It was 1976 when the first diplomates sat for the family medicine recertification exam. To recertify, they also had to meet other requirements, including the completion of 300 hours of CME. The certifying board, the American Board of Family Practice, has since changed its name to the American Board of Family Medicine (ABFM) and, in 2012, expanded its maintenance of certification (MOC) program. These changes meant that diplomates’ certificates only remained valid if they continually met ABFM’s MOC requirements.

As with physicians in other specialties, Family Medicine doctors found the requirements to be burdensome. Although still controversial, ABFM has reformed its program to respond to feedback from physicians while still striving to meet its objectives of ensuring diplomates stay current with best practices in medicine, adhere to essential professional standards, and continually engage in the pursuit of medical knowledge. In 2019, ABFM made its largest shift when it began offering the Family Medicine Certification Longitudinal Assessment (FMCLA) as an alternative to passing the high-stakes recertification exam.

There is a lot of information to sort through to understand what is needed to stay certified, which is why we wrote this guide. We hope it will help you learn about your assessment options and clarify the other requirements for maintaining your Family Medicine certification.

ABFM Maintenance of Certification (MOC)

ABFM MOC refers to the ongoing continuing medical education and assessment program family medicine physicians participate in to maintain their board certification. However, ABFM no longer refers to the program as “Maintenance of Certification (MOC)”. Instead, Family Medicine MOC is now called Family Medicine Certification.

2023 ABFM Continuous Certification Requirements2023 ABFM Continuous Certification Requirements

ABFM Continuous Certification consists of ongoing activities that, according to ABFM, collectively demonstrate to the public and other stakeholders a physician’s commitment to professionalism, self-assessment and lifelong learning, cognitive expertise, and performance improvement (PI). These values are integrated into the Family Medicine Continuous Certification process, outlined below.

In addition to maintaining a valid, unrestricted, and unchallenged license plus staying current on annual ABFM fees, Family Medicine physicians must meet the following ongoing requirements to stay certified:

  1. Earn 150 Continuing Medical Education (CME) credits every three years
  2. Earn 50 Self-Assessment and Performance Improvement (PI) points every three years
  3. Demonstrate Cognitive Expertise either by passing the traditional 10-year exam or by participating in and passing FMCLA

The tables below provide the detailed information about each of these requirements.

ABFM CME Requirements

1. Earn 150 Continuing Medical Education (CME) Credits every three years

ABFM CME Requirements
ABFM CME (continuing medical education) is a key element of the ABFM Continuous Certification Process. To remain certified, Family Medicine Physicians need to earn 150 CME credits every three years. At least half of the 150 credits need to be Division I credits. Division I credits can be earned through various activities ranging from scientific sessions sponsored by hospitals or medical associations to digital learning media, such as NEJM Knowledge+ Family Medicine Board Review. Two types of CME that qualify as Division I credits are AMA Category I CME or AAFP prescribed CME credit.
AMA PRA Category 1 Credits™
AMA PRA Category 1 Credits™ can be earned with activities that receive the blessing of the Accreditation Council for Continuing Medical Education (ACCME) or authorized state medical society CME providers.
AAFP Prescribed Credits
AAFP Prescribed Credits can be earned through activities that are designed chiefly for physicians and focus primarily on patient care and care delivery. To qualify as an AAFP Prescribed credit, activity design must involve an active or lifetime AAFP member physician who ensures the content is relevant to the Family Medicine specialty.
*NEJM Knowledge+ Family Medicine Board Review allows you to earn up to 348 AMA PRA Category 1 Credits™ and 348 AAFP Prescribed Credits*. Click here to learn more.

ABFM KSA and Performance Improvement (PI) Activities

2. Earn 50 Family Medicine Certification Points every three years by completing Self-Assessment and PI Activities:

  1. Knowledge Self-Assessments (KSAs)
  2. Performance Improvement Activities
  3. Additional KSA Activities
a. 10 points from Knowledge Self-Assessment (KSA) — FM Physicians have three options for meeting this requirement:
Option 1: 1 KSA — Complete at least one of these ABFM activities that target a single topic such as diabetes, heart disease, pediatric care, or an area of mental health.Option 2: Participate in 4 Continuous Knowledge Self-Assessments (CKSA) that each involves answering 25 computer-based questions covering various family medicine topics.Option 3: Read/Answer Questions for 10 ABFM National Journal Club (NJC) Articles — Read at least ten NJC peer-reviewed research articles and correctly answer the four corresponding assessment questions. (Diplomates have unlimited opportunities to redo the questions.)
b. 20 points from Performance Improvement (PI) Activities
Earn 20 points every three years by completing a PI project developed by ABFM or an approved provider. These activities help physicians identify opportunities to improve their practice and delivery of patient care, create improvement plans, and then use data to measure the efficacy of their efforts.
a. 20 points from the Physician’s Choice of KSA and/or PI Activities
Earn 20 additional points through the physician’s choice of KSA, PI, or other ABFM-approved activities.

FMCLA and ABFM Recertification Exam

3. Demonstrate Cognitive Expertise

In conjunction with the above Self-Assessment and Lifelong Learning and Performance Improvement requirements, diplomates must also demonstrate Cognitive Expertise by passing the ABFM Certification exam every ten years OR by participating in and passing the Family Medicine Certification Longitudinal Assessment (FMCLA).
ABFM Certification ExamFamily Medicine Certification Longitudinal Assessment (FMCLA)
The traditional in-person Family Medicine certification exam is offered twice a year, in April and November. According to ABFM, the purpose of the exam is to “measure the knowledge that sets board-certified family physicians apart from non-physicians and other non-certified medical practitioners with less training and experience,” and affirms for the public “that you are up to date and aware of best practices in medical care in the total breadth of family physicians . . .”Beginning in 2019, Family Medicine physicians who were due to renew their ABFM Certification could opt to participate in ABFM’s FMCLA pilot. FMCLA, an alternative to the in-person exam, has since become a permanent fixture in the ABFM Continuous Certification process.
Fast facts about the FM Certification Exam:

  • The test consists of 300 multiple-choice, single-best-answer questions broken into four 95-minute sections with 100 minutes of optional break time to be used at your discretion.
  • The exam is offered at and proctored by Prometric testing locations.
  • Exam topics include community medicine, adult medicine, maternity care, gynecology, and care of neonates. View the full breakdown of content covered in the ABFM Blueprint.
  • The test is computer-based and allows you to flag items you wish to revisit while still in the current section. You can also highlight question content, cross out answer choices, and review a list of completed or flagged questions. You can not return to questions if the time for that section has expired.
  • You can try an exam tutorial from ABFM to familiarize yourself with computer-based testing.
Fast facts about FMCLA:

  • Participants need to answer 300 of the 400 questions that are delivered over four years with 25 questions offered each quarter.
  • Test-takers can work on the assessment online from anywhere on any device.
  • Physicians who sign up for FMCLA are required to engage in “meaningful participation” meaning they must answer (correctly or incorrectly) at least 75 of the 100 questions they receive in their first year.
  • Questions are multiple choice with a single-best answer. The breakdown of topics can be found in the ABFM Longitudinal Assessment Blueprint.
  • Five minutes are provided to answer each question and participants can tackle one question at a time, all the questions at once, or anything in between.
  • Almost any point-of-care resource can be used when answering questions, but examinees are not permitted to consult with other individuals.
  • If meaningful participation is not met in the first year or the minimum passing standard is not achieved at the end of four years, diplomates will be required to pass the one-day exam to retain their certification.

How to Prepare for the ABFM Certification Exam

Many physicians will prefer the one-and-done aspect of the traditional exam so they need not worry about the assessment portion of Family Medicine Continuous Certification for ten years. If you decide to take the exam, you’ll want to develop a preparation plan based on your study style and the time you have until exam day. Additionally, you’ll want to maximize your preparation time with effective study strategies and ensure you know what to expect on the big day by reading, ABFM Exam Day Essentials — Everything You Need to Know About the Day of the Test. You may also want to learn with your colleagues by starting a study group to create accountability and stay committed to your plan.

NEJM Knowledge+ Family Medicine Board Review, proven to increase test scores, can help with:

  1. Adaptive Learning that leverages artificial intelligence (AI) to personalize your experience and serve content based on what you know and don’t know. This allows you to minimize the time spent preparing for the exam.
  2. Two Practice Tests provide you with critical opportunities to refresh your skills, confidence, and ability to answer questions within the allotted time when taking high-stakes exams.
  3. A comprehensive question bank mapped to the ABFM blueprint so it covers the same content, in the same topic proportions as the ABFM recertification exam. Our questions are developed through a rigorous process by top experts in medicine.

How to Prepare for FMCLA

For physicians who choose the ongoing commitment to learning offered by the FMCLA, there are several ways to prepare. Review clinical topics as they come up in practice and study recent journal and clinical review articles such as from the New England Journal of Medicine.

NEJM Knowledge+ Family Medicine Board Review is the perfect companion to help you prepare. As with the FMCLA, NEJM Knowledge+ delivers multiple-choice, single-best-answer questions. (Learn more about our meticulous editorial process for developing questions.) Like FMCLA, our questions are paired with detailed feedback that facilitates learning and retention. And if you use a timer such as the one on your phone, you can practice answering questions within the five-minute time limit you get with FMCLA questions. By using NEJM Knowledge+, you can simulate the FMCLA experience, improve your practice, and extend your opportunities to engage in the lifelong learning process.

Whichever assessment option you choose, NEJM Knowledge+ Family Medicine Board Review is the perfect resource to help you accelerate your learning and pass. Plus, it allows you to earn up to 348 AMA PRA Category 1 Credits™ and 348 AAFP Prescribed Credits.

NEJM Knowledge+ Family Medicine Board Review: Your Indispensable Resource for ABFM Continuous Certification and Lifelong Learning

The American Board of Medical Specialties (ABMS) released a report from their Vision Initiative in 2019. It includes research demonstrating that physicians often have challenges with self-assessing or identifying their knowledge gaps. NEJM Knowledge+ Family Medicine Board Review can help you overcome this challenge in two ways:

  1. First, it is adaptive, which means questions are delivered based on your performance. In other words, the algorithm adapts the content you see based on what you know and don’t know, automatically targeting your knowledge gaps and saving you valuable time.
  2. Second, NEJM Knowledge+ asks you about your confidence level as you answer questions and then generates Confidence vs. Performance reports that allow you to compare your actual performance with how you anticipated you would perform. This metacognition analysis not only helps you prepare for your assessment efficiently and effectively, but it also helps you develop self-awareness about your medical knowledge which improves your efficiency and efficacy in diagnosing and treating patients.

Learn more about how NEJM Knowledge+ Family Medicine Board Review helps you pass your ABFM Recertification exam or FMCLA, earn up to 348 AMA PRA Category 1 Credits™ and 348 AAFP Prescribed Credits, and improve your practice to optimize patient care.

Frequently Asked Questions

What is ABFM Maintenance of Certification (MOC)?

Now referred to as ABFM Continuous Certification, ABFM MOC is the process family medicine physicians engage in to maintain their board certification. Participants in the program must complete designated activities in four categories: 1) Professionalism, 2) Self-Assessment and Lifelong Learning, 3) Cognitive Expertise, and 4) Performance Improvement (PI).

How do I maintain my ABFM certification?

Practicing physicians maintain their Family Medicine certification by participating in the ABFM Continuous Certification Program. To participate successfully, Family Medicine Physicians are required to:

  • Earn 150 Continuing Medical Education (CME) Credits every three years
  • Earn 50 Self Assessment and Performance Improvement (PI) points every three years
  • Demonstrate Cognitive Expertise in Family Medicine either through the traditional ten-year exam or through FMCLA (Family Medicine Certification Longitudinal Assessment)
  • Remain Current on ABFM Fees ($200 per year) and hold a valid and unrestricted license to practice medicine in the United States or Canada.

What are ABFM CME requirements?

Family Medicine Physicians are required to earn 150 CME credits every three years, at least half of which need to be Division I credits. Two types of credits that qualify as Division 1 credits are AAFP Prescribed credits and AMA PRA Category 1 CME Credits™.

What is the difference between AAFP Prescribed Credits and AMA PRA Category 1 CME Credits™?

AAFP prescribed credits are earned through activities that must be approved by the American Academy of Family Physicians (AAFP). These activities are designed to meet the specific educational needs of Family Medicine physicians. AMA PRA Category 1 CME Credits™ are earned through activities from CME providers who are accredited by the Accreditation Council for Continuing Medical Education (ACCME) or any state medical society authorized by ACCME.

NEJM Knowledge+ Family Medicine Board Review allows you to earn up to 348 AMA PRA Category 1 Credits™ and 348 AAFP Prescribed Credits*. Click here to learn more.

What is the ABFM Recertification Exam?

The ABFM recertification exam is the same as the ABFM initial certification exam, which is a one-day summative assessment made up of 300 multiple-choice, single-best-answer questions. The exam is available at Prometric testing locations around the United States and abroad. ABFM diplomates who do not participate in FMCLA must retake the exam every ten (10) years to stay certified.

How long is the ABFM Certification Exam?

The ABFM certification exam is approximately eight hours long. The exam is made up of four 95-minute sections for answering 75 questions each. Recipients receive 100 minutes of break time to use as needed between sections.

How many questions are on the ABFM Certification Exam?

The ABFM certification exam consists of 300 questions broken into four 95-minute sections.

What is a passing score for the ABFM Certification Exam?

The minimum passing score for the ABFM exam in 2021 was 380. The minimum passing score is reviewed and set by the ABFM Board of Directors Exam Committee every three years.

What happens if I fail my ABFM Certification Exam?

Candidates who are meeting all other ABFM Continuous Certification requirements will be given an opportunity to apply for and retake the exam. A new examination fee of 50% will be required.

What is Longitudinal Assessment?

Longitudinal assessment is a formative method of evaluation, based on adult learning principles, that administers shorter, technology-enabled assessments over time to not only assess knowledge of the content but also facilitate learning and retention of the content.

What is ABFM Longitudinal Assessment (FMCLA)?

The ABFM Longitudinal Assessment or ABFM FMCLA (Family Medicine Certification Longitudinal Assessment) is a testing format that allows Family Medicine physicians to meet their cognitive expertise requirement of continuing certification by answering questions incrementally and at their own pace. They can work on the assessment on any internet-connected device in any location using the same resources they use to provide care and treatment for patients except for another person.

How many questions are on FMCLA?

FMCLA consists of 400 questions delivered 25 questions per quarter over four years. Participants are required to answer at least 75 of the 100 questions delivered in the first year to meet ‘meaningful participation requirements,’ and a minimum of 300 of the 400 questions within the four-year FMCLA cycle.

What is the format of FMCLA questions?

As with the ABFM one-day exam, FMCLA questions are multiple-choice with a single-best answer and are based on the FMCLA Blueprint.

What is the FMCLA passing score?

Because raw scores for FMCLA are scaled, ABFM does not have a set passing score. Scaled scores range between 200 and 800. Questions are adjusted based on their difficulty level. Scaled scores must meet or exceed a minimum passing standard (MPS). Official scores will be given at the end of the four-year FMCLA period for your cohort.