medicine because they have passed their curriculum examination and Licensing examination. They do not practice medicine just because they have Board Certification. Attorney’s Board is totally different. ABIM and ABOphthalmology exam concepts and focus have been very very different. ABIM is creating a megamachine business model to test and retest and keep “them coming back.” An ideal Board should pass majority of candidates due to sufficient knowledge, skills and competency. If a Board does not pass enough candidates, there may be problem with questions, wording and tricky scenarios.




A Better Question
Jul 21, 2014

I’d like to know: why are so many doctors who passed the initial ABIM certifying exam 10 years ago now failing the RE-certifying exam? The pass rate of the initial certifying exam has remained in the 84-88% range the last 5 years while the pass rate for the recertifying exam went from the 84-90% range from 2009-2012 to 78% in 2013? And it didn’t get better in 2014 so far– the overall pass rate on the spring recertfying exam was 65%. Look it up.

If we’re supposed to believe that medical education and training is so inadequate that our latest graduates are unprepared, what is the explanation for the graduates of 10 years past not being able to pass the recertifying exam?

Don’t you think it just MIGHT be because the ABIM is intentionally making the exam more difficult? And if you want to know why they would do that– don’t you think it would be to push through their MOC narrative that nobody asked for or cared about or thinks is anything more than money into the pockets of the ABMS and its other corporations?


Ils reposent sur un concept d’ordinateurs portables proches des netbooks (léger et économique) animé par le système d’exploitation Chrome OS qui organise toutes ses fonctionnalités autour du cloud (donc du web), notamment en ligne sur où il est en précommande depuis le 15 juin.48%) et Altice (24, La réorganisation de lentreprise intervenue en mai dernier sest inscrite dans cette logique. et se rend indispensable pour jongler avec les différents formats vidéos et audio (MPEG-1, VLC Media Player est un élément important de FreePlayer,01 pour Windows?Le système de jeu est simple, la sortie grand public du photophone Lumia 1020 et son capteur de 41 mégapixels. malgré quelques divergences dans leurs estimations respectives.

Jul 18, 2013

Reading “The Creative Destruction of Medicine” by Eric Topol, M.D. shows one possible future, as well.

Jul 18, 2013

“Focus exams closer to real practice.” Brilliant.
‘Beware Nostalgiaitis Imperfecta’. Again, brilliant.

There is, however, a missing educational component that we discovered in corporate America. We called these the Critical Success Factors for Learning.”

Technology dependency is still dependency.

Jul 3, 2013


Re: your points:

Re: 1 – Eric Holmboe (renowned medical educator and internist) just wrote on his twitter account: ‘Beware Nostalgiaitis Imperfecta’. Genius.

Re 2- Love the point of view you and Dr. Hersh have stated: “Focus exams closer to real practice.”

There are probably a bunch more factors, and we can likely innovate faster than what we have done in the past. Technology is exponential, and we have not grown even linearly. 😀

I wrote a longer reply at this site – http://t.co/CuvwWXHsAF – in defense of my fellow GenY/Millennial folks 😀


Jul 2, 2013

This “Gilding the lily” as you call it raises the question of what is the motive for having this exam in the first place? Essentially, it seems like justification for our high salaries. If we have to pass a really hard exam, then we are worth the $200k. No one seems to be asking if IM physicians really need to know all the stuff on the exam to be competent physicians. Is someone a better doctor because they can name – off the top of their head – the drug used to treat a pregnant woman with syphilis who happens to be allergic to penicillin? Frankly, I’d prefer my doctor to take the 15 seconds it takes to google that than try to remember it from their med school training.

ABIM of course would say the exam isn’t harder. Unfortunately, they have an incentive to justify these high salaries, and having less people pass increases that cache. We should do a couple things:
1. stop criticizing young trainees because they’re “different” than the old guard – they’re less empathetic, they’re less dedicated, they’re chronic googlers. Seriously, you’re just revealing your age and grumpyness. Hey kids, get off my lawn! Yawn.
2. Focus exams closer to real practice like what Dr. Hersh suggested above. People whined when kids could use calculators for math and science exams; now they are considered an accurate reflection of the skills kids need when they’re outside the classroom. I know medicine is about 50 years behind any educational or operations management innovations, but lets try cutting that down to, say, 10 and we’ll be in much better shape


I agree this development is a concern, but before we ascribe blame to health IT, Gen Y/millenial laziness, or anything else, can we see some data supporting the assignment of blame? Let’s not let this finding be a Rorschach test for everything each of us does not like about medicine, healthcare, or society.

In the meantime, however, I have a more fundamental question: Is an exam like the ABIM the best indicator of how a physician best applies his or her knowledge to the optimal care of patients? In other words, when it comes to applying knowledge to real patients, does it matter whether the knowledge resides in the physician’s head or is easily accessible on a computer? Do we want performance on this test to be the standard by which we judge the competence of physicians? I thought we were getting away from that approach.

Instead, why don’t we test physicians by some sort of vignette process, whereby they are presented with a case, armed with their brain, their computer, and anything else they want to use? Then we can see who orders the right tests, prescribes the right treatment, etc.?

Jul 1, 2013

The American Board of Pediatrics has an even lower pass rate than the ABIM, it has been hovering around 70-75% for the past 20 years.

Jul 1, 2013

Interesting post- I did hear the question banks did need to get refreshed after a board review cheating scandal a few years ago…

infusing new questions into the pool (esp if they did not have time to test the questions) could make the test harder…just a thought. it does not likely explain everything, but its just something to consider.

i wonder if ACP – ITE exam scores have been going down at this same time – that may speak to something that is more intrinsic to residents or their training – as opposed to something specific with the test.

Jul 1, 2013

Or perhaps the exam is harder.

What did you expect the ABIM to say?

Happy Hospitalist
Jul 1, 2013

What affect is lower objective academic standards for med school acceptance to increase diversity having on the objective success rate down stream? Perhaps it’s something to study and define.