As I’ve mentioned before, I’m an internist. After finishing my residency, I could have hung out a shingle and started to practice. But I chose to become boarded in my specialty by taking the internal medicine board exam, a two-day long headache-inducing, sitzfleish-requiring, circle-filling extravaganza. Why would I bother? The board exams don’t change my ability to open an office, bill my patients, and buy my house. But being “board-certified” in my specialty confers a certain legitimacy. It says that the powers that be in my specialty have tested me and found me likely to be competent, or at least knowledgeable. My hospital will only allow me to be on staff if I am board certified. Still, there are plenty of physicians out there who aren’t boarded; I just don’t refer to them. If they couldn’t pass their boards, or couldn’t be bothered to try, I’d rather they didn’t see my patients.
So who could object to this process of conferring legitimacy to doctors? The AAPS, that’s who! (Up at the top left is a picture of an ignorant ass, in case you were wondering.) In the latest edition of my specialty newspaper is a letter from an executive at this quasi-medical association:
Recertification Wastes Time and Money
I want to express my opposition to the concept of maintenance of certification in the field of internal medicine (“ABIM Proposes Comprehensive Internist Concept,” Dec. 15, 2007, p. 1).
I agree with others who have noted that it would further fracture the practice of internal medicine.
The article says that this program would not bring in any additional dollars to the Maintenance of Certification Program, but that statement begs the question of just how much money the ABIM is generating from the program. There is no reason, in my opinion, for this program other than to bring in a stream of revenue to the ABIM.
When I was certified by the ABIM in 1977, it was for life. The purpose of an internal medicine residency was to train physicians in interviewing patients, performing a competent physical examination, constructing a differential diagnosis, making appropriate use of the available laboratory tests, and then prescribing appropriate treatment. The process of evaluating a patient and constructing a differential diagnosis has basically not changed, just as human anatomy and physiology have not changed.
What has been changing continuously, and this was true even before 1977, is the range of diagnostic tests and treatment modalities that are available. What one is required to study for a maintenance-of-certification examination could be obsolete long before the next one. And what is most pertinent for a physician to know for his particular practice depends upon his patient population and the services that he chooses to offer.
If a physician is not a highly trained professional with knowledge of scientific principles, cramming for an examination periodically is not going to help. If he is such an individual, the examination is just a way of stealing his money and his time that could be better spent in activities of greater value.
The very concept of the need to be continuously recertified is an insult to the profession of medicine. Lawyers, engineers, and other professionals are continuously learning as they perform their jobs. They continually receive feedback from the outcome of their work in the real world. They are continuously monitored by their colleagues, their patients or customers, and other oversight agencies. If they are not more knowledgeable about their particular job than anybody else, then they don’t belong in that job in the first place, and recertification will not help.
Physicians are being sufficiently demeaned by lawyers, insurers, and bureaucrats of every description. Professional societies should be working to enhance the integrity and standing of the profession, not contributing to its demise.
Jane M. Orient, M.D.
Executive Director, Association of American Physicians and Surgeons
Tucson, Ariz.
Internal medicine news, Issue 5, Page 12 (1 March 200
http://www.internalmedicinenews.com/article/S1097-8690(08)70244-0/fulltext
The recertification process is an expensive pain in the ass (pictured above). But medical science changes daily. This process insures that your doctor is at least nominally up to date in their field. Remember, a doc is free to practice even if they aren’t boarded, so really, the only reason to object to the concept is sloth or incompetence. If you want to be judged to be in my league, then take the damned test.
March 12, 2008 at 2:38 pm
The recertification process is an expensive pain in the ass (pictured above). But medical science changes daily.
I’m up for recert in general medicine this year. It is a pain, but necessary. Especially for research oriented specialists who find it way too easy to slack off in following progress in general internal medicine. Having been competent and up-to-date in 1998 doesn’t prove anything about the same in 2008.
March 12, 2008 at 4:22 pm
I resent being compared to Jane Orient. I will ask my attorney if this is actionable.
Did you understand what she wrote? “If a physician is not a highly trained professional with knowledge of scientific principles, cramming for an examination periodically is not going to help.” In other words, there is no point in re-testing incompetent doctors; they should just be allowed to blunder on …
No true ass would make such an argument.
March 12, 2008 at 4:30 pm
Of course, the market will take care of incompetent docs because they will get sued out of existence…because it’s incompetent docs who get sued the most, right? (Hint:anwser is “no”
March 12, 2008 at 5:17 pm
“cramming for an examination periodically is not going to help” - doctors should actually not bother with med school (lots of cramming) - just practice medicine until you’re good at it. After all, practice makes perfect.
March 12, 2008 at 5:19 pm
The process of recertifying, at least in internal medicine, is much more than just the exam. There are educational modules that need to be completed before sitting for the exam. These are useful for learning, and prep you for the test.
But I must admit I like the idea of just forgetting the test and saying “trust me, im a doctor”.
March 12, 2008 at 7:19 pm
I think this person has just demonstrated that they are “not a highly trained professional with knowledge of scientific principles”. There are a number of serious flaws in the “argument”.
Making the argument that because other professions don’t do it, that internists shouldn’t either?
If this statement were true “If they are not more knowledgeable about their particular job than anybody else, then they don’t belong in that job in the first place, and recertification will not help.”, then there should only be one person in each job? Because there is only one person who is most knowledgeable? There should only be one internist in the world because there is only one internist who is “most knowledgeable”?
From my perspective, no one except me can do anything that demeans me.
The only way I can see this contributing to the demise of the “integrity and standing of the profession”, is if people of low standing and integrity cheat or otherwise weasel their way past these tests.
March 12, 2008 at 9:21 pm
I re-certified last year. The process was laborious, but ya-know-what, it was a great way to freshen up on a lot of material. Many of us would likely never refresh our knowledge base if staff privileges and reimbursement did not depend on it. The cost is huge though. As one approaches retirement, I can see why many would pass on this.
By the way, could the ABIM website for board certification be any less helpful? I doubt it.
March 12, 2008 at 11:35 pm
As a lay person, the idea of any recertification/training puts me at ease, it certainly would shift my opinion of a doctor.
March 13, 2008 at 8:12 am
@Blind: no, it couldn’t be any less helpful, but perhaps they have a Braille version for you…
March 14, 2008 at 9:17 am
By the way, could the ABIM website for board certification be any less helpful?
The ABIM website is pretty bad, but IMHO, for complete unusability you can’t beat the NIH website.
March 19, 2008 at 9:08 pm
The tone here bothers me - it does not sound as if we are trying to serve our patients best. Just to trump each other. Name-calling is successful in certain radio shows but not appropriate for physicians.
Conventional medicine is in a crisis - as demonstrated by out-of-control costs and by patients seeking alternative treatments.
In my nearly thirty years of medical practice I have seen my share of bad medicine in alternative medicine AND in conventional medicine. Not to mention that I probably made some mistakes along the way - luckily minor ones. Two years ago my son nearly died because one of the leading teaching hospitals overlooked a tularemia.
As a US-board-certified internist with a medical degree in natural medicine (from a European sub-specialty medicine board - not from some quack academy) I can’t see what this discussion is about. Venting stress? Being right, always? Testosterone? Mid-life crisis?
Alexa Fleckenstein M.D.
P.S. So why is it that we need recertification but lawyers not? I am not against recertification - just curious.
March 19, 2008 at 10:08 pm
As have I. But the fact that is a non sequitor. I’ve seen my share of bad in auto mechanics too, but that doesn’t qualify them to practice medicine.
Because medicine is fundamentally different than the law. Medicine changes daily, law not quite as much. And, while my lawyer friends will surely correct me, filing a brief correctly is not the same as knowing how to properly treat hypertension based on the latest evidence.
I certainly don’t care. AAPS is a crank organization that apparently lies to the public for their pet agendas.
That depends on definitions. I serve them best by providing care that is based on evidence.
March 25, 2008 at 4:53 pm
Just a quick note for all those who seem to think that re-certification isn’t necessary. I work in the IT field and certain of my professional qualifications expire unless renewed (usually via articles, exams et cetera). Why shouldn’t medicine be the same?
July 10, 2008 at 1:13 am
The AAPS has some goofy ideas about certain things, not doubt. They also definitely wouldn’t appeal to a fashionably ironic, card carrying democrat-socialist with the intellectual depth of a petri dish. You probably have a CMS clinical guideline poster hanging in your den, signed by a Clinton HHS secretary. While you goosestep along with the other liberal fascists who can’t see the some of the issues that recertification brings with it in terms of physician autonomy and extrinsic control, others might see some danger in the progressive encroachment of our government via their proxies in the medical industrial complexl such as the ABMS. And before you wet your pants about the dangers of the conservative conspiracy, let me ask you a few questions? Does passing a recert test make you a competent doctor? I know lots of people who can pass a test and are not particularly clinically astute. Some of them are professors of medicine and surgery. Is their any empiric evidence to demonstrate a correlation between passing your recert exam and the quality of your care? Sure, continuing education is critical. And I’m all in favor of physicians demonstrating competency over their careers. When you can actually design and prove a useful way to do this that involves taking a written test let me know. I guess actually taking care of patients for years and seeing the outcomes seems a better test to me, but what do I know? Finally, I seem to recall quite a brouhaha in your specialty about your recertification process and its implementation a few years back. It would seem that many of your colleagues, not just the right wing nuts you mention, also think the recertification process may have some problems. Oh and yes, I did recertify in my specialty…waste o’ time and money, not to mention the effort involved in compiling a case list. Enjoy your recert. certificate. Not one patient has any idea what it means. Nor do they care. You need to spend a weekend getting deprogrammed at the Cato Institute.