- Who Runs the Credential
- Exam Format at a Glance
- Domain Weights and What Each Tests
- Scoring: What 100 on a 0-200 Scale Means
- Eligibility Checklist
- 2026 Cycle Fees and Dates (Historical)
- Test-Day Rules
- Newer Blueprint Topics to Review
- After You Pass: The Continuing Certification Program
- A Domain-Ordered Prep Sequence
- Frequently Asked Questions
- The initial exam has 165 multiple-choice questions (150 scored, 15 unscored) with a three-hour limit.
- Medical Knowledge carries 30% of the exam; Regulatory, Compliance & Quality Improvement follows at 26%.
- Passing means a scaled score of 100 on a 0-200 scale, not a fixed 50% correct.
- Eligibility requires 400 hours of hospice-related activity in five years plus one qualifying pathway.
Who Runs the Credential
Hospice Medical Director Certified is administered by the independent Hospice Medical Director Certification Board (HMDCB), which is the sole current certifying body. The American Academy of Hospice and Palliative Medicine (AAHPM) supplies related preparation resources and holds a liaison role, but it does not administer the exam. If you want the plain-language definition before the details, see What Is HMDC Certification? or What Does HMDC Stand For?.
This page condenses the facts that matter most into one scannable review. It is built from HMDCB's 2026 Initial Certification Cycle handbook (dated July 22, 2025) and its public pages. Where the live website and the handbook differ, this sheet flags it.
Exam Format at a Glance
| Item | What to Know |
|---|---|
| Question count | 165 multiple-choice questions |
| Scored vs. unscored | 150 scored, 15 unscored (pretest items you cannot identify) |
| Time limit | Three hours |
| Delivery | Computer-based, by appointment, at U.S. assessment centers |
| Testing provider | PSI Candidate Services |
| Attempts | One initial attempt per calendar year |
| Passing standard | Scaled score of 100 on a 0-200 scale |
Because you cannot tell which 15 items are unscored, treat every question as if it counts. At 165 questions in 180 minutes, you have a little under 65 seconds per item on average, which is tight for case-style stems that require you to weigh regulatory and clinical details together. For a candid look at pacing and difficulty, read How Hard Is the HMDC Exam?
Domain Weights and What Each Tests
HMDCB publishes five examination-objective areas with percentage weights, drawn from its Content Blueprint and the 2020 Practice (Job) Analysis Study. Roughly speaking, more than half the exam rests on just two domains. A deeper walk-through lives in HMDC Exam Domains: Complete Guide to All 5 Content Areas.
| Domain | Weight | Core Orientation |
|---|---|---|
| Domain 2: Medical Knowledge | 30% | Clinical decision-making in end-of-life care |
| Domain 5: Regulatory, Compliance & Quality Improvement | 26% | Hospice rules, billing, and quality |
| Domain 1: Patient and Family Care | 20% | Care planning with patients and families |
| Domain 3: Medical Leadership and Communication | 14% | Interdisciplinary team and organizational leadership |
| Domain 4: Professionalism | 10% | Ethics and professional conduct |
Domain 2: Medical Knowledge (30%)
The largest domain. Expect clinical content framed around hospice patients rather than general medicine.
- Prognostication and the clinical picture of a declining patient
- Symptom management and the logic behind palliative choices
- Artificial nutrition and hydration, which the current live outline lists as an updated subobjective
- Prolonged grief disorder, also named in the updated outline
Domain 5: Regulatory, Compliance & Quality Improvement (26%)
This is where many clinicians feel least prepared, because it tests the rules of the hospice benefit rather than bedside medicine. The live page uses this heading; the handbook words it as Regulatory Compliance and Quality Improvement, with the same weight.
- Notice of Election and its addendum
- Revocation and discharge
- Advance Beneficiary Notice
- NP and PA billing
- Quality improvement concepts a medical director is expected to lead
Domain 1: Patient and Family Care (20%)
Applies clinical judgment to the patient-and-family unit, including goals of care and care planning across the hospice episode.
Domain 3: Medical Leadership and Communication (14%)
Covers the physician's role guiding the interdisciplinary team and communicating clearly with colleagues, staff, and families.
Domain 4: Professionalism (10%)
The smallest domain, but scenario-based items on ethics and conduct can be missed by candidates who skip it entirely.
Scoring: What 100 on a 0-200 Scale Means
The passing standard is a scaled score of 100 on a 0-200 scale. The equated raw passing score varies by exam form, so there is no single number of correct answers that guarantees a pass. In particular, it is not a 50% correct requirement, even though 100 is the midpoint of the scale. Scaling exists so that a slightly harder form and a slightly easier form demand the same level of competence.
The practical takeaway: do not try to reverse-engineer a magic raw number. Aim for broad strength across all five domains. More on how the standard works is in HMDC Passing Score: Exactly What You Need to Pass.
Eligibility Checklist
Every candidate must meet the baseline requirements and then satisfy one of three pathways. Full detail is in HMDC Requirements: Eligibility, Prerequisites & How to Qualify.
Baseline Requirements (All Candidates)
- A current, unrestricted medical license in the United States, its territories, or Canada
- A professional-conduct attestation
- 400 hours of broad hospice-related activities within the preceding five years
Choose One Pathway
- Work experience: two years of hospice work in the preceding five years, verified by a senior administrator
- Board certification: current ABMS or AOA board certification in hospice and palliative medicine
- Training: a 12-month ACGME- or AOA-accredited clinical hospice and palliative medicine training program
Fellows may apply while still in training but must test only after successfully completing the program. If you are unsure whether your hours count as "broad hospice-related activities," confirm against the handbook's pathway verification details before you pay.
2026 Cycle Fees and Dates (Historical)
The 2026 initial cycle is now closed, so the figures below are historical reference, not upcoming appointments. They are still useful for budgeting and for understanding how HMDCB structures its tiers. Check HMDCB for the next cycle's published schedule, and see HMDC Certification Cost: Complete Pricing Breakdown and HMDC Exam Dates: Testing Windows, Deadlines & Scheduling.
| Tier | Fee (USD) | Application Window |
|---|---|---|
| Early | $1,250 | January 26 - April 30 |
| Regular | $1,350 | May 1 - July 1 |
| Final / extended | $1,450 | July 2 - July 31 |
- The live page adds an August 1-August 7 extension that does not appear in the handbook.
- The last scheduling day was September 21.
- The examination window ran March 23 through September 28, 2026.
- The application fee includes the Expanded Content Blueprint.
Test-Day Rules
The initial-exam rules in the handbook are strict, and surprises on exam day are avoidable.
- No personal notes, no electronic devices, and no calculators
- The introductory practice tutorial sits outside the timed exam
- Breaks do not stop the clock
- Only one initial attempt is permitted per calendar year
Because breaks consume exam time, plan your pacing so you rarely need one. If a question stalls you, mark your best guess and move on rather than burning minutes you cannot recover. Since there are no calculators, any quantitative item will be built to be solvable by hand.
Newer Blueprint Topics to Review
The live HMDCB outline retains the same domain weights but carries updated subobjectives. Candidates studying from older notes may have gaps here. Make sure you can explain each of the following in your own words:
Recently Highlighted Subobjectives
These appear in the current live outline and are easy to overlook if you prepared from older materials.
- Prolonged grief disorder: recognition and the medical director's role in bereavement support
- Artificial nutrition and hydration: clinical and ethical reasoning, and how to counsel families
- NP and PA billing: how nurse practitioner and physician assistant services fit within hospice billing rules
- Notice of Election and its addendum: what they document and why they matter
- Revocation and discharge: the difference between the two and the circumstances for each
- Advance Beneficiary Notice: when it applies and what it communicates
Key Takeaway
Use the live HMDCB Content Blueprint, not a years-old summary, as your master topic list. The weights have not changed, but the subobjective detail has, and the regulatory items fall squarely in a 26% domain.
After You Pass: The Continuing Certification Program
Older multi-year recertification rules have been superseded. Today, certified physicians participate in an annual Continuing Certification Program (CCP) that begins the year after initial certification. It is a separate process from the initial exam.
| CCP Element | Requirement |
|---|---|
| Licensure | Ongoing unrestricted license |
| Conduct | Professional-conduct attestation |
| Assessment | 30 open-book, untimed longitudinal-assessment questions |
| Passing threshold | 80%; incorrect answers may be retried until passing |
| 2026 fee | $199 annual fee |
| 2026 due date | October 30, 2026 |
The open-book, retry-until-passing design makes the CCP a learning tool rather than a high-stakes gate. If you are weighing whether the credential justifies the ongoing commitment, read Is the HMDC Certification Worth It?, along with HMDC Salary Guide and HMDC Jobs for the career side of the decision.
A Domain-Ordered Prep Sequence
Rather than a generic study calendar, sequence your preparation around the blueprint weights and the domains most candidates find unfamiliar. The full strategy is laid out in the HMDC Study Guide; here is a compact ordering you can adapt.
Domain 5 First
- Learn the regulatory vocabulary while your energy is highest: Notice of Election, addendum, revocation, discharge, Advance Beneficiary Notice
- Review NP and PA billing rules
Domain 2 Depth
- Work through prognostication, symptom management, artificial nutrition and hydration, and prolonged grief disorder
- Spend the most hours here: it is 30% of the exam
Domains 1, 3, and 4
- Cover patient and family care, leadership and communication, and professionalism
- Practice scenario-style items on team dynamics and ethics
Timed Mixed Review
- Simulate the three-hour, 165-question format with no notes
- Use a full-length practice test to expose weak domains
The reasoning is simple: front-loading Domain 5 gives unfamiliar regulatory content the most repetition time, and Domain 2 gets the largest block because it carries the most weight. Finish with timed practice so the clock is not a surprise. Questions in a practice question bank that mirror the multiple-choice, scenario-driven style are the most useful way to rehearse.
Frequently Asked Questions
There are 165 multiple-choice questions, of which 150 are scored and 15 are unscored. You have three hours to complete them, and you cannot tell which items are unscored.
Medical Knowledge is the largest at 30%, followed by Regulatory, Compliance & Quality Improvement at 26%. Together they make up 56% of the exam. Patient and Family Care is 20%, Medical Leadership and Communication is 14%, and Professionalism is 10%.
No. Passing requires a scaled score of 100 on a 0-200 scale, and the equated raw passing score varies by exam form. It is not a flat 50% correct requirement.
The handbook permits only one initial attempt per calendar year. Plan your preparation so that your first attempt is a serious one rather than a trial run.
Certified physicians complete the annual Continuing Certification Program, starting the year after initial certification. It involves 30 open-book, untimed questions at an 80% passing threshold, with retries allowed, plus unrestricted licensure, a conduct attestation, and the $199 fee for 2026.
No. The 2026 initial cycle is closed as of October 10, 2026, so those dates and fees are historical. Consult HMDCB directly for the next published cycle, and use the exam dates guide to understand how windows are structured.