ABFM vs ABIM...whats more difficult?

[PCPDoc983]

Hey guys,

I was talking to a friend about something that will concern many of us entering primary care. The question is, for those Family Physicians that will not be doing full-spectrum FM (i.e. No OB, minimal peds)...how difficult would it be for one to prep for ABFM recertification every 10 years? I imagine the fail rate for those docs must be rather high..or do they just avoid recertification?

Is the difficulty of recertification as much of a problem with the ABIM? I understand this is also a very difficult exam, with many smart residency graduates failing after lots of preparation.

I know other things come to mind when choosing a specialty, but one must also consider the difficulty of certification/recertification exams since this is something we will have to deal with forever, especially as generalists.

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[Smurfette]

Moving to FM forum where users may be better able to answer your questions.

 

[lowbudget]

I know other things come to mind when choosing a specialty, but one must also consider the difficulty of certification/recertification exams since this is something we will have to deal with forever, especially as generalists.

Yup I agree with you that you should consider recertification issues when picking a specialty. Both exams are hard, although I have never taken the ABIM. The breadth of the ABFM test is predictable, but the depth and specificity of the questions asked are not. That said, there are 2 modules where you can pick the topics you wanted to be tested on (hospital, ambulatory, OB, peds, emergent/urgent care, sports med, Geri, women's health, etc.) which recognizes the diversity of practice in FM.

I don't know about the ABIM but my friends who prepped and took it said that it was ridiculous. Many of the questions are written by sub specialists and are written at the level of the sub specialty and not necessarily things that you would consider in a general outpatient internists' practice. So they hate it because its these esoteric zebra stuff.

My internal medicine attending and pediatrics attending reviewed our FM in training exam and they said that the FM ITE was more reasonable with the expectations of a primary care physician, while they felt that their specialty boards was totally off-base with what they do as general internists and general pediatricians.

I thought the ABFM test was hard, but I knew the scope of materials I needed to cover. The question when I was prepping was always, ok, to what extent do I really need to drill down to that infinitesimal detail. That's when I stand back and say well if I was a full-scope doctor, what is the standard of understanding? (I don't need to know step by step how to perform a lap chole, but I need to know indications, contraindications, and complications as well as the basic sciences around cholecystitis). That way of thinking helped me study. I think after doing an IM residency, you'll understand what the ABIM test would expect from you as well.

That said, I wouldn't stress out over it. I'm sure whatever field you pick, you'll find a way to pass,the test.

 

[deleted87716]

Most people in any specialty will study before they recert, at least in the areas they don't deal with on a regular basis.

 

[group_theory]

I don't know about the ABIM but my friends who prepped and took it said that it was ridiculous. Many of the questions are written by sub specialists and are written at the level of the sub specialty and not necessarily things that you would consider in a general outpatient internists' practice. So they hate it because its these esoteric zebra stuff.

My internal medicine attending and pediatrics attending reviewed our FM in training exam and they said that the FM ITE was more reasonable with the expectations of a primary care physician, while they felt that their specialty boards was totally off-base with what they do as general internists and general pediatricians.

I thought the ABFM test was hard, but I knew the scope of materials I needed to cover. The question when I was prepping was always, ok, to what extent do I really need to drill down to that infinitesimal detail. That's when I stand back and say well if I was a full-scope doctor, what is the standard of understanding? (I don't need to know step by step how to perform a lap chole, but I need to know indications, contraindications, and complications as well as the basic sciences around cholecystitis). That way of thinking helped me study. I think after doing an IM residency, you'll understand what the ABIM test would expect from you as well.

I agree with lowbudget. I was Med-Peds so I took the ABIM and ABP boards (and as such, did not take any ABFM or Family Med in-service exams so I will not comment on their respective boards). Both ABIM and ABP would ask questions that have a lot of depth (and 2nd-3rd order question).


(the following were not board questions on my exam, just random possible questions from my study guide)

The ABP might show you a picture of a kid with Smith-Lemli-Opitz Syndrome and mention that he is having behavior problems. Would you know what metabolic derangement to treat to help with the behavior problem?

ABIM might show you a 60 year old male with colon adenocarcinoma, and have you recognize the staging of the cancer along with treatment of choice for each stage. They might ask for details like if the patient had Stage IV colon cancer with mets only found in the liver, what is the treatment of choice? Or they may present with a guy diagnosed with colon cancer that has spread through the submucosa and muscle layer with 2 lymph node involvement. What side effects would you expect from the chemotherapy of choice?


The first-time pass rate for ABP is 75% (for 2011). The first time pass rate for ABIM is 84% (for 2011). The first time pass rate for ABIM for those re-certifying is 88% (n=95,323). For the ABFM, first time pass rate is 81.3% (for 2011) and recertification was 66% (for 2011) (n= 3541 and 2338 respectively).

However, I would not choose a residency (or specialty) based purely on how difficult the board exam would be, or requirements for MOC.

*source: ABP, ABIM, ABFM

 

[deleted87716]

The first-time pass rate for ABP is 75% (for 2011). The first time pass rate for ABIM is 84% (for 2011). The first time pass rate for ABIM for those re-certifying is 88% (n=95,323). For the ABFM, first time pass rate.

I'm not really sure why we're talking about pass rates for the ABIM and ABP exams in the FM forum.

ABFM pass rates, if anyone cares...

https://www.theabfm.org/moc/passrate.aspx

 

[PCPDoc983]

Thanks for the info! Hope ya'll are havin a good holiday.

Just curious...what happens to an attending who doesnt recertify or fails? Can they still work in a group/private practice and do solely outpatient work without hospital priviledges? Do they get a cut in reimbursements from medicare for not being board certified?

 

[lowbudget]

Thanks for the info! Hope ya'll are havin a good holiday.

Just curious...what happens to an attending who doesnt recertify or fails? Can they still work in a group/private practice and do solely outpatient work without hospital priviledges? Do they get a cut in reimbursements from medicare for not being board certified?

It depends. If you're employed, and if being board certified is required, they can let you go if you fail. Many insurance plans require that you be board certified, so they have the right to drop you from their plans, which means a loss of patients and pay potentially. Although I know a guy who chose not to recert and their practice manager said it was fine. Not sure how.

A friend of mine had an urgent care contract and was told that board certified docs earn more per hour salary than non-board certified.

 

[lowbudget]

The ABP might show you a picture of a kid with Smith-Lemli-Opitz Syndrome and mention that he is having behavior problems. Would you know what metabolic derangement to treat to help with the behavior problem?

ABIM might show you a 60 year old male with colon adenocarcinoma, and have you recognize the staging of the cancer along with treatment of choice for each stage. They might ask for details like if the patient had Stage IV colon cancer with mets only found in the liver, what is the treatment of choice? Or they may present with a guy diagnosed with colon cancer that has spread through the submucosa and muscle layer with 2 lymph node involvement. What side effects would you expect from the chemotherapy of choice?

Uh... C.
Next question.

 

[Textbookversion]

If you don't want to do OB or Peds why would you do FM? Seems silly when you can do IM and have the option of escaping to fellowship depending on the future of primary care. Plus IM boarded hospitalists tend to get paid more than FM boarded hospitalists and that's another escape.

 

[deleted87716]

IM boarded hospitalists tend to get paid more than FM boarded hospitalists

Prove it.

 

[VA Hopeful Dr]

Prove it.

Quoted from e-how, which claims to have taken this data from a 2009 survey from the Society of Hospital Medicine....


Salary by Specialty

Area of specialty impacts hospitalist salaries. Those specializing in internal medicine earn a median salary of $215,000 as of 2009, according to survey data from the Society of Hospital Medicine. Hospitalists with a family practice focus earn a median $218,066, and those in pediatrics garner a median $160,038 in annual compensation. Among these specialties, earnings vary based on such factors as the size of the practice employing the hospitalist as well as the practice's geographic location.

 

[lowbudget]

If you don't want to do OB or Peds why would you do FM? Seems silly when you can do IM and have the option of escaping to fellowship depending on the future of primary care. Plus IM boarded hospitalists tend to get paid more than FM boarded hospitalists and that's another escape.

FM is more than IM+Peds+OB. You have to consider the inpatient/outpatient aspects of the curriculum. There's too much perverse politics going on in hospitals to make me think that hospital medicine is an escape.

All that said, I agree that if you can't handle being a well-rounded physician, FM is not the place for you.

 

[smq123]

If you don't want to do OB or Peds why would you do FM? Seems silly when you can do IM and have the option of escaping to fellowship depending on the future of primary care. Plus IM boarded hospitalists tend to get paid more than FM boarded hospitalists and that's another escape.

I gather you have VERY limited experience with hospitals, if you think that working for a hospital is an escape....

 

[deleted87716]

There's too much perverse politics going on in hospitals to make me think that hospital medicine is an escape.

No kidding. More like "out of the frying pan and into the fire."

 

[deleted87716]

Area of specialty impacts hospitalist salaries. Those specializing in internal medicine earn a median salary of $215,000 as of 2009, according to survey data from the Society of Hospital Medicine. Hospitalists with a family practice focus earn a median $218,066.

Thanks. I find it interesting that the median salary for FPs was a little higher, but for all practical purposes, they're equivalent.

 

[MedicineDoc]

FM hospitalist here. No difference in pay for FM or IM hospitalist. Hospitals generally offer a set contract without regard for IM or FM. Hospitalist who have a production component tend to make more but probably work harder with seeing more patients. Nocturnists tend to make more as well especially if its based on RVUs which would be higher for H and P than follow up notes. Some places that may be "hairier" with less backup may pay more with wanting lots of procedures with less backup but I would think the risk of getting sued would be a lot higher as well. More rural areas a lot of times pay more even if its rural with a big hospital and hospitalist program.

 

[DIce3]

Agreed. Financially, IM=FP hospitalist. Suspect the difference is noise and not real.

 

[Textbookversion]

I had heard it was more difficult to land a job as a hospitalist coming out of residency as an FM doc compared to IM, and the compensation was lower. Apparently that is wrong based on the salary survey linked. Although maybe the underlying skew is FM docs only tend to get the hospitalist positions in more rural areas and therefore get more procedures because of lower staffing levels of other specialties... point being is it's hard to know without the full data set.

I still maintain that if you don't want to do peds or OB, IM makes more sense.

 

[VA Hopeful Dr]

I had heard it was more difficult to land a job as a hospitalist coming out of residency as an FM doc compared to IM, and the compensation was lower. Apparently that is wrong based on the salary survey linked. Although maybe the underlying skew is FM docs only tend to get the hospitalist positions in more rural areas and therefore get more procedures because of lower staffing levels of other specialties... point being is it's hard to know without the full data set.

I still maintain that if you don't want to do peds or OB, IM makes more sense.

There is some wisdom in your last part there.

That said, I prefer to think of it as "if you want to do mainly outpatient, go into FM". Many IM places are really neglecting their outpatient training in favor of hospital medicine.

http://www.hopkinsmedicine.org/news...nts_graduate_unprepared_for_primary_care_jobs

Food for thought...

 

[MedicineDoc]

I had heard it was more difficult to land a job as a hospitalist coming out of residency as an FM doc compared to IM, and the compensation was lower. Apparently that is wrong based on the salary survey linked. Although maybe the underlying skew is FM docs only tend to get the hospitalist positions in more rural areas and therefore get more procedures because of lower staffing levels of other specialties... point being is it's hard to know without the full data set.

I still maintain that if you don't want to do peds or OB, IM makes more sense.

Still not right. I had no problem getting offers out of residency for above average salary. I was just offered a contract in an urban setting (16th largest city). The pay was lower not because of FM but because it was in a place with more doctors. FM hospitalist are only becoming more common. I have encountered one program that maintained that they wanted IM only and their hospitalist program was started up by some guys I went to med school with who went through the same IM residency program with now practicing in a medium sized city with a somewhat rural overall area. I understand they are having staffing issues and have been recruiting for a long time. My understanding is they dont even do procedures there. I don't think the IM only thing will hold up there much longer. FM trained docs make great hospitalists. Being well rounded in terms of understanding both inpatient and outpatient care is not a detriment to hospitalist work. Many FM residency programs are unopposed and inpatient heavy full scope training programs.

 

[cabinbuilder]

Plus IM boarded hospitalists tend to get paid more than FM boarded hospitalists and that's another escape.

Not on this planet.

 

[Textbookversion]

Not on this planet.

Cool. Guess I was wrong. I'm in AZ and that's what I'd heard around town. Probably just IM docs blowing smoke.

 

[cabinbuilder]

Cool. Guess I was wrong. I'm in AZ and that's what I'd heard around town. Probably just IM docs blowing smoke.

It all comes down to how saavy you are with negotiating your contract. I am more well rounded with what I can offer - Peds, ICU, urgent care, ER, joint injections, casting, lines, manipulation, surgical assist, suturing skills etc so I can command more salary and usually get it.