Our database of 129,867 matriculants in the national 1993–2000 cohort included 88,263 matriculants who had graduated before 2003. Of these 88,263 graduates, 4018 graduates had completed the Graduation Questionnaire and indicated the intent to become certified in surgery. Of these 4018 graduates eligible for inclusion in our study based on their Graduation Questionnaire intention to become certified in surgery, we excluded 156 (3.9% of 4018) graduates who, according the AAMC GME track records, did not initially enter GME in general surgery. We also excluded 407 (10.1% of 4018) graduates who were otherwise eligible for inclusion in our study because they completed the Graduation Questionnaire, indicated the intention to become certified in surgery and entered GME in general surgery, but who, according to AAMC GME track records, had completed only preliminary training at the general surgery training programs they had intially entered after graduation from medical school. Of the remaining 3455 graduates who were thus fully eligible for inclusion in our study, our final study sample included 3373 graduates (97.6%) with complete data for all variables of interest. Of these 3733 graduates, 2036 (60.4 %) were ABS-BC, 342 (10.1 %) were other-BC, and 995 (29.5%) were non-BC.
Descriptive statistics for all graduates in the study sample grouped by board certification status are shown in . There were significant differences observed in chi-square tests of the associations between ABS-BC and other-BC graduates on the basis of of gender, age at graduation and Step 2CK results. Of the 342 other BC graduates, 56% (191/342) were initially certified by one of three ABMS-member boards that included the American Board of Anesthesiology (n = 90), the American Board of Family Medicine (n = 52) and the American Board of Radiology (n = 49). Of the remaining 151 other-BC graduates, 61 (61/342, 17.8%) were initially certified by those ABMS-member boards that broadly encompass surgical specialties, including the American Board of Plastic Surgery (n = 25), the American Board of Otolaryngology (n = 9), the American Board of Thoracic Surgery (n = 9), the American Board of Urology (n = 7); the American Board of Ophthalmology (n = 6), the American Board of Obstetrics and Gynecology (n = 3) and the American Board of Orthopedic surgery (n = 2). Also shown in , there were significant differences observed between ABS-BC and non-BC graduates on the basis of graduation year, gender, race/ethnicity, age at graduation, total debt at graduation, USMLE Step 1 results, USMLE Step 2CK results and medical-school ownership. Results of the multivariable logistic regression model that compared other-BC to ABS-BC graduates are shown in . Graduates who were women, > 26 years old at graduation, and initially failed Step 2CK were more likely to be other-BC compared to ABS-BC; graduates who rated the quality of their surgery clerkship more highly were less likely to be other-BC compared to ABS-BC.
Characteristics of Graduates Certified by the American Board of Surgery, Certified by other American Board of Medical Specialties Member Boards and Non-Board Certified Graduates
Predictors of Being other American Board of Medical Specialties-Member Board Certified and Non-Board Certified each Compared with American Board of Surgery Certified*
also shows results of the two multivariable logistic regression models comparing non-BC graduates with ABS-BC graduates; one model included all non-BC graduates and all ABS-BC graduates in the study sample, and the second model included only those ABS-BC and non-BC graduates in the sample who were practicing in surgery. Primary specialty of practice data from the American Medical Association Physician Masterfile in 2009 indicated that 93.0% (1893/2036) of the ABS-BC graduates and 76.8% (764/995) of the non-BC graduates in our study sample were practicing in surgery. In both models, graduates who were women, URM race/ethnicity, Asian/Pacific Islander race/ethnicity, > 28 years old at graduation, graduated in more recent years, graduated from privately owned medical schools, initially failed Step 1 and either initially failed Step 2CK or obtained Step 2CK scores in the lowest tertile of passing scores were more likely to be non-BC compared to ABS-BC. In the second of these two models only, graduates from medical schools in the South were less likely than graduates from medical schools in the Northeast to be non-BC compared to ABS-BC.
Total debt at graduation and medical school research-intensity were not independently associated with board-certification status in any of the three models examined.