Friday, March 11, 2016

When Medical Students Push Back

There are few times when medical academics sound more foolish that when they're caught with their hand in the regulatory cookie jar.

Take, for instance, this response to the recent pushback by medical students against the National Board of Medical Examiners' Step 2 CS requirement.  For those unfamiliar, this is an attempt for the NBME to "standardize" the patient encounter while collecting $1250 at one of only five specialized testing centers is the US for the pleasure.  Their excuse for such a requirement?
"... most medical school faculty don’t have time to observe third- and fourth-year students doing a complete physical exam, so it’s important to test those skills as part of the licensing process.

“It’s really just a part of what we do to become physicians and to demonstrate to the public that we have earned their trust — that they can put their faith in us and feel comfortable with it,” Kastufrakis said.

The exam also serves as a sort of quality assurance test for medical schools, to make sure they’re teaching patient care skills, said Dr. Lia S. Logio, president of the Association of Program Directors in Internal Medicine. “I think everyone coming to my residency program should pass it, and pass it on the first attempt,” Logio said."
Medical school faculty don't have the time? Seriously? That's their job. If medical school faculty, working 9 months a year while planning their resarch projects and next grant application, don't have the time to evaluate the medical students that fund their salaries sufficiently, then perhaps they need to look inward rather than asking medical students to submit themselves to this money grab. Medical school is already incredibly expensive (private schools here in Chicago enjoy a tuition and fees of over $54,000/year). Certification and licensure fees are many more thousands on top of that (again and again and again).  Unnecessary testing is a waste of time and resources for physician-trainees who are increasingly thrown under the bus by the non-practicing bureacratic elite. The whole process needs serious reassessment. Otherwise, our best and brightest will understand all too soon what they're up against and that won't be good for the "public" at all.

I suggest the NBME stop Step 2 CS and adjust their budget accordingly.


Addendum: Interesting that the NMBE made $136 million in 2014  from testing fees, 50% of which went to salaries.


Lisa said...

"demonstrate to the public that we have earned their trust"

Not the most trusted profession at this point in time, right down there with used car salesmen and clergy.

There's still a handful of doctors with some ethics and morals and good stuff like that, but it's America..."Forget it, Jake, it's Chinatown"

IRiS said...

NBME Transparency? How much do these NBME bureaucrats get in individual compensation?

Why does the NBME not have clear links (or any link) in order to look at their finances and leadership on their website? Financial info should be easy to find, but it's not.


Does NBME have trouble reporting on time and reporting all income (related and unrelated)?,-Exempt-Organization-Business-Income-Tax-Return

The policing of physicians starts early and never ends. Why would anyone want to be a physician if they had to follow idiot rules designed by profiteers and idiots?

USMLE security questions answered by the past president.

Rip-off report said...

NMBE Philadelphia President Melnick in the 2013 tax year received nearly a million dollars in compensation.
$996,391 $248K in "other" and over $113K in "deferred" compensation.

In 2013 a VP of program development is worth $486,096 (Swanson)
A SVP of professional services got $457,112 (Nungester)

Are these guys physicians, Wes? I did not see MD or Dr. attached to anyone's name.

CS2 is BS2 said...

Donald E. Melnick, MD has been NBME president since 2000 and has been with the firm since 1983 in various positions. 33 years with the NBME. He currently gets how much in compensation? Over a MILLION BUCKS.
The Harvard medical students are absolutely right to oppose this useless testing.
I remember taking this worthless CS exercise with a fake patient from Philadelphia who did not really want to cooperate with the physical exam. How objective is that?
In giving the chest exam they did not want to be touched at all there. Why, I asked politely. "Because it's my damn chest, they replied back with a hostile roar." I still don't know if that was a part of the test, but I have never in real life encountered a patient like that.
The NBME, like the ABMS leadership is another profligate gang of executives and VIP's who refuse to play fair and be equitable by hoarding all the money! How professional is that!

Anonymous said...


Maybe President Melnick is alright as he is not participating in MOC according to the ABIM.
Perhaps he could be just as easily persuaded to see the light about CSII and end it.

Question: If Dr. Melnick, who is a grandfathered certified physician, is head of one of the most powerful, important, and lucrative testing agencies in the US does not participate in MOC, what kind of message does that send to the ABMS about the value of maintenance of certification?

Anonymous said...

only when all the unjust and predatory regulation designed only by greed will be removed - then america will be a great place to live.

OIG said...

Assessment dinosaurs lay another testing goose egg on physicians just to hatch another golden goose.

Look at all these so-called "non-governmental testing organizations" or NGO's that are nothing more than "cash cows" or the proverbial "golden goose" for elite medical executives.

Does the clinical skills test really have value?

It used to be only IMG's took the exam because they came from "another" country or "different" medical system. How valid were those concerns for step 2 to be administered by the FSMG and USMLE and then making it mandatory for all?

Kaplan and other test review companies certainly made out big in taking all the immigrants' money - and then totally draining young US physicians' bank accounts. Is it really because clinical skills was no longer taught anywhere? Most who took the USMLE clinical skills test thought it was a total waste of time and money.

I wonder how much money gets scammed out of the pockets of every "future physician" and "practicing provider" mandated by the emperors and tsars of endless testing? How many of the questions on a USMLE test also appear on an ABMS certification exam? Quite a lot are recycled or written by the same "authors."

And what about the biggest scam of all that we pay for tuition at the highest rates in the country to end up not being physicians but something far shy of it - we get to be mere healthcare providers. Are other non-physicians primary healthcare providers showing up in one of the five USMLE imperial cities to take the clinical skills assessment test?

Well then, what is all this certification about if physicians are just providers in the end?

There must be an honest compact offered and one that is live up to. Just like the promise of lifetime certification. A broken compact. And then it all gets made into something meaningless by a few hundred elite executives who have lost moral integrity and are no longer good with their word.

MOC is total mockery of the integrity of the certification industry and the entire testing process. So is the clinical skills exam a sham. The elite bureaucrats who left the practice of medicine in pursuit of easy money became heads of a false state. They took the money and lost their way - compounding the myriad questions of trust by repeatedly breaking their word.

3-D world said...

The USMLE is not keeping step with the fast pace of medicine

The whole USMLE "Step process" needs to be re-examined along with the entire ABMS testing bureaucracy. It must be assessed for waste, inefficiency, and redundancy.
What makes it most wasteful if the squandering of money and pampering those in power with it.

Consider taking the lucrative money out of it altogether. Medicine is changing and so should the "mediocrity" that runs these assessment rackets. Money in bureaucrats hands, lots of it, has done nothing to improve medicine at all. The professional medical bureaucrats have just gotten lazy (and many are dull-minded) with all that cash and cush.

All the latest medical guidelines inform us that less is more. It is now time for the Melnicks, Barons, Cassel's, Nora's, and all the rest of these professional medical bureaucrats to start getting in line with the times and the message. Take a substantial pay cut and stay a little later at the office at night and on the weekends to create a higher quality data bank of knowledge. Find better ways for the dissemination of continuous learning - worthy of physicians of the instantaneous information superhighway.

FYI NBME has board members at large. One of them was the past president of one of its partner organization, the FSMB - another troublesomely unproductive redundant NGO looking to do as much harm to physicians as possible if allowed to do so. The current president of the FSMB makes around 630,000.00 dollars.

If you want to work in some states you have to pay these guys at the FSMB Credential Verification Service big money for the privilege of storing your key information; but the states make you do it all over again because the liability of gathering non-primary-sourced credentialing information is too great to entrust to the FSMB, who after all just wants your money like the ABMS certification scam.

BTW the founder of the ABIM in 1936 was previously the head of the FSMB, which was founded in the early twentieth century celebrating 100 years of keeping the people safe as of 2012.

That's how old the revolving door system of power, favors and money goes back. The only difference is the huge money paid out for working at a non-profit today. In years gone by the ABIM expected you to be a volunteer working for no pay as an officer or board member.

How about restructuring the NMBE? Make the executive positions voluntary - limited to a year. We need practicing docs not MD bureaucrats for life. What good is it to be cushioned from life with all that cash and making decisions that affect physicians who are actually living a real life treating patients. In case you had not noticed, Dr. Melnick, we are at war and everyone is receiving their medical rations and pharmacy stamps. How do you come off with your millions upon millions of bucks for doing what should be a privilege to do for free?

Ditto for Baron and Nora.

Anonymous said...

Dr Lia S. Logio... you graduated in 1992, so you have never taken Step 2 CS ( BEFORE 2004 the exam was not administered because ot had problems with reliability=subjectivity).
Why don't you take it to protect your own patients first, and then- do you think you are a worse physician because you have never taken and passed this exam? Your statement is very hypocritical, and lacks simple logic.
Before talking, start thinking, because obviously you are brainwashed. And shows stupidity.
Majority of NBME's physicians have never taken this exam, some of them have bad reviews by their own patients, some of them have good reviews. However, since Dr. Logio has never researched the issue and just wants to show (stupidity) and loyalty to the NBME, here is what some studies found:
-real and standardized patients differ, and Step 2 CS can tests only initial 15-min impression ( i.e. for a doc-pt relationship it is not reliable).
- CIS portion is highly subjective and shows large variations in scores,
-Governmental organization does not reccommend using this test when the candidate is supposed to improve gain knowledge and skills during training, i.e. the exam is more appropriate AFTER residency.
And many more reserach studies available in the data base, including NBME's own reserach studies, which shows NBME's DECEPTION WITH STEP 2 CS.
Next time, dr Logio, please take the exam, do your homework, use your brain to analyze the data, and THEN comment.