Home Forums Discussions General Discussion "Boarded to Death" - ABIM's Maintenance of Certification

Recent NEJM commentary on ABIM's controversial costly new MOC requirements:
[i]Boarded to Death ? Why Maintenance of Certification Is Bad for Doctors and Patients[/i].

I you agree, sign the petition.

We have been facing this the last few years in Family Medicine. The ABFM requires two different types of activities to be done in 2 year stages. If you don't keep up, not to mention all your CME requirements, you have to take the Board Exam every 7 years instead of every 10. This is being seen by more and more physicians as a meaningless waste of our time and another opportunity for the boards to profit themselves at our expense. No other professionals, such as lawyers, engineers, or others have to do this. Advanced nurses are practicing in our area without supervision, and 19 other states, and getting paid the same as I am. Not only do they avoid these requirements, but they've never been board certified or been to medical school or residency, as they are not physicians.

The beatings will continue...until the morale improves.

ABFM is our road to extinction.
I'm not sure why any enterprising 20-year old would go to medical school as things currently stand, but if, by some chance you find yourself with an MD degree, you certainly wouldn't want to share it with all the other people operating as "PCP's"

I am starting to be repulsed by the term 'provider'.

Everyone should be signing the petition. All of us.

"provider" is repulsive.

It is so they can use PA's and Nurse Practioners in corporate practices -- pay them less, but charge as much as for doctors -- and not have to negotiate the difficult part of what to call them, since they can't call them "doctors".

Of course, now we have "doctors of Nursing Practice" -- don't know how that is going to come down.
But as I said before -- why would you want to go to medical school and come out $200K in debt -- to do the same job as a PA or NP?

A few of my patients still know the difference between a real doctor and a mid level. It drives me crazy when they call Susan Soandso Dr. Soandso. I worked damn hard for my degree, and continue to work to remain board certified.

Don't even get me started. As a former PA who recognized early on I was sorely educated and poorly trained, I dug in, went into tremendous debt, gave away my youth and got my MD degree only to see it devalued by the "physician extender". I currently have so many patients that have switched to me because "they never get to see the doctor". My current employer's stance is "we'd better hire them before someone else does"!!! We as physicians made our bed and now we have to lie in it. I am just so very glad I am at the end of my career and not the beginning.

It's just as bad as the ABP. Used to be you took a test every seven years. I would use the UCLA Board Review (something like 60 hours of lectures on CDs I would play in my car). Then, I would go pass it and actually learn a ton by listening to the lectures in my card. Now, we have the exam every ten years, and the MOC 2 and 4. It's ridiculous.

I started the MOC 2, which is an open journal article test. You have to make 80% of 50 to 100 questions (can't remember). So, rather than using something like UpToDate, where I could read through it, I have to use a Pediatrics Journal article on ADHD. So, I am skimming thorugh this six to eight page article trying to find the actual answer, because if you just use what you have been doing for 19 years, there is a 75% chance you will get it wrong. But, even when you find the answer written verbatim, there is no guarantee you will get the question right. So, far, I have done five questions. I have one on Hold. And, I am two out of four on the other. And, I am pretty sure I am going to get the one on Hold wrong. So, I will be at 40% (2 correct and 3 wrong after five questions and 45 minutes).

The people who write the questions for the MCATs, USMLEs, and board certification tests write good questions. These questions are horrible. I sent them an email and I got a response back saying, "Yes, the questions are a bit outdated."

I love the way they do the actual ten year board exam. The exam is free, but if you fail it, you can retake it for $1200. And, if you get a failing score and you officially contest a wrong answer, you may do this, but if you are found to still be wrong, they charge you $250. The good news is if they find that the question was unfair, your challenge is free.

Funny -- this thread was active for a couple of weeks in January (when I was getting ready for my Board exam in April.) There were no more posts until yesterday -- apparently Bert just got started on his own decennial journey of frustration and outrage (MOC) and decided to dredge up the thread to vent....

Anyway, I passed-- I think it is my 5th time (the intervals used to be 7 years) -- and I become a little more discouraged each time I go through this.

In the beginning (early 70's) the board certification and maintenance of certification was about creating a culture of lifelong learning -- and not incidentally, a "brand" -- Family Doctor, Pediatrician, Internist. We idealists all bought into that. Medical conferences were educational, interesting, cutting edge -- and fun.

This has been so sadly diluted by the MOC "process", and like all industrial processes has relentlessly crushed the human value of any of the original goals. I see that the American Board of Internal Medicine is a little disturbed by the current MOC process, or at least with the bad press it is generating -- but they are very happy with their $700,000 "CEO". I'm not aware of very many practicing internists who agree with what is going on, so I guess the profession is irrevocably split into the Managers and the Managed.

The same thing happened to labor unions when their "management" started demanding huge salaries and they got into bed with the corporate management (in the prone position, of course) -- and apparently have made themselves completely irrelevant. Where do you see "Union Made" any more?

As for the "brand" -- well, the patients are forced into accepting a "PCP", (that's just generic-speak for physician) and if you thought there was any chance of a doctor demanding a somewhat higher compensation for his/her work, well think again. The doctors gave away the farm quite a few years ago-- it's owned and run by financiers and bureaucrats now-- and we physicians are overqualified in the new world of industrial medicine.

Board certification now means nothing except that you have to work a lot harder for the same money as a PA or NP.

Venting is only good if someone hears you. Thanks Tom.

You are welcome. I enjoy rants.
Did you know that the Break The Red Tape thread is somehow flagged as an "announcement" now. I couldn't post my comment --

Damn. Thanks for pointing that out. I changed that. You would think I would know that being an admin for like 7 years.

I am going to have to make you a moderator.

thanks anyway, Bert
But as you know, I am not "moderate."