Effectiveness of written and oral specialty certifcation examinations to predict actions against the medical licenses of anesthesiologists

Background: Te American Board of Anesthesiology administers written and oral examinations for its primary certifcation. Tis retrospective cohort study tested the hypothesis that the risk of a disciplinary action against a physician's medical license is lower in those who pass both examinations than those who pass only the written examination. Methods: Physicians who entered anesthesiology training from 1971 to 2011 were followed up to 2014. License actions were ascertained via the Disciplinary Action Notifcation Service of the Federation of State Medical Boards. Results: Te incidence rate of license actions was relatively stable over the study period, with approximately 2 to 3 new cases per 1,000 person-years. In multivariable models, the risk of license actions was higher in men (hazard ratio = 1.88 [95% CI, 1.66 to 2.13]) and lower in international medical graduates (hazard ratio = 0.73 [95% CI, 0.66 to 0.81]). Compared with those passing both examinations on the frst attempt, those passing neither examination (hazard ratio = 3.60 [95% CI, 3.14 to 4.13]) and those passing only the written examination (hazard ratio = 3.51 [95% CI, 2.87 to 4.29]) had an increased risk of receiving an action from a state medical board. Te risk was no different between the latter two groups (P = 0.81), showing that passing the oral but not the written primary certifcation examination is associated with a decreased risk of subsequent license actions. For those with residency performance information available, having at least one unsatisfactory training record independently increased the risk of license actions. Conclusions: Tese fndings support the concept that an oral examination assesses domains important to physician performance that are not fully captured in a written examination.