Appendix 1 — History of Medical Certification

In response to the growth of substandard for-profit medical education in the early 20th century, the Carnegie Foundation commissioned a comprehensive evaluation of every medical school in the U.S. and Canada. This study resulted in the 1910 publication of the Flexner Report, which subsequently helped tie medical schools closely to universities and firmly established the quest for scientific knowledge as the heart of medicine, raising the standard of medical education and making the United States the world’s leader in medical research [1]. This new culture of reform inspired physicians to seek clarification of their training and qualifications and to establish more formal and consistent postgraduate education in their specialties. Furthermore, this led to the development of specialty boards to test and certify within each subspecialty area of medicine. The first such board was the American Board of Ophthalmology, formed in 1916 [2].

In June 1933, then-existing specialty boards formed the Advisory Board for Medical Specialties, later renamed the American Board of Medical Specialties (ABMS). Today, “The ABMS and its 24 member boards are aiming higher to improve the quality of healthcare by elevating the discipline of specialty medicine through board certification” [3]. The 24 ABMS member boards, including the American Board of Radiology (ABR), have authority over approximately 900,000 doctors nationwide [3].

In the early 1930s, five radiology organizations worked together to conceptualize a board “to provide examinations for certifying physicians as specialists in the discipline of radiology” [4]. These sponsoring organizations were the American Roentgen Ray Society, the Radiological Society of North America, the American Radium Society, the American College of Radiology and the American Medical Association Section on Radiology, although these groups no longer have a direct role in the conduct of the ABR [4]. The ABR was incorporated in January 1934 in Washington, DC, and became a member board of the ABMS in 1935. (See Table 1 for a chronology of the ABMS and ABR.)

The ABR began certification testing in 1934 [4] and currently provides primary certification in four radiology specialties: diagnostic radiology, interventional radiology, medical physics and radiation oncology. It also provides separate certifications in hospice and palliative care, neuroradiology, nuclear radiology, pain medicine and pediatric radiology [5].

Following a reorganization in 2016, the ABR’s Board of Governors became the governing body of the organization, currently consisting of nine members [6]. The Board of Trustees plays an important role as subject matter experts in support of item-writing committees and other components of exam development; however, they do not have the fiduciary duties of governance. The objectives and purposes of ABR, as listed in its bylaws, include “to issue certificates to qualified and competent candidates in the specialties and subspecialties of the ABR” and “to promote lifelong and continuous learning, professional growth, quality and competence through its MOC programs. …” [6]. Also, ABR representatives have stated that “physicians are not the primary relevant stakeholder group. … The ABR considers patients to be key stakeholders in the competency of practicing physicians” [7].

Table 1



1916 First medical board formed: American Board of Ophthalmology
1933 Formation of the Advisory Board for Medical Specialties, later renamed American Board of Medical Specialties (ABMS)
1934 ABR was incorporated and began certification testing
1935 ABR became a member of ABMS 
1973 ABR began offering voluntary recertification 
1997 American Board of Internal Medicine began developing a Maintenance of Certification (MOC®) system 
2000 ABMS adopted MOC as a policy
2002 ABR began only offering 10-year time-limited certification
2006 ABR required all time-limited certificate holders to participate in MOC 
2012 ABR shifts from time-limited certification to continuous certification 
2019 ABR changes from a 10-year recertification exam to Online Longitudinal Assessment (OLA) 


  1. The Physicians Foundation. 2018 Survey of America’s Physicians: Practice Patterns and Perspectives. September 2018. Accessed July 9, 2020.
  2. American Board of Medical Specialties. ABOP celebrates 100 years. Published February 17, 2016. Accessed July 9, 2020.
  3. American Board of Medical Specialties. About the American Board of Medical Specialties. Accessed July 9, 2020.
  4. The American Board of Radiology. Our history. Updated May 16, 2017. Accessed July 9, 2020.
  5. The American Board of Radiology. Our certificates. Updated March 22, 2019. Accessed July 9, 2020.
  6. The American Board of Radiology. Bylaws of the American Board of Radiology. Updated April 18, 2016. Accessed July 9, 2020.
  7. Kaufman JA, Gordon T, Flemming D. Broadening stakeholder perspectives on Maintenance of Certification research. Am J Roentgenol. 2020;214(5):W82.