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Salahuddin Kazi, MD,
Chair, Rheumatology Board

The Rheumatology Board, which meets twice a year and is responsible for oversight of policy and assessment in the specialty, held its spring meeting on March 11, 2025. Representatives from the American College of Rheumatology (ACR) joined for a portion of the meeting*.

The following is a summary report of the spring meeting. Visit the ABIM Blog for reports of prior meetings. To share your feedback with the Rheumatology Board on this report or other issues that are important to you, please complete this brief survey.

ABIM and the Rheumatology Board gratefully acknowledge the service of Susan K. Chrostowski, DNP, APRN, ANP-C, Maryah Mansoor, MD, and Philip Seo, MD, whose terms on the Specialty Board end June 30, 2025.

Contents:

ABIM Leadership Update*

Furman S. McDonald, MD, MPH, President and Chief Executive Officer of ABIM and the ABIM Foundation, joined the Specialty Board to discuss progress on key initiatives and ongoing areas of focus for ABIM, including:

  • Exploring alignment of Maintenance of Certification (MOC) requirement due dates with the Longitudinal Knowledge Assessment (LKA®) cycle to help make the MOC program more reliably predictable.
  • Enhancements made to the LKA in response to feedback from physicians who identified areas for improvement, intended to keep the program relevant and effective.
  • Expanding ABIM’s engagement with stakeholder communities such as early career physicians, specialty societies and patient-focused organizations.
  • Upgrades to the ABIM website and Physician Portal for 2025 designed to make it easier for both physicians and the public to find information.

Salahuddin Kazi, MD, Chair of the Rheumatology Board, asked whether ABIM would ever recognize physicians who score above a certain threshold. Dr. McDonald discussed both the appeal and the challenges of this idea, emphasizing that staying current in medicine is a continuous process with no ceiling. ABIM is exploring ways to recognize physicians for their performance on assessments or doing more than the requirement. Amish J. Dave, MD, MPH, inquired how stressors may contribute to candidates failing the certification examination and Dr. McDonald stated that knowledge gaps were the primary cause, though ABIM provides safeguards to reduce stress like grace periods and consideration of compassionate exemptions for extraordinary life circumstances. Most physicians meet the assessment requirement on their first attempt.

Elise Carlson, MD, asked about the possibility of ABIM collaborating with specialty societies to help them develop study materials for their members, which Dr. McDonald affirmed as a long-term goal. Susan K. Chrostowski, DNP, APR-N, ANP-C, asked whether ABIM will offer continuing medical education (CME) credits through the LKA. Dr. McDonald explained that the LKA provides MOC points for questions answered correctly, but since ABIM is not an accreditation organization, it does not offer CME credit. Thousands of activities are eligible for both MOC and CME via a collaboration with the Accreditation Council for Continuing Medical Education at cmepassport.org.

Specialty Board Oversight of Assessment*

Each spring, the ABIM Specialty Boards review data related to certification and assessment trends in their disciplines to help guide their decisions on assessments. At this meeting, the Rheumatology Board received statistics on the current state of active certification in rheumatology, assessment enrollment, demographics and pass rates, and data from post-assessment surveys. (Some data, such as exam pass rates and resident and fellow workforce trends, are publicly available on ABIM’s website.)

In 2024, 82% of ABIM Board Certified rheumatologists due for an assessment opted for the LKA over the traditional, 10-year MOC exam. Dr. Kazi asked if this rate was expected to continue, and staff explained that while some physicians may choose to return to the traditional exam after their first five-year LKA cycle, many physicians have not yet been eligible to participate since the program’s launch in 2022. Therefore, enrollment may rise as those physicians become due to meet the assessment requirement. On average, physicians who are eligible for an assessment are choosing the LKA at a rate of around 80% across all specialties and multiple years of enrollment. Thousands of subspecialists are also using the LKA to reinstate their lapsed certifications in internal medicine.

Initial Certification and Training Data in Rheumatology*

The Rheumatology Board also reviewed new data from the National Resident Matching Program (the Match), Board Eligibility data and outcomes in rheumatology. Erica N. Johnson, MD, FACP, FIDSA, Senior Vice President for Academic Affairs, added that ABIM provides program directors with aggregate performance data in their programs and, with permission, individual graduate data so that program directors can make adjustments to the programs as needed. ABIM does not contact individual programs with a lower pass rate to initiate changes to the program. She also noted that in cases where physicians do not successfully become board certified within the seven-year period of Board Eligibility, there are opportunities for them to retrain in that discipline. ABIM’s Academic Affairs department reviews requests to retrain. To date, ABIM has approved 78 total (or 100%) of requests to retrain for one year to again become Board Eligible.

Carol A. Langford, MD, MHS, President of ACR, pointed out ACR’s engagement in workforce issues. She reported that ACR and the Rheumatology Research Foundation have both pursued initiatives related to increasing training programs and applicants.

Diplomate Professional Profile*

The Diplomate Professional Profile is a questionnaire built into the ABIM Physician Portal and required of all ABIM Board Certified physicians. The questionnaire gathers information about clinical work and practice patterns, and ABIM uses the information to help update exam blueprints, develop policies for initial certification and MOC, and ensure adequately diverse representation of the profession in research. To date, 44% of physicians have completed the Diplomate Professional Profile. Siddartha G. Reddy, MPH, Senior Research Associate for ABIM, reviewed aggregate data gathered so far related to rheumatologists, including practice type and setting, practice size and ownership of practices.

Dr. Dave noted the Diplomate Professional Profile’s potential outside of Specialty Board discussions with data that could be valuable to patients with specific needs and conditions. He suggested that ABIM work with ACR in the future to publish information about practicing rheumatologists to make it easier for patients to seek rheumatology care from certified physicians in their region.

Community Practice in ABIM Governance*

Dr. Johnson led a discussion with the Rheumatology Board on community practice in rheumatology to create a more inclusive understanding of its role and scope. She also sought input on overlapping aspects of community practice across the disciplines of internal medicine to inform ABIM’s recruitment efforts for broad physician representation in governance roles.

Since 2013, ABIM Specialty Boards have been required to include at least one physician member primarily engaged in community practice, defined broadly in applications as “clinical practice in a non-university, community setting.” A workgroup convened in 2020 found that the existing practice categories candidates could choose were inadequate to the real scope of community practice and proposed updates drawn from the American Medical Association and the Diplomate Professional Profile.

Several members of the Rheumatology Board spoke about the challenges that community rheumatologists face and the need for better training and resources. Dr. Carlson, a community-based private rheumatologist, noted how many community physicians feel excluded from decision-making processes that affect them. She emphasized the unique challenges of private practice, including business models, recruitment difficulties, healthcare system pressures and a disconnect from the certification process, though she acknowledged the growing support for the LKA over the traditional exam. Dr. Dave added that many rheumatologists need better access to resources on contract negotiations, insurance updates and healthcare disparities. Mary C. Wasko, MD, MSc, and Dr. Mansoor underscored disparities between academic and community settings, noting that community rheumatologists referring patients to academic centers are often viewed as practicing “inferior” medicine despite managing complex cases with suboptimal local resources. Dr. Mansoor stressed that fellows train with specialist support that does not truly reflect community practice. She suggested that training programs should better prepare physicians for independent practice in both rural and underserved urban areas.

News from the American College of Rheumatology (ACR)*

Steven Echard, IOM, CAE, Executive Vice President of ACR, updated the Rheumatology Board on advocacy efforts and collaboration with other societies as healthcare policies shift under the current administration. ACR has identified administration and regulatory changes as key advocacy areas and aims to focus resources where they can have the most meaningful impact. ACR operates an office in Washington, D.C., with staff dedicated to legislative and regulatory affairs, lobbying, building coalitions and engaging with policymakers on multiple issues. ACR also maintains a legislative action center for members to access advocacy updates.

Myria Stanley, Senior Director of Educational Programs, shared ACR’s progress on making rheumatology training more accessible through virtual and on-demand education options. ACR hopes to receive final approval by December on an application for joint accreditation that would expand its education offerings for nurses, physician assistants and pharmacists. Finally, she noted several educational events in 2025, including the Division Directors Forum and the Rheumatology Research Workshop, May 19 – 20.

Innovations in Assessment*

ABIM’s Research and Innovations department has been leading a program of research on improving assessments through three main areas: supporting assessment staff efficiency, facilitating the item development process and enhancing the assessment experience for physicians. The Rheumatology Board received an overview of eight current projects related to emerging technology as applied to ABIM’s assessments.

The group discussed how ABIM might include patient characteristics in assessment items to reflect how demographics and medical history factor into real-life decision-making for physicians. Jerome Clauser, Ed.D., Senior Director, Research and Innovations, acknowledged that this is a complex and debated issue. He explained how ABIM is studying the way patient characteristics affect assessment performance with the intention of conducting further research in the future to determine whether these elements should be integrated into the assessment process. Patient characteristics are currently included only if they are essential to the question. The need for further research in this area with physician input is essential.

Annual Diplomate Report*

ABIM is looking into the potential for publishing annual reports of data that will highlight broad statistics across each discipline of internal medicine, both for a given year and historic trends over time. This would include the current number of physicians certified in each discipline and its geographic distribution, participation rates in MOC, demographic characteristics and assessment performance. While some of these data have been made available on request for research purposes, ABIM has never published a consolidated annual report.

The Rheumatology Board reviewed a draft report and provided feedback on how it could be improved to optimize its value to the larger community, such as formatting changes to clarify information and potentially adding data that are currently collected through the Diplomate Professional Profile but do not yet have sufficient responses.

Society guests departed at this point in the meeting.

Candidates for the Rheumatology Approval Committees

ABIM Specialty Boards are responsible for selecting members and chairs of the Approval Committees annually and as needed. At the spring meeting, the Rheumatology Board reviewed candidate materials for four openings and voted to approve the following appointments:

  • Julianna Desmarais, MD, Oregon Health and Science University, to join the Rheumatology Traditional, 10-Year MOC Exam Approval Committee
  • Michael Guma, DO, Optum (formerly Riverside Medical Group), to join the Rheumatology Traditional, 10-Year MOC Exam Approval Committee
  • Jefferson Roberts, MD, Tripler Army Medical Center, to join the Rheumatology LKA Approval Committee
  • Kalyani Govindaraju, MD, Foundation Medical Partners/Southern New Hampshire Health System, to join the Rheumatology LKA Approval Committee

Visit ABIM’s website for a full list of current openings.
Approval Committee openings are usually posted in the fall.

Updates from the Rheumatology Approval Committees

Kenneth S. O’Rourke, MD, Chair of the Rheumatology Traditional, 10-Year MOC Exam Approval Committee, updated the Rheumatology Board on the composition and recent meetings of the two Rheumatology Approval Committees, as well as the Rheumatology Item-Writing Task Force.

ABIM is always looking for physicians to join the Item-Writing Task Forces and help write questions for assessments. Dr. O’Rourke suggested contacting board certified physicians who participated in the ACR CARE program item-writing group to recruit for the task force, and Dr. Dave suggested contacting physicians who participated in the ACR Convergence Knowledge Bowl as well.

Advocacy and Research in Rheumatology

Dr. Johnson led the Rheumatology Board in a discussion about opportunities for ABIM Governance members to participate in advocacy and research that demonstrates the value of board certification. As a 501(c)3 organization, ABIM is under strict limits with regards to political and lobbying activities but may advocate for issues within those limits and consider policy issues in an educational manner. Dr. Johnson asked the Specialty Board to identify current or emerging issues that affect health care in rheumatology, and to consider opportunities for the Specialty Board to address these issues within the appropriate framework of its oversight of the discipline.

Members of the group noted several topics: the challenges of healthcare access for immigrant populations, access to properly administered and monitored injections at home, and shifts in treatment guidelines and insurance provider practices. Physicians are being encouraged to explore costly treatment options earlier, exacerbating healthcare inequities, and changes to traditional insurance plans and payment structures are making it more difficult for physicians to prescribe effective medications.

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