Thursday, April 09, 2015

More on the American Board of Internal Medicine and maintenance of certification

Yesterday I linked to the latest Newsweek piece on the ABIM and MOC.  It was a follow up to an earlier Newsweek piece which you can access here for a little background.  Though like much written on this subject it makes some simplistic assumptions about how doctors keep up in their specialties it is generally spot on.  Though not new to this discussion I found the article added clarity.  It is an important read. 

I found this of particular interest:

Then, something strange happened, doctors say. The tests started including questions about problems that had nothing to do with how doctors did their jobs. For example, endocrinologists who worked exclusively with adults said they were forced to answer questions about endocrinology for children, even though the pediatric information was irrelevant to their practices. Heart specialists who do not perform transplants – and even those at hospitals with no heart transplant programs – said they had to study techniques for reading transplant tissue slides and how best to evaluate these patients so they could answer questions on the tests. But that knowledge was unrelated to the care they provide to their real patients, they said, and took time that they could have spent learning the latest medical findings about the cardiology work they actually perform.Videos and study sessions sold to help doctors prepare for re-certification exams often featured instructors saying physicians would never see a particular condition or use a certain diagnostic technique, but they needed to review it because it would be on the test.

This rings true to my own experience in attending board review courses sponsored by academic institutions.  Speakers would say "you may never see this but it always seems to show up on boards.". Although this brand of teaching for the test is pervasive even among the most reputable board prep resources, the ABIM called it "cheating", took legal action and drove at least one board review company out of business --- one which, it appeared to me, was in competition with board prep activities ABIM had "partnered" with.  Curiously, this particular ethical question has received scant attention in the discussion though I blogged it extensively a while back. 

And citing the progressive decline in board exam pass rates the author asks these questions:

Wow. Was it Obamacare? Ebola? A sign of the end times? What was turning so many American doctors so stupid all of sudden? Not to worry, the ABIM declares—the board could help doctors keep their certification. All they had to do was pay to take the tests again. Making doctors appear ignorant became big business, worth millions of dollars, and the ABIM went from being a genial organization celebrated by the medical profession to something more akin to a protection racket.

The ABIM disputes that characterization. Lorie B. Slass, a spokesperson for the ABIM, says “there have been and always will be” fluctuations in test results, since different groups of doctors are taking the exam each year. But in each of the categories cited above, there are no statistically significant fluctuations—the passing rate keeps going down. So the point remains: Either doctors are getting dumber each year, or the test that helps determine who gets to practice medicine has less and less to do with the actual practice of  medicine.


It goes on to describe the lavish salaries of ABIM's leaders.  By contrast, according to the piece, the leaders of Teirstein's newly formed National Board of Physicians and Surgeons will work for free. 

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