The American Board of Family Medicine (ABFM) publishes annual, public pass-rate summaries that include first-time and repeat examinees from both the spring and fall testing windows. Depending on which numbers are cited, these reports are often shared without context, which can make the exam appear either more difficult or easier than it truly is. For example, the overall pass rate for 2023 was 87.4%, and for 2024 it was 88.4%. These only hint at the story – the most meaningful numbers are not in the bottom-line – they are in the details.
The first key to interpreting pass rates correctly is to separate first-time U.S. residency graduates from repeat or international candidates. Those groups differ significantly in pass rates and preparation background. You’ll also want to factor in the results for Spring vs Fall – there can be a big difference. Of course, as interesting as the data on pass rates is, what matters most is your individual preparation to ensure that you are in the “passing” column.
Across the 2020–2024 exam cycles, the overall ABFM pass rate consistently remained between the high 80s and low 90s.
However, those overall numbers mask an important distinction:
The same pattern appears every year. In 2023, the overall pass rate was 87.4%, with a 92.3% first-time pass rate and 66.7% for repeats. In 2022, the overall was 88.9%, and in 2020, it was 91.2%—showing remarkable year-to-year consistency.
These statistics show that while the exam is rigorous, first-time candidates coming directly from U.S. residency training typically pass more than nine times out of ten.
The spring exam window almost always yields higher pass rates than the fall window—especially for first-time U.S. residency graduates. This seasonal variation reflects candidate mix, not differences in difficulty or scoring.
Most residents take the spring exam immediately after graduation, while fall windows include a larger proportion of repeat and delayed testers. That population difference explains the gap between the 96% (spring) and 79% (fall) pass rates for U.S. first-time examinees in 2024.
Each ABFM pass-rate report defines its categories carefully:
Each category’s data is aggregated separately because their baseline preparation and training contexts differ. Interpreting “total” or “overall” pass rates without noting those categories can be misleading.
The In-Training Examination (ITE), administered annually to family medicine residents, uses the same psychometric scale as the ABFM certification exam. It’s designed to measure progressive learning and predict board readiness.
Peer-reviewed studies published in the Journal of the American Board of Family Medicine (JABFM) and Family Medicine journals have consistently shown that ITE scores correlate strongly with certification outcomes.
In practice, a PGY-3 resident whose ITE score meets or exceeds the ABFM passing standard is highly likely to succeed on the first attempt.
Two main factors shape the combined overall rate:
In 2024, for example, the overall pass rate was 88.4%, but that number included both first-time and repeat attempts across both test windows. For first-time U.S. candidates, the pass rate was more than 93%.
ABFM reports each candidate’s scaled score and provides domain-level feedback showing strengths and weaknesses across the blueprint. If you pass, your certification or recertification requirement is complete.
If you do not pass, review your domain performance carefully—this guides targeted study for your next attempt. Most candidates who retake the exam within 6–12 months, using focused remediation, significantly improve their results.
For diplomates in Longitudinal Assessment (LA-FM), performance is judged against the same passing standard. If you do not meet that standard after answering 300 questions (typically over four years), ABFM will direct you to the one-day exam to complete your certification requirement.
Q1: Why do ABFM pass rates look different from year to year?
Because each year includes a different mix of first-time, repeat, and international examinees. Changes in this mix affect the combined overall rate more than changes in exam difficulty.
Q2: Do first-time candidates really pass at higher rates?
Yes. U.S. first-time residency graduates consistently pass above 90% each year.
Q3: Why is the spring exam window higher scoring than fall?
Spring testers are mostly graduating residents taking the exam immediately after training. Fall windows include more repeat and delayed testers.
Q4: Do ITE scores predict ABFM exam success?
Yes. Final-year ITE scores strongly predict ABFM outcomes. Scores above the 30th percentile correlate with >95% first-time pass rates.
Q5: Are ABFM exams easier some years than others?
No. ABFM uses statistical equating to ensure that passing standards remain consistent across all forms and years.
Q6: Is a low overall pass rate a sign that the exam is getting harder?
Not necessarily. Overall pass rates often reflect who tested, not how difficult the exam was.
How can you prepare for the ABFM Exams? Med-Challenger Family Medicine Boards Prep