Wednesday, July 30, 2014

Fail Maintenance of Certification? I Need Your Help

With the increasing failure rate of first-time test takers of the American Board of Medical Specialties' Maintenance of Certification program, no study of the impact of failing the examination upon physicians (and the patients they serve) has occurred.  Specifically, I am interested in the economic, professional and psychologic consequences of failing the Maintenance of Certification examination for previously board-certified practicing physicians.

To that end, I'd like to compile the stories of people who have FAILED their Maintenance of Certification examination.  I would like to know the cost in both time, money and consequences that was impacted by the failure, whatever they were or were not.  I hope to publish a paper in a major medical journal on my findings.  Commentary can be sent to me one of two ways: (1) private e-mail (wes -at- medtees dot com) or  (2) by placing a comment to this post (since all comments are moderated, I will only publish those that I am granted specific permission to publish) here. 

I would like to know the following:

(1) A bit about you: your age, gender, specialty, years in practice, practice setting
(2) Number of patients you treat annually
(3) A description of what it was like to learn you failed, actions taken (re-score request, additional review course, repeat testing, retirement), loss of income.
(4) Impact to ability to practice, if any (loss of privileges, etc)
(5) Cost, but in time and money spent for the various parts of the process.
(6) Did your results appear on the website "CertificationMatters.org"
(7) Willingness to co-author a manuscript
(8) THIS ONE'S IMPORTANT: Willingness to have your name mentioned publically.  ALL RESPONSES WILL BE KEPT STRICTLY CONFIDENTIAL otherwise.
(Any other data you think is important and I have missed and would like included or NOT mentioned)

I will compile the data I receive, both as discrete variables and comments that allow publication.

It is quite possible that many academic journals will not publish the results obtained in this survey and, if so, I will co-publish the composite data on this blog for all to review.

I appreciate any and all feedback I might be able to obtain.  The face of the dark side of Maintenance of Certification needs to be understood and reported.

Thanks for your coooperation in this effort.

Sincerely,

Wes Fisher, MD


6 comments:

David L Keller, MD said...

I have never failed any board or recert exams, but I am compiling a list of hard factual errors in ABIM SEP modules, starting with several I found in the beta module I took this year. I am concerned that ABIM is pushing the "Choosing Wisely" campaign by distorting the facts in order to favor less aggressive treatments and screenings. Have you found definite errors in any of the SEP modules (without getting specific or violating ABIM's copyrights).

Anonymous said...

Response #1
On Jul 17, 2014, at 10:03 AM, Louis J. Grosso wrote:

Dear Dr. XXXXX

You’re email below was forwarded to me for reply.
Thank you for your e-mail regarding the content of the Maintenance of Certification (MOC) examination and requesting data comparing the numbers of physicians that passed/failed the MOC exam who were initially certified ten and twenty years ago. I understand your concerns about not passing the Internal Medicine MOC exam and will do my best to address those concerns here.

We are unable to provide the data you requested on the pass/fail rates based on when physicians were initially certified. ABIM only provides examination data that are publically available on the ABIM website. We receive numerous requests for data and information regarding our examinations and candidate population. Because of the resource commitment that would be necessary, fulfilling every request is not possible and it would not be fair to grant a request to some and not others.

With regard to your comments about the content included on the exam, please understand that ABIM spends a considerable amount of time and effort to ensure that examination content is carefully blueprinted to be comprehensive and relevant. Questions are written to reflect this blueprint and reviewed/revised two or three times by ABIM. After they are found acceptable but before they become part of the test, the questions receive yet another review by a larger group of practitioners. The goal of this process is to assure that the examination is thorough, relevant and fair test of medical knowledge and clinical judgment. Despite these efforts, we recognize that the test as a whole will not be equally relevant to all candidates, in part because of variations in practice patterns.

I also understand your desire for separate exams for generalists and subspecialties and adjusted scoring given your disappointment in not passing the examination. ABIM, in line with the requirements of the American Board of Medical Specialties, has established a common pathway to MOC for all candidates. One component of this process is passing the written examination with a common standard applied to all. This single pathway ensures that all candidates are treated fairly and that everyone faces exactly the same challenge. To offer an alternative based on a different standard or examination would be unfair to candidates who have already been successful and it would alter the meaning and credibility of the certificate.

I hope this is helpful in addressing your concerns.

Sincerely,
Louis Grosso

Vice President,
Knowledge Assessment – Production and Analysis
American Board of Internal Medcine
510 Walnut Street, Suite 1700
Philadelphia, PA 19106

Phone: 215-446-3538

Anonymous said...

Email #2 and response #2

Email #2

From: Dr XXXXX
Sent: Sunday, July 20, 2014 1:37 AM

To: Louis J. Grosso
Subject:
Re: External Request for Data –

Your response implies that my concern is a case of “sour grapes” I am more concerned with the overall trend. I do not NEED to be recertified in Internal Medicine in order to continue to practice Allergy/Immunology. I find it alarming that there was a 22% failure rate. You responded by telling me that: "ABIM only provides examination data that are publically available on the ABIM website” You are using circular logic, since of course you are only using data that is currently available on the website. The whole point of my question is that you SHOULD be including more detailed information and statistics on the website. Most of the “first time takers" I assume are only 10 years out from their initial certification. My guess is that those who are 20 years out probably have a higher failure rate. Knowing this would be valuable in that it would help those like myself decide whether or not it is worth the time and money to attempt to re-recertify after 20 or 30 years.

Response #2
Dear Dr XXXXX,

My email was not based on any assumptions about the intent of your questions. It was simply an attempt to respond to your queries.

I do understand your interest in seeing more detailed information. That being said, any finer breakdown of data needs to be conducted with appropriate rigor. Keep in mind that a candidate can elect to take an exam as early as the sixth year of a certification cycle. Consequently, there can be individuals who finished training from six to 20 years earlier. Although other measures of ability are key markers in the likelihood of success on the examination, there are a range of other factors that will contribute.

Email is not the best way to address your concerns. If you’d like to discuss this further I would be very happy to speak with you by telephone.

Respectfully,

Louis Grosso

Vice President,
Knowledge Assessment – Production and Analysis
American Board of Internal Medcine
510 Walnut Street, Suite 1700
Philadelphia, PA 19106

Phone: 215-446-3538

Anonymous said...

I recently had an email discussion with one of the individuals at ABIM. Since the ABIM keeps track of each certified physician by their ABIM number I thought it was not unreasonable to ask them to parse through the data and let us know the pass/fail rate of those who are taking the recertification exam for the first time (approximately 10 years out of their IM residency) as opposed to those who are taking the recertification exam for the second time or re-re-certification (approximately 20 years out of residency) I have posted the thread below..... Due to length It is posted in 3 separate comments. There are 2 emails and 2 responses: Overall he did not actually address the issue... Email # 1 From Address: Dr XXXXX Of those that did not pass the recent Internal Medicine recertification exam (myself included) I am wondering how many of those individual were now getting re-certified for the second time (like myself) as opposed to getting re-certified for the first time. I suspect on

Anonymous said...

Can I say that as a patient, a number of us who have a clue do NOT believe board certification is worth the paper its written on. I certainly don't give it a second glance when I choose a doctor. Has anyone ever done any study showing that outcomes are different? Patients have and it means squat.

Anonymous said...

I took the Int Med recert exam for the first time on May 5th and failed. I was devastated and I was in a "functional depression" until I found cyber friends on Sermo going through the same thing. It saved me. I was ready to quit even though I know I'm a competent, caring physician.

I will not put myself or my loved ones through this again, unless I am certain it's a fair test with transparency in its delivery and scoring. Actually, I won't give ABIM another dime of my hard earned money. I'm hoping a new system will prevail. One that is run by, and supportive of physicians. Not the money hungry vultures running the show right now!

I can't even begin to explain my exam. I know I can't give details, but the word OBSURE describes many of the questions I received. Like Dr. Keller's earlier post, I agree that many questions were geared towards the "Choosing Wisely" campaign by distorting the facts to choose less aggressive treatments and screenings. What is wrong here is that you cannot fit an imaginary patient into a "box" like that. I'm all for avoiding unnecessary tests, but those questions need to be seriously challenged.