The American Board of Medical Specialties (ABMS) of which the ABPN is a member Board, has modified its definitions of "clinically active" and "clinically inactive" and has asked that all Boards survey their diplomates as to their clinical-activity status at least every 24 months in each area of certification.

This status information is self-reported and will be available to the public.

Please take a moment to answer the survey by checking the appropriate responses below. When you are done making your selections, fill in all required information, and click the submit button at the bottom of the page. We greatly appreciate your cooperation in completing this survey so we may accurately report your status to the ABMS. Thank you!

1. Please check the specialty area(s) in which you are certified, and indicate clinical status by checking the appropriate box. If you are unsure of your status, please check "Unknown". If you are not certified in a specialty or subspecialty, you may select "Not Certified" or simply not make a selection in that row.

2. Do you plan to maintain certification in one or more specialty?

3. If yes, what is the primary reason for maintaining your certification(s)?

4. If no, what is the primary reason you have chosen to not participate in maintenance of certification(s)?

5. Please check the subspecialty area(s) in which you are certified, and indicate clinical status by checking the appropriate box.

6. Do you plan to maintain certification in one or more subspecialty?

7. If yes, what is the primary reason for maintaining your subspecialty certification(s)?

8. If no, what is the primary reason you have chosen to not participate in maintenance of certification for your subspecialty certificate(s)?

9. If offered, would you prefer to take a modular examination combining a specialty and up to three subspecialties instead of separate examinations?

10. Which one of the following categories best describes the percentage of professional time you spend in direct patient care?

11. Which one of the following best describes your primary employer?

12. In which one of the following professional activities do you spend the most hours per week?

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PLEASE NOTE: please do not use this form to change your address. Use the change address form.