Over the last five years, the American Board of Family Medicine exam has had one of the lowest pass rates of any medical board examination. Many physicians raised inquiries as to whether the difficulty level or scoring criteria of the test had changed. The ABFM denied any changes in either area, noting that the change in results may be due to a change in the exam requirements. In 2007, it became possible for candidates to extend their certification period from seven to ten years, meaning physicians would not need to be re-certified as frequently. For several years thereafter, this changed the “normal” pool of candidates taking the exam compared to years past. The pass rate for first-time exam-takers continues to be higher than that for repeat test-takers.