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 ""
(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.


Wes Fisher, MD


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.

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
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.


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.

Anonymous said...

I recertified recently after 2 prior recertification failures. Each time the failure notification email came, it was wrenching. I understand the realities of functional depression that comes over those who have failed. I also understand the need expressed to be strong for one's patients--patients who have no doubt been blessed by longstanding and very competent care. After many years, my patients generally admire or at the least respect me. For those who found personal, professional, or administrative/insurance interactions troublesome, they have found another PCP, and I wish them well. Like hundreds (?thousands) of others, I have known the feeling of near despair and have screamed "I just can't do this again!!" but then I pick myself up, allocate the time (literally 1 year before the last exam) and read those damned review books and answer those infernal questions. UGH! During that time, instead of relaxing after a hard but rewarding week of caring for patients, there I started yet another weekend with the books, with the questions. Going to bed at night was a joy if only as a reprieve from the board review misery.

Yes I was delighted and more than a bit relieved with the passing of the last board exam, but it came at a mighty high price. Not just the financial cost but the time, energy and emotional toil of the fight. Even though I passed, I really felt like I would never pass. I really felt I would be a black sheep among my fellow practitioners. I felt like the climb up the mountain was too hard.

But I am angry still. And I delight in the godly struggle, the righteous warriors whose articles and blog reports I read, the faithful fighters who want to move us all in a better and more sane direction. All who cry out, who demand, who insist that the status quo must go and that a clearer, better, more respectable medical assessment mechanism must replace the diseased, rotten, ivory tower, greed-driven current ABIM leadership. They disgust me.

So, I ask, how do we launch an effective MOC boycott? How does one become two become a community become a force to say NO!?

B Baca said...

I am not sure where to begin, as a family physician who was inspired to serve others with compassionate quality customer service delivery, I thought I was doing this for the last thirteen years. Until the day my life was completely changed in 2013 when I failed my board examine. Ironically, I never imagined that the field and practice of medicine, I committed my life to, would bring me to my knees. I will not woe others with my emotional, finical, mental losses but I will say this has been a journey and somedays I have to courageously find my two feet to stand on. I think those who have courageously spoken out are the faithful fighters who do want to move this field in a better direction and for that I thank all those who have spoke out. I to speak out and find solance in knowing that I am not alone and there are others facing this life challenge and I hope we all find are way someday. To the leadership of ABIM, the system in which you have so proudly created is defining quality doctors based off of an examine score, and we all know that in it self is erroneous. Please challenge your system as those examine scores are dratsically changing the lives of "great" doctors and unfortunately your system is not weeding out the bad ones.

Anonymous said...

I have elected not to recertify. My patients don't care. I do outpatient Pediatrics so do not deal with hospitals. After 30 years in practice I feel I know what I am doing. I complete PREP for CME so I keep up. I am not putting myself through the stress and expense.

Gerry Khurl said...

i did not pass, i didn't do the mksap questions, i did the NEJM review, just missed the cutoff, just an unbelievable waste of time. I did not take a class because i have small children and cannot be away from them for too long, the whole thing makes no sense, you have to spend months on end studying zebras you will never see. The clinical vignettes are purposely trying to trick you. Now I am going to take the aweesome review course in a few months and be forced to sit in a class for 12 hours a day for the next 7-8 days, have my wife scream at me for not being home, and for what, absolutely nothing. You aren't learning anything, you are just building your brain up to regurgitate a bunch of facts that 60-70% of which you will forget 1 month later. I am a practicing internist and i see patients at the 95% percetile of all internists, what am i supposed to do, just bail on all those people for 6 weeks so i can cram for a test like in freaking college? Recertification should be an active progressive process I would love to listen to modules and lectures, spend time discussing things with colleagues. instead i have hole myself up in my basement and cram from 10-12:30 at night for the first half of the year. Total bullshit..