A run on the ABO?

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medphysik2015

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Re: Oral boards postponed

Given the situation, I have asked for a refund. I encourage others to ask for a refund as well.

I believe there are major issues with the oral/written board process in ophthalmology, and I have heard older Docs express their dissatisfaction with the ABO relating to Maintenance of Certification.

Looking at their taxes, they have around 5.5 mil in net assets, 5 mil in essentially fixed costs per year, and their CEO makes ~ 700K a year. If all candidates ask for a refund ~900 this will be 1.8 mil or 40% of their net assets. Perhaps this is a golden opportunity for negotiation with the ABO and change give we certainly have bargaining power collectively.

Please provide your comments/insights.

Tax data: https://abop.org/media/134922/form_990_2018_american_board_of_ophthamology__1_.pdf
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With respect, as a graduate of an US accredited ophthalmology residency program with multiple state medical licenses and successfully completion of the written boards; I feel there is little need for an oral board. Student loans have significant increase over the years as reimbursement has decrease. The oral boards add an unnecessary expense and lost of clinic time. If I'm not currently safe to practice ophthalmology, the system is significantly broken and taking an oral board is not going to fix that. The board has recently sent out an survey and now is the time to respond if you disagree with the current system.
 
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I hated taking oral boards but I've got a lot less issues with it than the entire MOC process.
 
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Thanks all, I sent the following email to them and took out identifying info. Shout out to PCC108050, your statement was well said so I borrowed it.

Not sure it will go anywhere, but at least it is out there in the world.

<<>>


Dr. Bartely,

I didn't get to fill the survey out but I wanted to provide my feedback and thoughts from the 20+ fellows we have here at ***.

I personally started studying in November and put many hours into preparing for the Oral boards in March. Many of us here at ** studied together every weekend since the start of the year. Preparing for 2 board exams during fellowship certainly has taken away from our fellowships and it is unfortunate that ultimately the oral exam was canceled given the sacrifices that we have all made to prepare for the exam.


Currently, we are all under an undue amount of stress and distraction given the current COVID19 situation. Things are changing rapidly. Many of us are now thinking about how this will affect our transition to private practice and our future income potential not to mention this has drastically changed our day-to-day as fellows. I am not sure that many of us will have the mental capacity to study for the exam given the variety of other concerns we currently have regarding changing economics, job prospects, the health of our families and ever-changing clinical responsibilities. Most of us have 200+K in debt, and have no savings, we are very vulnerable to an economic downturn.

It was a huge sacrifice to study for the oral exam once, and now most of us will seek a time that is less stressful and more predictable to study for and take the oral exam in the future (however, when will that be?). In addition, because of this, I believe that some of us will elect not to become board certified if it is not necessary for our day to day practices as it may be sometime before outpatient medicine stabilizes economically. We will simply have other concerns.

In my opinion, as a graduate of a US-accredited ophthalmology residency program with multiple state medical licenses and successfully completion of the written boards and a fellowship (7/2020); I feel there is little need for an oral board. Student loans have significantly increased over the years as reimbursement has decreased. The oral boards add an unnecessary expense and loss of clinic time. If I'm not currently safe to practice ophthalmology, the system is significantly broken and taking an oral board is not going to fix that.
 
You spelled George Bartley’s name wrong. That letter will never work now... didn’t even have to read it.


Sent from my iPhone using SDN mobile
 
I think this is fantastic letter. I encourage all of us to petition and write to the ABO. I am drafting my letter as we speak. In these uncertain times, it is the least they could do is do away with the oral exam.
 
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Nice letter but you forget the fact the ABO would be losing the opportunity to extort, I mean receive, tons of dollars from you all for this oral board. You also can't take away the ABO's opportunity to mislead the public in to thinking they are raising the level of patient safety by you successfully passing the oral boards and then wasting time, I mean, successfully passing the MOC as well
 
Don't forget that George Bartley made $681,000 from the ABO in 2018. No way he is going to cut revenue because that would mean he would have to take a pay cut! Everyone else out there is struggling, but I'm sure you can guess who won't be.

2018 Form 990 for American Board of Ophthalmology (ABO) | Cause IQ

View and download the year Form 990 for American Board of Ophthalmology (ABO), for the fiscal year ending 2018-12.
www.causeiq.com www.causeiq.com
 
We received an e-mail yesterday that it's going to be done remotely at some point this year based on survey results....I never received a survey. Did anyone else not receive the survey who should have???
 
I did receive the survey. I am going to ask Dr. Bartley, at some point, to survey everyone to see if an oral exam is still favored. Radiology already did away with their oral exam about a decade ago.
 
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WashingtonRetinaDoc said:
I did receive the survey. I am going to ask Dr. Bartley, at some point, to survey everyone to see if an oral exam is still favored. Radiology already did away with their oral exam about a decade ago.
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How do we get this oral board exam abolished? It's ridiculous.
 
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Every generation of ophthalmologist has done it. Don't weaken our standards. Is this a millenial thing to take shortcuts?
 
"Because that's the way it's always been done" is a lame and lazy justification for old traditions from the Boomer generation.

That being said, I do think the oral boards has utility and should be continued.
 
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Thank you for your comments, however, participating in generational warfare is unlikely to be productive.

I personally believe it is time for young leaders to start making their marks across medicine, technology, and business. If you are at all unhappy with the ABO in regard to the oral board exam (or the maintenance of certification process), I encourage you to reach out to them via email. Likewise, if you have positive feedback I am sure they would appreciate this as well.

In reality, the ABO is supported by the Opthalmology community. If something is not working, we should all raise our concern so that the problems can be fixed. No one will hold the ABO responsible other than the Ophthalmology community itself. I believe the younger generation has a bigger voice here as we will be paying into the ABO for much longer (possibly +30 years of MOC at this point for myself).

Anyways, here is to staying safe out there while the ABO figures out when and how exactly to administer the "Skype" oral board exam.
 
In reply to the poster above, generations of previous ophthalmologists did face and pass this exam. But they did it as a certification to distinguish themselves. Now, we face multiple exams with 70-80% pass rate in order to be able to practice and get hospital credentials and insurance credentials while juggling hundreds of thousands of dollars of student loans. If you cannot pass, you cannot work long term. Many of the smartest people I know have had to take the exam multiple times. Meanwhile other specialties have much higher pass rates.
 
The pass rate for the oral board exam for first-time examinees is around 80%. The pass rate for people taking it a second time is around 80%. Thus the pass rate is around 96% (80% of the 20% re-taking equals 16%) when looking at examinees who have taken the test once or twice.
 
estes8000 said:
The pass rate for the oral board exam for first-time examinees is around 80%. The pass rate for people taking it a second time is around 80%. Thus the pass rate is around 96% (80% of the 20% re-taking equals 16%) when looking at examinees who have taken the test once or twice.
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80% is way too low for an exam such as this. If ophthalmology residency adequately prepared you for real-world practice, then the pass rate should be >90% (in line with all other specialties). If 20% of ophthalmology graduates are UNFIT FOR PRACTICE, which is what the oral board claims to measure, then we need a massive overhaul of our training programs.

On the other hand, if the oral board exam measures skills that are NOT RELEVANT to daily practice but is instead a compendium of buzzwords and mind games, then we have to question the utility of the exam. Not to mention the waste of $3K for all the examinees.
 
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TheLesPaul said:
80% is way too low for an exam such as this. If ophthalmology residency adequately prepared you for real-world practice, then the pass rate should be >90% (in line with all other specialties). If 20% of ophthalmology graduates are UNFIT FOR PRACTICE, which is what the oral board claims to measure, then we need a massive overhaul of our training programs.

On the other hand, if the oral board exam measures skills that are NOT RELEVANT to daily practice but is instead a compendium of buzzwords and mind games, then we have to question the utility of the exam. Not to mention the waste of $3K for all the examinees.
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Exactly. So does an 80% PASS RATE mean that 20% of graduates are not fit to practice ophthalmology to the standard that is required by the ABO? If that is the case, the problem is not with the test takers but rather the ophthalmology programs. There is no way that it is the residents' fault for such a low pass rate when they have already passed so many prior exams to be even able to get into residency.
 
Would be interesting to assess favorability opinions of Ophthalmologists depending on career stage: >10 years in practice, 5-10 years, 0-5 years, and residents/fellows. I imagine there would a significant disparity. Passions run highest when it's on deck and you're questioning the point of all the time, effort and cost.

For myself, having passed it a few years ago, it could certainly be improved but I would not go so far as to label it a useless endeavor.
 

wow. 30% fail rate on most recent exam. this is shocking, and alarming trend since going virtual. perhaps I will wait until it returns to live format where stats are more favorable. what do others think about this chart​

​

Oral Examination​

YearTotal Candidates1st Time Takers1st Time Takers
Passed		Repeat TakersRepeat Takers
Passed		Overall PassedOverall Failed
2020D180156113 (72.4%)2413 (54.2%)126 (70%)54 (30%)
2020C186147109 (74.2%)3927 (69.2%)136 (73.1%)50 (26.9%)
2020B171143110 (76.9% )2819 (67.9%)129 (75.4%)42 (24.6%)
2020A1028768 (78.2%)1511 (73.3%)79 (77.5%)23 (22.6%)
2019F379336263 (78.3%)4333 (76.7%)296 (78.1%)83 (21.9%)
2019S282226194 (85.8%)5638 (67.9%)232 (82.3%)50 (17.7%)
2018F338292249 (85.3%)4635 (76%)284 (84%)54 (16%)
2018S335277242 (87.4%)5845 (77.6%)287 (85.7%)48 (14.3%)
2017F292225187 (83.1%)6753 (79.1%)240 (82.2%)52 (17.8%)
2017S337274220 (80.3%)6341 (65.1%)261 (77.4%)76 (22.6%)
2016F290199155 (77.9%)9165 (71.4%)220 (75.9%)70 (24.1%)
2016S312262190 (72.5%) 5032 (64%) 222 (71.2%) 90 (28.8%)
 
Wow, yeah I know several people including myself that failed last round on the online format. I would say the online format is not ideal. All the issues that people talk about regarding the oral exam are simply made worse and compounded with the online format. In addition, you only get around 7 cases per section when you previously got 14 cases per section so if you bombed on one or two it wasn't as large as 2 out of seven cases.

I personally am waiting for an in person exam and so that I can line up all the review courses such as osler etc beforehand.

I would reach out to the ABO for a full refund if you are registered and cite the failure rate and poor format. A fail rate of 30% is simply ridiculous and points towards either an obvious testing issue or failure of our educational institutions.
 
Your table doesn't go back that far. Back when I took it (>decade ago), the fail rate was 30% as well. Just take it again. It will be a nice lesson in perseverance.
 
LightBox said:
Haha, ok "snowflake" :) Toughen up a bit. The world can be a harsh place.
Click to expand...

Certainly. All the more reason to add artificial and unnecessary hurdles for recent, cash-strapped trainees in the name of tradition, right? It is selfish and backward-thinking ophthalmologists like you who ruin the profession for future generations.
 
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It’s been 6 years since I took the Orals (passed first try). Prior to taking the orals, I would have said it was a useless exam and a way for the board to make money. (I think it was the nerves talking). After taking it, I thought it was the most clinically relevant exam I have ever taken. I think the preparation for the Orals made me a better clinician. It was expensive, time consuming, and the most stressful thing I have ever done but I am glad I did it.

I think it would be a shame for the ABO to get rid of it.
 
TheLesPaul said:
Certainly. All the more reason to add artificial and unnecessary hurdles for recent, cash-strapped trainees in the name of tradition, right? It is selfish and backward-thinking ophthalmologists like you who ruin the profession for future generations.
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Let's just get rid of MCATs, USMLE's, while we are at it. We don't want to hurt anyone's ego's, now do we?

I've heard that they made USMLE Step 1 Pass/Fail. Just another way to pander to the snowflakes with fragile egos.
 
LightBox said:
Let's just get rid of MCATs, USMLE's, while we are at it. We don't want to hurt anyone's ego's, now do we?

I've heard that they made USMLE Step 1 Pass/Fail. Just another way to pander to the snowflakes with fragile egos.
Click to expand...

That's a strawman argument. Obviously there need to be standards for medical education. However, it is seriously doubtful that a full 30% of graduating ophthalmology residents are unfit for practice. Either the test is unfair/unnecessary, or 30% of ophthalmology programs are inadequate. Obviously it is not the latter. Why create a test that fails 30% of residents who are certified competent by their faculty? It $eem$ $u$picou$.

Also, way to go on the name-calling. Might want to switch off Fox News for a bit and realize the younger generation is just as hard-working and talented as you thought you were. I bet you're also the kind of ophthalmologist who was got fat billing Medicare and screwed reimbursements for the rest of us.
 
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Agree preparing for orals was beneficial, and exams have their place (USMLE Step 2 CS probably most beneficial exam ever). Fact of the matter is I've always scored >2 SD above the mean on every standardized test since the MCAT (had essentially a higher score on the written than anyone I knew in a large fellowship class). This is what helped me land a great fellowship from a small institution so I see the upside to exams (would advocate against making USMLE P/F for this reason, hurts the little guys from small places). But I was certainly thrown by the online oral format (don't trust ophthoquestions, the format is all wrong). Sure preparing for it a second time will also be beneficial in the future and even more character building for my snowflake soul as per LightBox ;}

However, question the 30% failure rate and horrible online format/reduced number of cases on oral. Are 30% of us truly incompetent to practice? If so, educational reform should ensue. If not then exam parameters/layout need to be changed. However abop is basically their own boss and not directly responsible to the consumer so there will likely be no change. This highlights the fundamental problem I am raising, no responsibility to the consumer aka recent grads. You literally get no feedback when you fail either. Just like ... sorry ... please insert another 2 grand to continue... Thankfully you can essentially take it an unlimited number of times now without consequence.

Anyways .. thank you all for being supportive and having an open discussion/dialogue about this. It will be very nice to see the younger generations rise up into leadership roles and force change in the future.
 
medphysik2015 said:
Agree preparing for orals was beneficial, and exams have their place (USMLE Step 2 CS probably most beneficial exam ever). Fact of the matter is I've always scored >2 SD above the mean on every standardized test since the MCAT (had essentially a higher score on the written than anyone I knew in a large fellowship class). This is what helped me land a great fellowship from a small institution so I see the upside to exams (would advocate against making USMLE P/F for this reason, hurts the little guys from small places). But I was certainly thrown by the online oral format (don't trust ophthoquestions, the format is all wrong). Sure preparing for it a second time will also be beneficial in the future and even more character building for my snowflake soul as per LightBox ;}

However, question the 30% failure rate and horrible online format/reduced number of cases on oral. Are 30% of us truly incompetent to practice? If so, educational reform should ensue. If not then exam parameters/layout need to be changed. However abop is basically their own boss and not directly responsible to the consumer so there will likely be no change. This highlights the fundamental problem I am raising, no responsibility to the consumer aka recent grads. You literally get no feedback when you fail either. Just like ... sorry ... please insert another 2 grand to continue... Thankfully you can essentially take it an unlimited number of times now without consequence.

Anyways .. thank you all for being supportive and having an open discussion/dialogue about this. It will be very nice to see the younger generations rise up into leadership roles and force change in the future.
Click to expand...
Care to elaborate on how the ophthoquestions format is off?
 
They definitely don't want us to disclose much about the exam (and make you swear to this during the exam I believe), but just generally in my experience, they don't want you to just ramble off a bunch of memorized stuff like ophthoquestions suggests. I basically had everything memorized to the tee from ophthoquestions. Maybe in the past this is what they wanted? But honestly probably would have been just more successful looking at the picture and free ballin it.
 
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Maybe too much preparation is bad bc you get stuck in your own way of thinking and then when they come in asking you questions from 3rd base it's confusing as hell bc your like well ... I haven't listed the 10 things I'd ask them yet let alone the 20 things I'd look for on exam, why are you asking me about diagnostics?

With USMLE step 2 CS there was a particular format that everything had to adhere to, which is not the case in my experience with the oral boards even though it is represented this way by ophthoquestions. Oral boards is more of an exercise in the game of "guess what I am thinking" than you will ever realize until you take it. Maybe a good way to prepare is to just interrupt each other and ask random questions.

I have no idea. The cruddy part is they also give you zero feedback when you fail, so you have no idea how to improve. Maybe some feedback from the people who actually passed the dammed thing would be beneficial.
 
I recently was one of the 30% who failed.
I prepared my scripts; and right away I got confused because they just asked a ton of questions and the script plan failed immediately.

Does anyone actually know if you're supposed to deliver the script or not?
 
TheLesPaul said:
Also, way to go on the name-calling. Might want to switch off Fox News for a bit and realize the younger generation is just as hard-working and talented as you thought you were. I bet you're also the kind of ophthalmologist who was got fat billing Medicare and screwed reimbursements for the rest of us.
Click to expand...

Haha, well he started it with his "boomer" comment. I'm a Generation X'er btw :) Anyways, I guess I was a little harsh and rubbing salt in the recently opened wound. It definitely does suck to fail an exam that takes so much time to prepare for and that is so expensive. I definitely am against the high fees associated with the exam. How can they really justify that fee when it is virtual now?!? They don't have to pay for expensive hotel rooms and meals anymore, so that does not make sense. Also, if someone fails, they should be allowed to take it at a severely-reduced cost (e.g. $250). I also agree that some post-hoc feedback is dearly needed especially if someone fails. But I guess they like to maintain the "secrecy" of the exam grading criteria.

I guess I wanted to emphasize that the Oral Boards (virtual or not) have been like this for a long long time. You will eventually get past it and perhaps be even "stronger" because of the added pain. Since you've presumably always done so well on your exams, a humbling experience is sometimes good for the soul. But the ABO definitely could reform things with fees, etc.

Btw, it looks like the ABO has some simulation videos that demonstrate the format of the exam:

Preparing for the Exam | American Board of Ophthalmology

We never had these videos back in "my day", but the format appears pretty similar in that they want you to have a cohesive spiel regarding acquisition of knowledge, DDx, management, etc for each scenario.

One thing that I've always been impressed with is how they have been able to maintain the secrecy of their grading criteria for so long. You would think by now that a "rogue", former oral board examiner would have spilled the beans by now. But I guess they choose their examiners very, very wisely. To ruffle someone's feathers even more, these examiners seem to be the ultimate yes-(wo)men of academia who are super obedient to the ABO/AAO.

Anyways, best of luck -- you will definitely pass it the 2nd time!
 
CECFellow2018 said:
I recently was one of the 30% who failed.
I prepared my scripts; and right away I got confused because they just asked a ton of questions and the script plan failed immediately.

Does anyone actually know if you're supposed to deliver the script or not?
Click to expand...
I'm sure you need to be flexible...but still have the knowledge ready to go in a "script" form or whatever. I think memorizing scripts could help with reflexive knowledge so that you aren't struggling to come up with content. I don't think you can just go in and wing it and sound like you are blubbering/meandering/going on tangents.
 
LightBox said:
Haha, well he started it with his "boomer" comment. I'm a Generation X'er btw :) Anyways, I guess I was a little harsh and rubbing salt in the recently opened wound. It definitely does suck to fail an exam that takes so much time to prepare for and that is so expensive. I definitely am against the high fees associated with the exam. How can they really justify that fee when it is virtual now?!? They don't have to pay for expensive hotel rooms and meals anymore, so that does not make sense. Also, if someone fails, they should be allowed to take it at a severely-reduced cost (e.g. $250). I also agree that some post-hoc feedback is dearly needed especially if someone fails. But I guess they like to maintain the "secrecy" of the exam grading criteria.

I guess I wanted to emphasize that the Oral Boards (virtual or not) have been like this for a long long time. You will eventually get past it and perhaps be even "stronger" because of the added pain. Since you've presumably always done so well on your exams, a humbling experience is sometimes good for the soul. But the ABO definitely could reform things with fees, etc.

Btw, it looks like the ABO has some simulation videos that demonstrate the format of the exam:

Preparing for the Exam | American Board of Ophthalmology

We never had these videos back in "my day", but the format appears pretty similar in that they want you to have a cohesive spiel regarding acquisition of knowledge, DDx, management, etc for each scenario.

One thing that I've always been impressed with is how they have been able to maintain the secrecy of their grading criteria for so long. You would think by now that a "rogue", former oral board examiner would have spilled the beans by now. But I guess they choose their examiners very, very wisely. To ruffle someone's feathers even more, these examiners seem to be the ultimate yes-(wo)men of academia who are super obedient to the ABO/AAO.

Anyways, best of luck -- you will definitely pass it the 2nd time!
Click to expand...

I would support an online-only oral board exam that costs <$500, even if they didn't change the 'difficulty'. However, there are plenty of humbling experiences in residency (and if not -- you didn't see very many patients!) such that I don't think this artificial failing of 30% of graduating residents is necessary. It also doesn't make sense to hit recently graduated and indebted residents up for $2K who surely just put on their credit card and hope they pay it off soon.

I'm several years out of residency and have passed it. I just feel the 30% number is too high --- 5% I could see. And make it cheaper! Cheers
 
I think residency programs do vary in the quality of their board exam preparation. For example, my program had year-long lectures that followed the BCSC and a yearly mock oral that all residents were required to take. Everyone in my graduating class that took the recent virtual oral exam passed. Do other programs do mock oral exams every year?
 
Bronze Medal said:
I think residency programs do vary in the quality of their board exam preparation. For example, my program had year-long lectures that followed the BCSC and a yearly mock oral that all residents were required to take. Everyone in my graduating class that took the recent virtual oral exam passed. Do other programs do mock oral exams every year?
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Some programs give you the pleasure of a mock oral if you "fail" the okap.
 
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Yeah, sorry about the Ok, Boomer comment. TRUCE!

Hardly winging it when you've prepared for hundreds of hours already, read the BCSCs book series around 10 times, and also read literally every resource for oral boards out there. Just should probably be a bit more flexible is all.

Alright, y'all convinced me. Despite my better judgment, I'll sign up again in 2021.
 
How much did you practice out loud? E.g. with a partner or in front of a mirror?
 
thats the hundreds of hours I alluded to. Perhaps I was speaking too fast during the exam or there was a bad internet connection, sometimes they would ask me questions but I had already mentioned what they were asking a few minutes before.
 
Sorry to hear that. I'm sure you will do fine the 2nd time around. Yeah, but it does suck to shell out another 2k or whatever.
 
The dumb thing about the oral boards is that there is no transparency, and no feedback in how to improve. I do feel that the oral exam is fairly if you prepare sufficiently, but the frustrating part about it is that it's being used as gatekeeping in a bad way, and the preparation given to you by the ABO is not that helpful.

The whole point of this exam is to make sure the field does not graduate ophthalmologists who are not ready or have no right to practice. The difficulty is that it's tough to standardize what is essentially a subjective method to determine who is qualified or not. It also doesn't help there is no feedback in how to improve. The way I see it, if someone can make it through residency and the written boards, that person definitely has the knowledge to practice. The process seems just so arbitrary and luck-based.

And let's be honest; it's not the newer ophthalmologists who really need this exam, it's the older guys whose standards of care and knowledge are decades behind.
 
Slide said:
The dumb thing about the oral boards is that there is no transparency, and no feedback in how to improve. I do feel that the oral exam is fairly if you prepare sufficiently, but the frustrating part about it is that it's being used as gatekeeping in a bad way, and the preparation given to you by the ABO is not that helpful.

The whole point of this exam is to make sure the field does not graduate ophthalmologists who are not ready or have no right to practice. The difficulty is that it's tough to standardize what is essentially a subjective method to determine who is qualified or not. It also doesn't help there is no feedback in how to improve. The way I see it, if someone can make it through residency and the written boards, that person definitely has the knowledge to practice. The process seems just so arbitrary and luck-based.

And let's be honest; it's not the newer ophthalmologists who really need this exam, it's the older guys whose standards of care and knowledge are decades behind.
Click to expand...


So true its laughable. Miss those early days of medicine/medical school when I felt that medicine was a calling. It is a challenge to feel like this somedays with all the constant hoops, crazy practice issues that arise, challenges with reimbursement/insurance and future of our field. Somedays Ophthalmology feels merely like a job (though grateful to have an interesting job and help folks).

Perhaps that is just the reality, and the oral exam is a perfect example of this. It's just an exam that you have to pass, and really doesn't represent you passing some idealist threshold to be "fit for practice" even though that is it's claim. And it exists for the purpose of having something, and is by no means perfect. A placeholder.

Lets not forget the reason that many of us decided to go into Ophthalmology in the first place. Not to make a million dollars a year, do 60 phacos a day, or become an academic in the ivy tower. But to help people see, and also have a relatively decent and stable home life. Thank god this is definitely still possible in many areas of the country. The oral board is just a temporary nuisance.
 
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