Sunday, April 13, 2008

A Cocktail Conversation

"I have to recertify for boards for the second time on Thursday. My year was the first year they started this every-10-year re-certification game."

"Are you nervous?"

"I think frustrated is a better word - I mean, why does a busy orthopedist in private practice with my experience have to prove his expertise every 10 years? I'm a spine guy. I haven't done club feet in years. I have no intention of doing club feet again - and yet I have to learn not only about club feet, but the whole gamut of orthopedics for this stupid test. And the practice questions - you take them and they give you five answers, none of which are really the right answer - but you have to figure out the "best" answer of the group. Stupid.

Worst of all, no one pays you for taking these tests. I mean, they're expensive. You have to take 50 hours or so of continuing medical education credits per year, just to qualify, at what, four to five thousand dollars a pop? And you're away from your practice losing money all the while… Then you sit for an expensive test that doesn't really cover your knowledge base.

Those regulators should be paying me to take their required tests.

I can tell you one thing...

... I'm not doing it a third time."


shadowfax said...

One wonders whether docs are just going to start dropping their board certifications. Certify once to establish baseline competency, then trash it.

Our hospital doesn't require it. Our group requires that you obtain BC status, but doesn't require that you maintain it.

Especially as they start to get more intrusive in the Maintenance of Certification. for ER docs now you have to take an annual test in addition to the every-ten-years one, and soon you'll have to be submitting charts or something like that.

If it weren't that hospitals will exert leverage for their docs to stay BC, I'd say that the Boards are at risk of making themselves irrelevant.

Anonymous said...

+1 hate the boards.
at least they could make the people who sit at the c-level for the boards maintain their certifications.

i think finishing an accredited residency should stand as certification for ten years or something. as well those tests are used to push personal agendas, and content covered is certainly biased.

Anonymous said...

I'm a retired airline captain. I sweated a stressful recurrent training event every year during which I demonstrated my knowledge of numerous arcane aviation subjects, many of which I'd never contend with while "flying the line."

The privilege of exercising my FAA Airline Transport Pilot certificate required that I be capable of managing these type of events. There was no disclaimer on this license that said "not valid for events involving encounters with volcanic ash," for example.

Reference the spine-specialzing orthopedics doc who complained about recertifying his knowledge about club feet, until you doctor's license has a limitation stating "limited to treating diseases of the spine, only," I suggest you just renew your acquaintance with club feet and continue to be proud of your status as an orthopedist.

TBTAM said...

As much as I hate re-certification, I must completely agree with the comment by the Anonymous ex-pilot up there, who, by the way, I am fairly certain is my brother, and who shall henceforth be known as "Dr Al".

by: PM, SN said...

"And the practice questions - you take them and they give you five answers, none of which are really the right answer - but you have to figure out the "best" answer of the group."

Funny, that sounds like the opposite of our nursing boards practice questions, in some of which you're given four or five questions which are all GOOD answers, but you have to pick which one you should do -first-.

Anonymous said...

retired pilot-how much did those tests cost you personally annually?

pm,sn: we get those kind of questions as well.

shadowfax said...

Retired pilot --

Great analogy, but not quite on target. Medical licenses are unrestricted but employment and medical staff privileges are specialty specific in the same way a type rating is. If you qualified at one time for the 737 but your current employer only operates the A330, then your annual tests focus on all aspects of the A330, and not on emergency procedures etc for the 737. I assume that after a certain time you would need to requalify on the 737 if you wanted to go back to flying it.

This is more true for the orthopedic surgeon who subspecializes than it is for me, an ER doc. My boards will be more relevant to my real-world practice. The irritation for me is that unlike the excellent recurrent training and testing pilots undergo, the new concept of continuous certification for docs is half-assed, intrusive, and not particularly helpful.

Doctor David said...

For those of us who are super subspecialized, the recertification process is even less relevant. I do pediatric bone marrow transplantation. I am therefore board certified in Pediatrics and in Pediatric Hematology/Oncology. So every 7 years I have to take a multiple choice exam that includes questions on things I have not done, nor do I ever plan to do again, for decades. If I don't know the latest outpatient treatment for Chlamydia, does that make me less competent to manage a child's graft-versus-host disease? I don't think so.

The irony? The last time I recertified in Pediatrics, my best subsection score was NOT oncology... it was adolescent gynecology. Go figure.

Ian Furst said...

We had some big arguements with the high-stakes board exams up here. Who would administer them, which regulator gets to declare you compentant, etc... In the end the my understanding is there isn't a great correlation between your mark on the exam and your skill as a surgeon. I think they should leave high stakes exams for qualifying initially and CE programs for ongoing recertification. Is it just a cash grab?