ABIM Board Certification: Nearly Everything You Need to Know
By Debra L. Beck, MSc | Updated: October 3, 2022
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Initial board certification is an important milestone for physicians. Board certification (and recertification) in internal medicine and cardiology is overseen by the American Board of Internal Medicine (ABIM). Below we provide all the details (and links to more information) you need to start this important journey.
Board Certification
Board certification is a voluntary process intended to demonstrate expertise in a specific medical specialty. It differs from medical licensure, which documents the minimum competency required to diagnose and treat patients.
Medical licensure is not specialty-specific and is required to practice medicine in the United States. Board certification is specialty-specific and is not required to practice medicine in the United States. Generally, board certification requires a physician to have a full medical license.
Board certification is something physicians and surgeons are rightly proud of. It takes hard work to achieve and is an important career milestone. Board certification, however, is about more than just bragging rights. It’s also about patient care.
Being board certified has been shown to have a direct impact on patient outcomes (although some dispute this claim). In a recent article published in the Journal of the American Geriatrics Society (AGS), board-certified general internists who were in the top quartile on their ABIM Internal Medicine MOC exam prescribed fewer potentially inappropriate medications to older patients as compared to those who scored in the bottom quartile (Vandergrift JF, et al. J Am Geriatr Soc. 2021;69:3584-3594).
In another 2021 study, top ABIM MOC scorers were less likely (than physicians who performed less well on the examination) to prescribe opioids for back pain when the standard of care shifted away from routine opioid prescribing (Gray BM, et al. JAMA Netw Open. 2021;4:e2115328)
ABIM and the American Board of Medical Specialties (ABMS)
There are a number of different organizations that provide board certification for different medical specialties, but board certification in internal medicine and cardiology is overseen by the American Board of Internal Medicine (ABIM). The ABIM is the only ABMS-approved board to provide board certification in internal medicine and cardiology (cardiovascular disease). The ABIM is one of 24 member specialty boards that make up the American Board of Medical Specialties (ABMS). Through ABMS, the boards work together to establish a common standard for physicians to achieve and maintain board certification.
Together the ABMS member boards certify specialists in more than 150 medical specialties and subspecialties. More than 80% of practicing physicians in the United States have achieved Board Certification by one or more of the ABMS Member Boards.
Some of the other ABMS member boards include the American Board of Dermatology, the American Board of Obstetrics and Gynecology, the American Board of Radiology, the American Board of Pediatrics, the American Board of Surgery, and the American Board of Emergency Medicine. (See the full list below.)
The ABMS Board Certification Database shows that as of June 30, 2021, there were 949,928 U.S. physicians with active board certification in one or more of the 40 specialties and 88 subspecialties approved by ABMS. This includes 253,914 physicians certified in internal medicine, 110,934 in pediatrics, and 97,613 in family medicine.
According to ABMS, there were also 657,814 diplomates participating in continuing certification (also called ‘maintenance of certification’ or MOC). Continuing certification is the ongoing process of board certification that simultaneously supports diplomates in keeping their knowledge and skills current while validating their increasing expertise in a specialty. Both the total number of physicians achieving board certification and the number of physicians opting to participate in continuing education is steadily increasing (see Table below).
(Ref: ABMS Board Certification Report 2020-2021
ABIM Initial Board Certification (in Internal Medicine and Cardiovascular Disease)
ABIM Certification (“Board Certification”) demonstrates that a physician has completed a residency in a specified medical specialty and has passed a rigorous knowledge assessment exam.
“Internists and subspecialists who earn and maintain board certification differentiate themselves from their non-certified peers through their specialized knowledge and commitment to continual, lifelong learning in service of their patients.” (ABIM)
The American Board of Internal Medicine (ABIM) was founded in 1936 in response to a public call for more uniform standards for physicians. It is a physician-led, non-profit independent organization governed by more than 2350 members on more than 50 boards and committees. The majority of the ABIM’s governance members are practicing physicians or interprofessional healthcare team members.
Being ABIM Board Certified means that a physician has “met rigorous standards through intensive study, self-assessment, and evaluation,” according to the ABIM. Board certification also sets the stage for continual professional development through values that are centered on lifelong learning.
In order to be considered ABIM Board Certified, a physician must:
- Complete the requisite predoctoral graduate medical education
- Meet the training requirements
- Meet the licensure requirements and procedural requirements
- Pass the ABIM’s board certification examination
The American Board of Internal Medicine (ABIM) certifies physicians practicing in internal medicine and 21 subspecialties, namely:
- Adolescent Medicine
- Adult Congenital Heart Disease
- Advanced Heart Failure & Transplant Cardiology
- Cardiovascular Disease
- Clinical Cardiac Electrophysiology
- Critical care medicine
- Endocrinology, Diabetes & Metabolism
- Gastroenterology
- Geriatric Medicine
- Hematology
- Hospice & Palliative Care
- Infectious Disease
- Interventional Cardiology
- Medical Oncology
- Nephrology
- Neurocritical Care
- Pulmonary Disease
- Rheumatology
- Sleep Medicine
- Sports Medicine
- Transplant Hepatology
Many subspecialty certifications require initial certification as a prerequisite. So, for example, in order to be board certified in advanced heart failure and transplant cardiology, along with the appropriate subspecialty training and showing required competency, the physician must first be board certified in cardiovascular disease. Again, the ABIM is the only ABMS-approved board to provide board certification in internal medicine and cardiology.
However, since cardiology is considered a subspecialty of internal medicine, in order to become certified in cardiovascular disease, physicians must, at the time of application, be previously ABIM certified in internal medicine. Some subspecialty exams, including the advanced heart failure and transplant cardiology exam, are only given every two years.
A similar path is available for doctors of osteopathic medicine (DO). The American Osteopathic Board of Internal Medicine (AOBIM) administers primary and subspecialty certification exams to graduates in osteopathic medicine. Similar to ABIM board certification, AOA (American Osteopathic Association) board certification is an important quality marker for patients and employers. The AOBIM also oversees osteopathic continuous certification requirements. To obtain certification in cardiology, an osteopath must first obtain primary certification in internal medicine. The osteopath continuous certification process is similar to the ABIM MOC path.
ABIM Board Exam Eligibility
The American Board of Internal Medicine (ABIM) considers all internal medicine and subspecialist physicians who have met the standards for Board Certification in general internal medicine or any of its subspecialties to be “Board Eligible” in the relevant specialty. In most cases, board eligibility lasts for a period of seven years.
The seven-year period of board eligibility begins when the candidate successfully completes the initial certification requirements in their field. During the period of board eligibility, the candidate may apply to take the ABIM board exam in the relevant specialty. If the candidate does not become board certified during the seven-year period of board eligibility, the candidate will no longer be deemed “Board Eligible” and may no longer represent himself or herself as such. Some amount of retraining may be needed to reestablish board eligibility once a candidate has let eligibility lapse.
ABIM Exam Information
2022 ABIM Exam Dates for Internal Medicine and Cardiovascular Disease Certification Exams
For updated exam dates (and for special accommodation exam dates), please refer to the exam information section of the ABIM website.
The Internal Medicine Certification Exam takes approximately 10 hours. The exam lasts one day and is divided into four sessions, each containing up to 60 multiple-choice questions. The 2022 Internal Medicine Certification Exam dates have passed.
In 2023, the Internal Medicine Certification Exam will be offered on August 14, 16, 17, 21, 22, and 28. Registration for this exam opens on December 1, 2022.
This year, the Cardiovascular Disease Certification Exam will be offered on October 27 and 28, 2022. Late registration was accepted until June 28, 2022.
In 2023, the Cardiovascular Disease Certification Exam will be offered on October 9 and 10, 2023. Registration opens on December 1, 2022, and closes on June 15, 2023. Late registration is accepted until June 28, 2023.
The Cardiovascular Disease Certification Exam lasts one and a half days. One full day of the certification examination is devoted to multiple-choice questions, which are administered in four two-hour sessions:
All deadlines are as of 11:59 p.m. ET (Eastern Time) on the dates listed above.
ABIM Exam Fees and Refund Policies for 2022
The cost of ABIM board certification is determined by the exam fee(s) and differs by subspecialty. According to the ABIM’s website, initial certification exam fees are as follows (as of March 2022):
- Internal Medicine Certification Exam: $1,430
- Subspecialty Certification Exams: $2,325 (except for Adult Congenital Heart Disease, Advanced Heart Failure & Transplant Cardiology, Transplant Hepatology, Cardiovascular Disease, Interventional Cardiology, and Clinical Cardiac Electrophysiology)
- Subspecialty Certification Exam in Cardiovascular Disease: $2,480
- Subspecialty Certification Exams: $2,995 for Adult Congenital Heart Disease, Advanced Heart Failure & Transplant Cardiology, Transplant Hepatology, Interventional Cardiology, Clinical Cardiac Electrophysiology, and Neurocritical Care
- Non-refundable Late Registration Fee: $400 **
- International Test Center Fee: $500 (waived for active members of the military.)
These fees are only for initial certification and do not apply for Maintenance of Certification (MOC).
ABIM Refund Policies
The ABIM has strict refund policies for which there are no “extenuating circumstances” that will result in an exception to said policies.
- 70% of the exam fee will be refunded if cancellation is received 48 hours prior to the exam date. (Example: For exams scheduled for October 11, the cancellation deadline would be 11:59 p.m. ET on October 9.) Candidates taking the Neurocritical Care Certification Exam can cancel until 96 hours prior to the exam. date per American Board of Psychiatry and Neurology policies.
- 55% of the exam fee will be refunded when cancellation is received less than 48 hours prior to the exam date.
- 85% of the exam fee will be refunded if your application is disapproved.
- Active military personnel may be eligible for additional exam refunds. E-mail request@abim.org for more information.
Cancellations should be done through the ABIM Physician Portal and the candidate will receive immediate confirmation of the transaction. ABIM will not accept cancellations by phone.
ABIM Practice Exam
The ABIM provides candidates with a comprehensive “what to expect on exam day” section on their website. The page includes all the details about exam day, like what time to arrive, how the exam works, examination policies, and what is permitted in the exam room.
They also provide an online tutorial for each examination that provides instructions and practice activities to prepare test takers for the navigation and functionality of the testing application. You are encouraged to complete these tutorials before exam day. These tutorials are not actual exams and do not include actual exam questions, nor do they represent the real exam questions in content or difficulty.
The tutorials allow test takers to view the exam interface, practice using exam features including notes, strikethrough, and highlight, and access exam resources, including tables or normal laboratory values. For the cardiovascular disease examination, for example, there is also a tutorial on how to answer ECG and imaging study questions on the exam.
These tutorials can be found on the ABIM website, specific to each exam.
ABIM Exam Format | Exam Blueprint
For each of the ABIM certification exams, an exam blueprint is provided that outlines the percentage of each content area that candidates should expect to see on any given exam.
All of the current ABIM internal medicine and subspecialty exam blueprints and MOC exam blueprints can be found here. Blueprints show content specifications for each exam. They include an outline of the content areas and their approximate percentages for a typical exam.
It should be noted that multiple editions, or “forms,” of each exam are used, and they may differ in question order and content. The exam is administered on 24” monitors with a widescreen display.
Depending on the topic area, some questions require the interpretation of illustrative materials such as electrocardiograms, radiographs, and photomicrographs (e.g., blood films, Gram stains, urine sediments).
An ABIM exam tutorial is available to provide instructions and practice activities to prepare test takers for the navigation and functionality of the testing application. This tutorial can be accessed on the ABIM website even before a candidate registers for the exam.
ABIM Internal Medicine Board Exam Blueprint
The internal medicine board exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the certified internist in the broad domain of the discipline, including the ability to make appropriate diagnostic and management decisions. The exam will test the candidates’ familiarity with both common and rare clinical problems likely to be seen by an internist.
Exam content is determined by a pre-established blueprint, or table of specifications, developed by ABIM with the input of trainees, training program directors, and certified practitioners in the discipline.
The primary medical content categories of the blueprint are shown below, with the percentage assigned to each for a typical exam:
The internal medicine initial board certification exam is composed of up to 240 single-best-answer multiple-choice questions, of which approximately 35 are new questions that do not count in the examinee’s score.
A tutorial including examples of the ABIM exam question format can be found at http://www.abim.org/certification/exam-information/internal-medicine/exam-tutorial.aspx. The primary medical categories can be expanded for additional detail to show topics that may be covered in the exam. Each primary medical content category is listed below, with the percentage of the exam assigned to this content area. Below major categories are subsection topics and their assigned percentages in the exam.
ABIM Cardiology Board Exam Blueprint | Cardiovascular Disease Board Exam Blueprint
The cardiovascular disease initial board exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of a physician board certified in cardiovascular medicine. The pre-established blueprint, also called the table of specifications, can be found here. (please note that the exam blueprint for the 10-year Maintenance of Certification (MOC) exam in cardiovascular disease is different. It can be found here.)
The cardiovascular disease initial board certification exam spans 1.5 days. The first day is devoted to multiple-choice questions, which are administered in four two-hour sessions, with optional breaks between sessions. The half-day portion of the exam is reserved for the electrocardiograms and imaging studies component of the exam (see below).
The blueprint is developed by ABIM and reviewed annually. ABIM solicits feedback from trainees, training program directors, and certified practitioners in the discipline to inform changes to the blueprint. The exam is composed of up to 240 single-best-answer multiple-choice questions, of which approximately 40 are new questions that do not count in the examinee’s score.
A tutorial including examples of ABIM exam question format can be found at http://www.abim.org/certification/exam-information/cardiovascular-disease/examtutorial.aspx.
Blueprint for the Half-Day, Electrocardiograms and Imaging Studies Component of the Cardiology Board Exam
On the second day of the cardiovascular medicine board examination, cardiovascular disease initial certification candidates will be evaluated on their ability to interpret electrocardiograms and imaging studies. Physicians pursuing recertification (also called maintenance of certification or the MOC exam) in cardiovascular medicine are not required to take this portion of the exam. The pre-established blueprint, also called the table of specifications, can be found here.
The electrocardiogram session is two hours followed by an optional 20-minute break. The imaging studies session, comprising echocardiograms and coronary angiograms, is two hours and 15 minutes.
This part of the exam may require recognition of common as well as rare clinical problems for which patients may consult a cardiologist. As with the full-day part of the exam, the content is determined by a pre-established blueprint, or table of specifications, reviewed and updated as needed by the ABIM.
Here are the content categories of the half-day ECG and imaging section of the cardiovascular medicine exam:
The exam is composed of up to 75 questions, of which about 10 are ‘test’ questions that do not count towards your score. The question formats used in this section of the exam require diagnostic interpretation of electrocardiograms, echocardiograms, and coronary angiograms. The format comprises a brief patient description and one (or multiple) images.
The ABIM provides some sample cases to help test takers become more familiar with the exam format, as well as an interactive ECG and Imaging Studies exam tutorial. Test takers are encouraged to complete the tutorial before exam day.