Two days ago after a typical day performing procedures in the EP lab, doing inpatient consults, fielding patient messages, attending administrative and research meetings, reading EKGs, Holter monitor recordings, and co-signing device clinic charts, I opened my email and saw this:
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| ABIM Email to Diplomats 11/20/2015 |
I was appalled. MOC is not longer about "keeping up" for physicians. It is a major distraction. This program is of unproven benefit to my patients and me. Thanks to haphazard and self-serving rule changes by the ABIM and their member boards over the past 25 years, the US Specialty Board system has become increasingly coercive. In fact, MOC program now threatens my ability to practice the work that I love because I could lose my facility privileges and ability to receive payments from insurers on December 31, 2015. That is my reality. This is the reality of every physician subspecialist who participates in the ABMS MOC program in US medicine today.
Remarkably, I just re-certified in Cardiovascular Diseases and Cardiac Electrophysiology in 2013 for the third time. I have never failed. I have over thirty years of experience treating patients and standing in the cross hairs of what it means to be truly accountable to those I treat. I have had over thirty years of nights when I lie awake at night worrying about by patients, about if I did enough, about why a patient had to die. My family, too, has endured years of being woken in the middle of the night or seeing their father have to leave a school play, holiday concert, or friend's dinner party to place an emergency pacemaker.
I am not unique. I am a practicing physician everyman. I stand in unison with hundreds of thousands of others here in the United States just like me who get up every day, kiss their loved ones, and head off to do their favorite job in the world - a vocation so completely immersive and rewarding that we gladly give up a part of ourselves to earn the trust and faith of our patients and fellow physicians.
And because I've been practicing medicine so long, I know I do not need a private, unaccountable, and irresponsible organization to tell me how to behave. I am better than that. After experiencing the busywork of the evolving MOC program and its lack of value for the time spent, I looked into the corporations who promote this exercise. I had the help of accountants and fellow physicians who were similarly upset and uncovered a vast array of hidden financial activities of the ABIM and their collaborators. There is so much financial corruption it is mind-boggling. The conflicts of interest that are never acknowledged and corrected make my stomach churn. The practice of medicine is better than this. Practicing physicians are better than this. We do not need some dystopic corporate Big Brother watching over us to assure we log into a computer every so often to enter data that can be used against us. We do not need webcams, video monitors, body inspections, keyboard tracking, and palm scans to prove we are honest and ethical and won't cheat on examinations. But this is what the ABIM has become: some new form of quasi-police state for monitoring physicians.
Working in fear is not what I want for medicine. It certainly is not how I want my youngest colleagues to grow up learning and practicing medicine. But the ABIM and their parent organization, the American Board of Medical Specialties (ABMS), seem to love fear, humiliation, and intimidation to get doctors to participate in their lucrative MOC program. It is sickening. It is also the height of hypocrisy for these organizations to claim to run an organization that attempts to "Choose Wisely" when that same organization funnels tens of millions of dollars for itself from hard working physicians so they can choose an investment portfolio with multi-million dollar condos, meet at swank meeting venues, pay for spousal travel fees and first class airfares as they preen themselves in front of media lights. The ABIM Foundation "created to define medical professionalism" for the public? Give it a break.
Rest assured I am not naive. I know how important this MOC program is to certain investors. As I peel back layer after layer of the interconnected workings of these ABMS member boards and the ACGME, I know how high this MOC program goes and how dark this MOC program and its tactics have become. I completely understand that these specialty board organizations have managed to wedge themselves into our new health care law that calls itself "Affordable," wedged there by undisclosed lobbying efforts funded by the very doctors whose blinded trust was violated beyond comprehension. Just because these corporations want to make a buck.
So let me take the stick a moment. Let me be perfectly clear and I don't say this lightly. I'm sure I say this on behalf of tens of thousands of other hard-working, honest, and ethical physicians. We have had enough of the ABIM and the ABMS MOC program. It is time to end it - completely. No more "modifications" to make this broken program "easier." No more "listening" to our concerns but continuing this failed experiment. No more "MOCA Minutes" that we have to turn our gaze from our patients toward the computer screen or iPhone even longer. Continuing the ABMS MOC that has proven itself to be morally and financially corrupt, and exceedingly expensive to physicians, patients, and our health care system is ill-advised for our profession. The conflicts of interests alone are worth hundreds of millions of dollars to the corporations that stand to make millions from physician assessment, yet we never hear a word about this from them ABMS or the ABIM on this reality.
I am better than how the ABIM and ABMS threaten to label me. I served this great country for twenty-six years as a physician with the United States Naval Reserves and I continue to work every day to make sure I do the best I can for my patients in this increasingly difficult health care delivery environment. I worked then and work now beside hard-working corpsman, nurses, administrators and technicians who don't want to rock the boat and just want to do what's needed to finish our job every day. These people and the patients I care for are why I go to work every day.
So I ask the leadership of the ABIM: "Why does the ABIM insist on placing a "scarlet A" on my reputation by labeling me a "Not Participating in MOC?" Such labels are offensive. I participate in ACGME-accredited CME as required by my license to practice medicine in the State of Illinois. I am not a slacker. I teach residents and fellows, for goodness sakes. I am certainly not one who doesn't mind working hard. I am a proud practicing physician with more years of clinical experience and direct patient care than any of you.
Please don't be libelous and cast aspersions my way with your on-line labels. I've got much more important things to deal with. Stop pretending that you speak for "the public" and know what's best for them in health care when you don't even crack the door of an examination room or know what I do. Proceeding to take away my hard-earned reputation and ability to practice medicine because of your little label is both threatening and hugely upsetting.
Think about these words. Think about them carefully.
I beg of you and your affiliated private organizations to stop the labels.
The profession of medicine is better than this.
Your everyman,
Wes
Wes,
ReplyDeleteYou don't even know the half of what kind of smear campaigns people can launch and ruin your life. In fact, you might even want to delete this blog entry because it feeds them knowing that you are scared for your reputation. It's like encouraging a bully.
I think I've mentioned before, this is strategic demographic targeting. You are going to be very high up on that list. And yes, I do still think you're naive, but it's cute. There is a whole lot of evil that people do to screw with whomever they want to. I hope you never really have to understand that fully, I really do.
We know you're "honest and ethical and won't cheat on examinations" and that you know what you're doing. This is that naive part, that you think it's about that.
This is what socialized medicine does:
https://web.archive.org/web/20101109142642/http://novayagazeta.ru/data/2008/gulag09/00.html
It's very antisocial. This is where we're going. By the time it's much worse, you will have died young or retired. But it is miserable, a lot of patients will die, a lot of doctors will be ruined. I've been warning you guys, they want you gone. They want you gone in the most ugly and emasculating way possible.
Hey, if they totally try to rip you a new one, at least you'll find out who your friends are and if your family genuinely respects you and is behind you 100%.
Proud to be the "total nobody loser" of good character,
Lisa
I had the same reaction to these nasty leaches. So do I let them bleed me for a couple hundred bucks per year, and waste my limited time on their MOC that's of value only to their greed, or go ABPS boards... if i pay per year, then in 10 years do I pay another few thousand and submit to their degrading "secure exam". I quit paying ACP dues since obviously they are also self-serving and don't care about the corruption. Slime.
ReplyDeleteAs a fellow physician, I can't begin to thank you enough for the countless hours you've spent unraveling this truly disgusting and incestuous MOC story. In fact, I was catching up on some of your recent blogs on this topic when I got a notification of this very same new email from ABIM in the corner of my computer monitor. How poetic. But the question is, are any of us going to "opt out"? Are you? I work in a state that has a state medical society resolution recognizing NBPAS as an alternative to ABIM for re-certification. But I doubt this holds any teeth if hospital privileges or insurance contracts are tied to ABMS/ABIM associated recertification. As an outpatient general internist with 20+ years left to practice, this whole ordeal just makes me want to vomit. I'm strongly considering standing my ground and refusing to do my 2015 module requirement, not take the recert exam in 2 years, do the NBPAS recert, and just dare my organization to fire me. At least I could start a direct primary practice and opt out of insurance and Medicare altogether. I just can't believe it's come to this. But it has. Physicians are sheep, and primary care docs in particular are just used to being abused from every angle. Unless the IRS or DOJ disband the ABIM, nothing will change because our colleagues will just turn the other cheek and allow the extortion and exploitation to continue in perpetuity. So sad...
ReplyDeleteAt least you are grandfathered in IM. If you have to participate in MOC for work, try paying for only one of the subspecialties, as they will still report you as "participating in MOC". I think they will only stop this nonsense if we at least try to hurt their bottom line, by paying as little and as late as possible.
ReplyDeleteIt is really so simple, Wes. The ABIM is not the ABIM of 1936.
ReplyDeleteToday, it is a greedy self-serving imposter. The voluntary nature of certification has been imprisoned by amateur medical bureaucrats. They print indentured contracts called medical board certificates and shower them on physicians just to make their big bucks.
These are bizarre pretend physicians leading the pack as if they were escapees from an insane asylum. The strange part is everyone goes along because these executives are immoral as well as mentally unsound.
They have created fear as the number one control factor. The bird of joy has flown. But these bogus bureaucrat doctors have been exposed. Their cover has been blown.
Hidden in the tax filings they say there was no lobbying.
ReplyDeleteWell Rich and Bob, Chris and Lynn, you got caught with your pants down.
They claimed quality was achieved by cutting costs. But every child knows only quality creates quality. They tried to claim there was an inverse ratio of cost and quality. The greater the amount spent on healthcare, the lower the quality. The lower the cost in healthcare delivery the higher the quality. This is propaganda.
ReplyDeleteBut then when did the ABIM ever produce anything of quality? They ABIM proves that Choosing Wisely is a lie, because the ABIM spends most of their revenues on the executives and their creature comforts. Unfortunately the highest paid executive at the ABIM never showed up for work, but instead put their efforts into lobbying for PPACA (aka Obamacare, yes, I voted for him.) and SHE gets the worst marks in the history of the ABIM. That CEO gets the worst marks for knowledge of medicine as well.
Let's talk about the certification tests and the MOC. It is a disaster. The poor quality of that educational side of things was produced on a shoestring budget. Even the highly paid current CEO admits that they "got it wrong." Well they got everything wrong since Walter Bierring the founder died in 1961. It was quality then because it was voluntary. Humanitarian and not-for-profit.
ReplyDeleteThomas Brem, the corrupt ABIM chairman and Big Tobacco prostitute created an executive position at the ABIM for political and personal financial reasons in 1965. That's what happens when all goodness and voluntary nature of a non-profit organization goes rogue. It goes to pot. It goes to hell. Brem and the corporate world destroyed the ABIM forever. It was set to dissolve administratively in 1986 and should have. Benson put his pen to that as the heir apparent to the ABIM's big "wheel of fortune." (Reference to Kroll's Maintenance of Certification tweet.)
We need to broadly inform the American public about the stench emanating from Walnut Street in Philadelphia. We need more Newsweek articles. We need 60 Minutes or 20/20 or CNN to point their unblinking camera lens on Rich Baron's face. We need John Q Public to demand Congress why this organization is wholly unregulated.
ReplyDeleteWe need new blood at the ABIM. We need a new petition to demand that Baron, Johnson, Krumholz, Emmuel and the entire ABIM and ABIM Foundation and ABIM 2020 all need to go away. We need honest, frugal, responsible, and transparent inclusive leaders to run this organization. The current leaders are too old, too corrupt, too entrenched, too obtuse and too inept.
In the military and in medicine, when faced with an enemy with deep roots, we use every means necessary to take down the opponent. If a strategy doesn't work, we outflank or redirect our efforts and try everything all at once at times. Just as you have noted in prior blog posts, this is the end of the beginning. As such, we redeploy and we attack from multiple fronts with the basis of our effort on DEFUNDING THE ABIM. No ABIM $$$=No ABIM Power.
Absolutely SUPERBLY written.
ReplyDeleteAnd captures the essence exquisitely.
I've watched this from Canada (we need to guard that it does not repeat itself up north, the tentacles are already spreading).
Consider submitting it for publishing it in the wider mainstream media ?
Hat tip, sir.
Anony 02:24AM -
ReplyDeleteI plan to keep all of my options (legal and otherwise) open regarding the ABIM and their parent organization, the ABMS. For now, I have no intention of participating in "MOC" to earn "MOC points." Such an exercise is meaningless to me and my patients. I have played the game long enough. I will wait to see what happens and then decide. I would encourage others to do the same.
I've said it before, it's all "please the stockholder"
ReplyDeleteThis is actually small-potatoes and minor: I have read that insurance covers "GENERIC HEART transplant, and the thinking is who cares where it came from.
Has anyone seen the paperboy recently?
26 years in the naval reserves! I must have had a sixth sense about it.
ReplyDeleteA salute and quadruple wing tip to you, Dr. Wes.
Sir, we will be flying along side you!
The crazy thing to me is that while ABMS and ABIM (and other boards) have use jumping through all these hoops, other health care professionals (nurse practitioners, etc.) are taking our jobs.
ReplyDeleteIf Cassel did not show up for work, and claimed to be working 35 hrs per week, I wonder if some of the millions paid in salary could be reclaimed.
ReplyDeleteAmazing summary of this corrupt saga, thank you Wes ! What about staging a hunger strike in front of ABIM or ABMS HQ to force change or at least bring more media and governmental attention to this issue ?
ReplyDeleteWes:
ReplyDeleteGreat summary and I do believe that you can lead us to a better place. Please don't forget to mention that the Choose Wisely campaign is responsible for an unknown number of deaths based upon their fraudulent recommendation to avoid complete revascularization in AMI. This disastrous guideline must be the branding of their incompetence and hence danger to the population.
This is off topic a bit but plays into the well known bureaucracy in medicine. Former head of CMS, Marilyn Tavenner, who implemented Obamacare is now a lobbyist for a cabal of health insurance companies. This is the essence of medicine nowadays--make big money off the hard working backs of docs in the trenches. While we are over-tested and over-scrutinized, these moochers mint millions.
drbob 12:04 PM
ReplyDeleteThis is part of the Great Replacement. Quality DOES NOT MATTER, and to an even greater extent YOU DO NOT MATTER. The limits will be pushed while nurse practitioners take your jobs, and by the time enough people die and cry foul then the doors will flood open for ready and willing H-1B Visa doctors who are grateful to be in this country. They will actually feel and be a thousand times more 'entitled' than most American doctors ever were and probably never grateful enough to pledge allegiance to the USA flag, but this will NOT be the media spin. Actually, a lot of you people will turn to suicide, which is very sad because only a very small minority actually deserve that.
From an economic standpoint, 0bamacare was brilliant. Consumers forced to buy product or else pay a penalty. Mergers beget monopolies, so consumer protections are stripped away and prices get out of control--but not ENOUGH out of control, so there's the TPP. All that matters is that all premiums and fees get paid. The legislators who got rich on this aren't concerned about the well being of Americans: just die. This is the plan. Make us money, or die. This is America now.
I know for a fact that you can buy some of the BEST insurance COVERAGE but it does not mean you will get HEALTHCARE. The banksters control that now, and whatever makes money is what is done. A patient can cause a transaction to occur but it will not mean that something useful has happened--that's not how this new system works.
The new face of medicine wears a Jason Hockey Mask. I miss the old face of medicine. So everyone keep fighting a good fight, corruption is everywhere not just this, a little overwhelming...sometimes I think maybe Putin will help us, he's doing a great job protecting us from isis and imagine other possibilities? In the meantime, thanks Wes and others proving some research and leadership and trying to fix this very broken system.
Hunger strike = do no pay MOC. Alternative board prn. Quit paying MOC and ACP dues until they represent internists, rather than their own political agenda and financial interests.
ReplyDeletedrbob is right. The apparent plan is to replace primary care physicians, which includes internists, with mid-level providers. This initiative, already being rolled out across the country, is rendering the physician "specialty" of internal medicine meaningless, since mid-level providers are now de facto internists with prescribing authority and an authorized scope of practice that is essentially identical to that of internists and family practitioners. It is also a fact that the gap between the income of internists, family practioners, and mid-level providers continues to close. Savvy medical students are taking note and choosing fields other than primary care.
ReplyDeleteThe future of internal medicine looks bleak. Mid-level providers are being embraced by insurers and CMS, and are hailed as the saviors of primary care (because, of course, there is a physician shortage for gosh sakes)while physicians are viewed as costly vestiges of old medicine. More insurers and employers are routing patients to drug store minute clinics for most primary care. Ironically, mid-level providers are practicing both outpatient and inpatient medicine without ABIM certification, while we, because of our alleged deep pockets, are forced to jump through the ABIM's hoops to certify and re-certify in a specialty that is going the way of the dinosaurs. It's unlikely that most patients lining up at the local minute clinic are wondering whether the NP they are waiting to see has the ABIM seal of approval.
At a minimum, physicians practicing primary care alongside mid-level providers should not be required to certify or re-certify in internal medicine as a specialty if in fact it is really no longer a specialty. Specialty certification should only be required of those physicians who are practicing a true specialty. Alternatively, the ABIM should demonstrate its commitment to internists by taking steps to reverse the ceding of our specialty to mid-level providers.
A few years ago, I was having financial problems (imagine that as an internist these days), and complained to ACP that cost for review course was less for NP than ACP member... They said it was because they earned less, until I pointed out that I earned less, but they did not care, they just wanted money... They favored NP over their own members.
ReplyDeletePerhaps Cassel's political agenda is for internists to be replaced by NPs, or perhaps it's just a result of current politics in which she and ABIM/ACP have played a major role. I don't know why pilot license (per Tierstein) and NP boards are so much less expensive, except that agenda of ABIM and ACP needs these bloated millions to pay themselves and their political agenda. Clearly it's not about safety or "quality". NP is "board certified" for $395 or as low as $270 if American Nurses Association Member. Recert q 5 years as low as $200 for ANA members and "proof of professional development which typically consists of practice hours and continuing education".
http://www.nursecredentialing.org/FamilyNP#track
Home study course book is only ~$100, three day board review course is <$500, and has PASS rate >99%http://www.npcourses.com/
Oh, and the recert gives them credit for actual patient care, and no MOC.
Is the public demanding MOC for NPs, or was the public demand for MOC for MDs just more of Cassel's self-serving nonsense?
Maybe we should start an internist to PA track, as I would gladly hire and be the patient of an experienced internist who stopped MOC, over most NPs who don't know what they don't know. Some of our experienced internists might continue contributing their expertise if they were paid like PAs, and did not have to put up with the ever increasing nonsense poured onto MDs....
In the meantime, I quit MOC and ACP. I've paid enough to be treated so badly by these people.
Yes, the profession of medicine is better than that. You are better. We all are better than that!
ReplyDeleteyou did a great job Wes
ReplyDeletei am reading your blog from France since a few years i am even not a practicionner but a journalist and Dr in pharmacy ... but covering international medical congress AND taking care of my old parents and of some good friends who sufferred big medical problems
i got interested in medical practice ..
and SADLY what i see in France even in well known hospital is not far from what you describe ..
where we have no ABIM but ...
we have TECHNOCRATS ...
and they are playing the SAME GAME !
killing internal medicine general practice
for tge benefit i guess of insurance companies ....
in France and in Paris
patients dy every day of this illness
Paris Attacks killed mostly young ones
this growing technocracy will kill every ones mostly the okd the poor and the unlucky ones .. While most practicioner do their best work hard give their live to their patients ...
at least the old ones as the younger are not teached any element of semiology and are less and less considering internal medicine and or general medicine an option .... prefering to work as employee with regular work hours than practice as GP in these conditions ...
bests
@psolere
We need to organize and sue not only these bastards but any insurance company or hospital requiring certification for payment of services or for privileges. Take them to court, jury trial so real people can see once all this is divulged, all of it and with great haste. The longer we wait the more doctors will be forced into early retirement by this sheer madness. One thousand dollars donated to a legal fund should raise some serious cash and hire the best attorney money can buy.
ReplyDeleteJack Rzepka, M.D.
Wes,
ReplyDeleteI enjoy your blog and support everything you are doing.
There is one thing I fail to understand. Why can't physicians REALLY unite around this cause and force change?
There are reportedly ~ 900,000 active physicians in the United States (http://kff.org/other/state-indicator/total-active-physicians/). MOC negatively impacts all of us. Yet, only a minority seem to be doing anything about it. For example, only ~ 7,500 have taken the pledge of non-compliance with MOC (http://www.petitionbuzz.com/petitions/nomocvow). Worse yet, for all of the attention the National Board of Physicians and Surgeons has received, only ~ 2,000 applicants have been completed and a miserable 11 hospitals accept this certification as an alternative to the ABMS (as of July 27, 2015 https://nbpas.org/News/news/).
You're doing your part in the fight. Paul Teirstein is doing his part. Some of the medical societies have spoken up against ABMS (all too politely I would add).
How do we rally the nearly 1 million physician troops together to meaningfully fight this?
Thanks.
To@psolere: We have solidarity with you! We know more of your pain than we can say.
ReplyDeletehttp://www.bing.com/videos/search?q=Elvis+Presley+I%27ll+Never+Fall+in+Love+Again&Form=VQFRVP#view=detail&mid=237254A11658723117EB237254A11658723117EB
Nous avons solidarité avec vous ! Abiento!
Mike, rue des ecoles
J R, you eloquently stated using the most exacting terms possible, "We need to organize and sue not only these bastards but any insurance company or hospital requiring certification for payment of services or for privileges."
ReplyDeleteThere are several lawsuits that need to be filed against the ABIM specifically and the ABMS generally for their participation as the umbrella organization that claim no oversight responsibility. Of course they have obligations and liability to the 24. Whatever they think or say don't bother to talk with them. Discuss it with THEIR INSURERS. If they did not have great liability they would not have a risk management team to lie about all the ways that they are not legally liable.
The ABMS insurers, who put themselves at grave risk, will tell you something entirely different, and once you see the policies and the premiums they pay you will understand what I am saying. I probed the waters. The ABMS executives and house staff are totally vulnerable to the ABMS members misstatements, omissions, obfuscations and Mafioso style legal and police/surveillance tactics.
Yes, ABMS has liability--even for the illicit deeds of the ABIM. You may find in discovery how deep and how high the corruption goes at the ABMS and their partners.
To get started, you need the best qui tam legal team to present to in the country, because the DOJ will quickly recognize that your civil case is of high merit and priority. One must know how to present it, only a highly skilled team of attorneys could do that. There is whistleblower money for the witnesses who come forward to testify. A lot of money is a stake. Look at the revenues of the ABIM alone over the past seven years. At least a half a billion dollars. Extend that out. The IRS will take them all the way back once they find out the wrongdoing, intentional and malicious. Once the DOJ gets drift of the slime in the apple barrel.
There are also great employment attorneys that mostly like will work for a contingency. Violations have occurred and physicians swim like a swarm of fish in fear.
There is a good attorney, but there are many. I found one from court records. She fought for a wronged ABIM employee over women's rights in the workplace. She' been on TV. Already familiar with the ABIM.
These are workplace rights issues violations(insurance and hospital privileges) and so much more. There are federal and state laws to protect you. How stupid to just sit there for years and take the beating right in the face year after year.
Fight. You throw the punches from now on. Get up off the ground and fight!
ReplyDeleteYou have a legal basis for suing them. They lobbied without claiming those lobbying effort to the IRS. All Cassel did was lobby and advise while working for the ABIM. What a scam. ABIM and cronies even used third parties to hide other activity. They were very sloppy and it all can be proven.
Name the ABMS and all the culpable insurers and every hospital in the country in your suits. It will take a very large team, so shop around. Get a cease and desist first and they will settle immediately when the judge finds out what they (ABMS, ABIM) have done to the constitution, bill of rights, even the legal system and who the ABMS has used to screw physicians and the public.
Yes, whatever the ABIM has done, the ABMS knows about it. It is their business to not only know but to synchronize and coordinate efforts. After all it is a vast corporate enterprise with deep pockets and much to gain or lose. Would you let a rogue organization like the ABIM or ABP act alone. Absolutely not!
Get a team of 8 civil liberties attorneys as well. You will understand once you get to discovery what they have done to every physician and American. If you don't know by now then you better find out what I am saying by investigating.
Don't hold your breath for the New York Times or Washington Post front page headline, ABMS caught in a massive fraud and racketeering scam that spans over sixty years. Your cases will all be settled to avoid jail time and contain costs for the survivors of the ABMS scandal.
Hit them with a racketeering charge. They will never survive even if it never goes to court. You know what I not even sure the government wants the ABMS anymore, otherwise bloggers would have been shut down a few years ago. And Newsweek would never have been allowed to run the opinion pieces. Think about it. Fight now.
These people are NOT going to just give up, there's too much money at stake. The only solution is for physicians to boycott these parasites and stop sending them money. Unfortunately, physicians are too timid to do that. The scumbags at the ABIM and other specialty boards will have to be FORCED to stop this nonsense, otherwise it will continue on some level.
ReplyDeleteDavid
Thank you for posting this. I am an internist intensivist and I just went through the challenges of taking my second recertification exam in internal medicine. I took the exam and passed it the first time in 1997, then 2007, and now 2015. Your words are powerful. Thank you for posting them.
ReplyDeleteRichard