Wednesday, April 10, 2013

Maintaining Board Certification Every Two Years

Remember the good ol' days when taking a single board certification examination from the American Board of Internal Medicine (ABIM) was good enough to call yourself "board certified" in a medical specialty?

Those were the days.

In 1990, things changed.  Board certifications became time limited.  To remain "board certified," the ABIM stipulated that doctors had to undergo a Maintenance of Certification (MOC) examination every 10 years to remain board certified, even though no data existed then (or now) that such testing achieves the ABIM's stated goals of promoting "lifelong learning and enhancement of the clinical judgment and skills essential for high quality patient care."

Now things are changing again.

I just received a notice in the mail (pdf here) that states the following: beginning 1 January 2014, the ABIM will require that at least one Maintenance of Certification "activity" be performed every TWO years and for EVERY TWO YEARS thereafter.  In addition, doctors will have to earn 100 ABIM "points and complete a patient survey and a patient safety module by December 2018 (in FIVE years and EVERY FIVE YEARS  thereafter). That's right: more testing of doctors and no data to support the testing's ability to maintain a quality physician workforce.

For those interested, more information can be found at .  According to this website, annual cost to physicians will be "about $200 per year" and "If you are maintaining more than one certification, the cost will be the fee of the most expensive certification plus half for each of the others."

Instead of assuring quality, then, it seems doctors are really being asked to improve the ABIM's cash flow.  Also, as a result of this initiative doctors will be spending consistently more time away from patients.  

It's crazy.

Clearly no one is listening to doctors on the front line.  Doctors are already overburdened with too many unproven bureaucratic requirements.  Adding these costly, unproven "certification" requirements to things like meaningful use, pay-for-performance, results checking, email answering, patient satisfaction surveys and the like just adds insult to injury.  How much time do the members of the ABIM think we have?

How much quality to we impart to our patients when we asked to stare at more and more computer screens rather than care for our patients?





Anonymous said...

Is this a case of punishing the good guys while trying to weed out the bad ones?

I know most Docs keep up with changes in their field, but there are too many who don't. I don't know how much can change in 2 years, but quite a bit can change over the course of a career.

I lived in a county where bad Docs went to retire after losing their license in some other state - a coastal place with a lax state board, plenty of retirees, fishing and golf.

The damage done to patients has been substantial, and the problems were well known by the medical community and ignored for too long. In the latest case, it took 60 minutes to shame a practice into cutting ties with a rogue oncologist. We had one surgeon who routinely performed one type of surgery while telling patients (and billing) that he was doing something a superior version.

I'm not sure that 2-yr certification is the answer, but should we do with the guys who just aren't competent anymore?

DrWes said...

Anony 07:48 -

Your question is a straw dog. ABIM has no jurisdiction for removing rogue doctors from medical staffs whether they are board certified or not, especially since NO data exists that this certification maintains competency in the first place. As I've covered previously, the ABIM can't even protect the term "board certified" (for instance, we have "board certified" family nurse practitioners now popping up at Walgreens now).

Local administrative and medical staffs of each hospital are better arbiters of poor performers rather than centralized credentialing boards because they're watching all the time, not just every few years.

Anonymous said...

Problem - Some small number of Docs are not competent. Real harm is done. They make the news, patients read the news, governing bodies want to act.

ABIM steps in and says - well, we can certify every 2 years. Governing bodies, not knowing any better say - yes, yes, let's do that!

You know it won't work - you've convinced me it's not helpful, but the problem (see above) still exists.

We do have evidence that local admins haven't done a good job of protecting patients from the rogues.

If you accept the problem (I'm asking) and you reject the every 2 year solution, then what?

People want to be assured that every Doctor out there is at least minimally competent. If not ABIM certification, what do you suggest? Local oversight has demonstrably failed.



Dr. Mike said...

Wes, I see this as an old conflict of town and gown. The academics have always used the private docs as a cash cow. You are a good doctor because you want to know everything you can to help your patients and you keep up. Most doctors in the trenches do keep up. This testing testing testing is all about money money money. Just like the Walgreens NP is all about money. If you follow the money it does not lead to the practicing physician but instead to the payors. The Academics have been cut like we have and they have gone after us for more money.

Anonymous said...

Hope this does not mean you will need to curtail blogging activity in order to perform for your potentially weekly recertification hoops..

Anonymous said...

Board exams are easily gamed as they are not about what you know, but how well you can play the board game - just don't charge us to take them... since they are a joke.

Sadly, Family Practice is gonna be dusted I fear, due to the expansion at Walgreens and others to come. Plenty of MDs will sell each other out and do this gig too, as you are your own worst enemies, and others steal your stuff because you took the wrong fork in the road a while back. So soon 100% MDs will be employees (the master plan achieved).


Anonymous said...

Just wait until MOC is linked to MOL (maintenance of licensure). Resistance is futile; you will be assimilated.

Anonymous said...

Resistance is NOT futile! Ohio has resisted, New York is trying. Check out the work of the Academy of American Physicians and Surgeons at for more.

Anonymous said...

Even if your certificate isn’t time-limited (ie, prior to 1990) the ABIM recommends that you voluntarily recertify, since this improves patient care (although no evidence supports this assertion).

Dr. Christine Cassel is President and CEO of the ABIM, so that recommendation stems down from her. I mean no disrespect in my following comment. Dr. Cassel is extraordinarily accomplished, including MACP, medical school dean, adviser to President Obama, listed as one of the 200 most influential people in healthcare, served on the IOM committee that authored “To Err is Human,” and has authored scores of papers and books. By comparison, I have accomplished nothing.

However, I am perplexed by the fact that the ABIM website states Dr. Cassel boarded in 1979 and has never voluntarily recertified in IM. I have certified or recertified three times and I was still popping zits in 1979.

How come the people that dictate the rules, in the interest of patient safety, are not subject to them? Again, no disrespect to Dr. Cassel, who I admire. However, this is a reasonable question that deserves an answer. Why is the rule important for me and not for her? Should my patients be kept safer than hers? If so, why?

Anonymous said...

Dr Richard Baron will replace Dr Cassel in leading the ABIM in June 2013. Dr. Baron certified in 1981 and has NEVER voluntarily recertified. The ABIM leadership hypocrisy continues as does my ranting.....

Anonymous said...

Just took my ABIM recertification exam I do think there is some learning value to it. But really its a bit too much. Its not fair for physicians in their 60`s and 70's to take a full day exam. And the anxiety the exam creates is not nice. ABIM needs to have a better system

Anonymous said...

ABIM recertification is administered by a third party.

The test room is crowded, very noisy, with test takers taking other examinations who type their answers hence you hear keyboard noise for at least 6 hours.

When you sign in you have to empty your pockets, remove your watch etc, and leave your wallet in a locker. Doctors are treated like a criminal.

They scan you palm prior to entering or leaving the room to make sure you are YOU and not someone else!!

If you take a break in the middle of the test to go to the BR, the clock continues to tick and you will lose time. You will have to go through security and palm scan again prior to re-entering exam room.

They make you feel like a criminal and treated with little respect. The test room was so noisy it was difficult to concentrate.

I tried to use the noise-cancelling headphone, however it was so old, uncomfortable and large that I removed it after a few minutes and used the harsh (probably the cheapest they could find) earplugs they had provided me. You cannot bring your own modern noise-cancelling headphone.

There is no mouse pad either. You can hear the test takers next to you moving their mouse on the table.

Taking ABIM recertification experience was truly torture.

Doctors must unite to stop this nonsense.