Board Exams

[120300]

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Can someone describe the board exams that RadOncs take (how many exams?, when?, all written? any orals?) and how they relate to directing the medical treatment of cancer patients?

 

[stephew]

in a word? Hell.

 

[3dtp]

in a word? Hell.

 

[Gfunk6]

end of PGY-4
1. Written Physics
2. Written Biology
end of PGY-5
3. Written Clinical
one year post-graduation
4. Oral Clinical

You must pass all four to get a 10 year certification.

 

[stephew]

this new policy of separating the phyiscs and radio bio from the clinical just makes for an extra year of misery. was much better to get it all over with.
S

 

[radonc]

i like the fact they are split up...easier to prepare for, less stressful (but more spread out). i just wished we could take them earlier in residency...radiology takes the physics during your pgy3 (r2) year, and your clinicals during your pgy4 (r3) year. however, they must wait till 1 year post grad for the oral exams.

 

[stephew]

i dont think it is less stressful. the pressure just goes on an extra year. Id rather have the pain short and sweet. But that's just me.

 

[deleted4401]

Boards sounds horrible. Can't wait until I'm through with that junk. Steph, you're stealing my 'S'. Give it back.
S

 

[Brim]

I like that we can get the physics and rad bio exams out of the way early, allowing one to concentrate their studying on the clinical exam without having to worry about those little pests.

 

[stephew]

yeah i thought id like that too. wrong. For my year they had extended out when you take the orals. it used ot be in senior year. its just another year of hell. for you guys its even more stretched out hell. what sounds good in theory doesnt always work in practice. it just extends out the pain. over years.

 

[stephew]

Boards sounds horrible. Can't wait until I'm through with that junk. Steph, you're stealing my 'S'. Give it back.
S

im very probably older than you so have had the 'S' first. 🙂

 

[3dtp]

this new policy of separating the phyiscs and radio bio from the clinical just makes for an extra year of misery. was much better to get it all over with.
S

Stephew, you are right on the mark

The boards are miserable and the ABR says we now have a "life-long" relationship with them. This process of extending the misery out year after year not only makes an extra year of misery, fear, uncertainty and doubt, but takes away time from what might be more productive educational tasks and advancement of the art.

The fact is, now, once we complete the three year (four year process now that they are demanding PGY2's start the payment cycle earlier) process of written board, written board, oral board, we start it all over again with Maintenance of Certification, recertification and repeat. Each step taking large amounts of cash and opportunity costs.

In the job search process, I have visited a center where I was concerned that the senior practitioner has not kept current with the field, but this appeared to be isolated. Most groups are current and diligent in keeping up with the art. I doubt that MOC/recert/and repeat will do any good for the vast majority of those who remain current, and will only be a minor prod to those who will not.

We live in an "evidenced based specialty." Show me the beef. Where is the evidence that multi-year/multi-part costly board certificationre-certification exams make for better oncologists?

 

[stephew]

well i dont agree with your last sentiment- id file that along with the "there are no randomized studies that show that parachutes save lives". I have no problem with board certf, or MOC. However the cost is ridiculous and the extended path to certification is not only hampering applicant qol, it also hampers your first year in practice when you are preoccupied with boards.

as for noticing very few who are not current in the field; Remember: you're probably visiting academic centers. perhaps these docs are keeping more abreast. Maybe its not so in the community. Or maybe in acacemia we get too specialized. both are at risk of getting rusty.

 

[120300]

What is the pass rate, on average, for each of the RadOnc Board exams? Perhaps a national average is published every year. If not can someone share a sampling of particular programs. Thank you very much.

 

[wagon]

http://theabr.org/RO_Pri_Score.htm
scroll to the bottom....

 

[deleted4401]

I wonder if it's the same people doing poorly on all the exams ... i.e people failing clinicals are more likely to fail orals. I'm also surprised at how high the physics fail rate was - 1/6.

S

 

[Brim]

I just noticed you can obtain a copy of your oral exam feedback -- all for a price of $250. You may pay by credit card.

 

[stephew]

I just noticed you can obtain a copy of your oral exam feedback -- all for a price of $250. You may pay by credit card.

really? that's new. I never heard of that. But if they think they're getting any extra dough from me they're deluded.

 

[xraydude]

I think the oral board report is only for those who fail - it's right below the hand rescore section.

As for MOC - it truly is a joke. The month after I passed my boards, they sent me a bill for $280 asking me to pay year 1 of recertification. I am now 3 years out and not paying until I actually need to. They say the cost is needed to support their extravagant MOC program - website, etc. I asked them why the cost was so high....and they said it was in line with other boards, but I looked those up, and we're certainly on the high end of this.

I'd love to start a movement to have the cost cut. The reality is that most decent sized groups stay on top of their training...you're forced to in a good practice....but I could see it a problem if you are a solo practioner.

Incidentally....for those of you who are upset of the board recert cost...you should know that at least ONCE a year, the ABR send all the trustees, and important gurus at YOUR expense to work on the exam. You would think they go somewhere central like Chicago....but they DON'T. They usually hold their retreat at the 4 Seasons in Kona, Hawaii (perhaps one of the most beautiful but expensive hotels in the world - I went there on my honeymoon) for about 10 days.....all on YOUR dollar. Other years they go to St. Maarten. This is well known fact.

One should do the calcuation - assuming about 100 grads a year, over 30 years, there will be at least 3000 people in the recert process. 3000 x ~$3000 is $9mil. And when you factor in all the radiologists - probably 30,000 a year...the ABR stands to earn almost $100mil every 10 years. Do you think their stupid MOC website cost that much?

We're being FLEECED.....because it's easy for this monopoly to do it....unless we all prostest together.

my 2 cents

 

[stephew]

no question. im doing the moc stuff for the year now and sent a nastygram to them just for making my ID # difficult to figure out. For that cash they can damn well make it easy for me.
and yes, xraydude is testifying to the truth.

 

[IndyXRT]

Ah - so glad to know what I have to look forward to (after written clinical and oral boards, that is).

 

[stephew]

id rather pay the 9 M myself than do that again. Oh wait. I will with the MOC.

 

[radonc]

id rather pay the 9 M myself than do that again. Oh wait. I will with the MOC.

moc is here to stay, so people should stop complaining about it and just accept it. if you want, you can blame the acgme, abms, ama, aamc, fsmb, ecfmg, nbme, joint commision, the institute of medicine (national academy) and almost any other major medical association that supports moc.

on the bright side, some of you may get reimbursed for moc from your future jobs while others will be able to deduct the cost from our taxes.

 

[Zap]

...while others will be able to deduct the cost from our taxes.

Isn't that kind of like saying getting a fancy coffin is on the "bright side" when you die?

 

[xraydude]

Radonc - While I agree with the principle of MOC, and it has been broadly accepted, we must agree that there can certainly be more cost effective ways of implementing MOC.

First the ABR can go have their yearly winter retreat in Louisville - if it's good enough for the boards, it should be good enough for them. More seriously, they could do it at a reasonable location, centrally located, at not at a 5 star hotel.

Second, they could make MOC more efficient. Why do I need to do 8 SAMs, that cost $50 a piece? Whey don't they just have them at ASTRO, you take a test, and have no cost.

Third - They set up this 'fancy' webiste to track CMEs and SAMs - that's what they justify the cost of MOC on (the website management). Well, it's pretty dumb to track CMEs, when they are already tracking licensure. Last time I check, most every state has a CME requirement of at least 20 credits. So if I maintain a license, that shoudl be sufficient.

Fourth - PQI - a joke. First of all, how many PQI programs are available? Not PARROT by ASTRO or RO-PEER by ACR. This is just busy work. Do you really think someone will really read your hard work analysis of your patient data. Any responsible physician should be doing this already. Or at least make it not busy work.

The reality is that if the ABR is going to mandate MOC, there should members of the MOC committee who are both academic and private. Certainly the academics can pass of their research at PQI, but in the private world, many of us are not publishing.

Also, the fees should be reigned in. How is it that MOC costs more than my initial primary certification which included an oral exam (where I was paying for the examiners trip to Louisville)? You justify that this is tax deductible - but this is basically a tax from the ABR. I don't care if it's deductible - that should not be an excuse to make it cost in excess of $3K.

The ABR just realizes this is a great money maker. Perhaps there should be some competition against this monopoly.

 

[radonc]

Radonc - While I agree with the principle of MOC, and it has been broadly accepted, we must agree that there can certainly be more cost effective ways of implementing MOC.

First the ABR can go have their yearly winter retreat in Louisville - if it's good enough for the boards, it should be good enough for them. More seriously, they could do it at a reasonable location, centrally located, at not at a 5 star hotel.

Second, they could make MOC more efficient. Why do I need to do 8 SAMs, that cost $50 a piece? Whey don't they just have them at ASTRO, you take a test, and have no cost.

Third - They set up this 'fancy' webiste to track CMEs and SAMs - that's what they justify the cost of MOC on (the website management). Well, it's pretty dumb to track CMEs, when they are already tracking licensure. Last time I check, most every state has a CME requirement of at least 20 credits. So if I maintain a license, that shoudl be sufficient.

Fourth - PQI - a joke. First of all, how many PQI programs are available? Not PARROT by ASTRO or RO-PEER by ACR. This is just busy work. Do you really think someone will really read your hard work analysis of your patient data. Any responsible physician should be doing this already. Or at least make it not busy work.

The reality is that if the ABR is going to mandate MOC, there should members of the MOC committee who are both academic and private. Certainly the academics can pass of their research at PQI, but in the private world, many of us are not publishing.

Also, the fees should be reigned in. How is it that MOC costs more than my initial primary certification which included an oral exam (where I was paying for the examiners trip to Louisville)? You justify that this is tax deductible - but this is basically a tax from the ABR. I don't care if it's deductible - that should not be an excuse to make it cost in excess of $3K.

The ABR just realizes this is a great money maker. Perhaps there should be some competition against this monopoly.

First, the ABR has been having their retreats at 'expensive' locations for many years now, not just since the implementation of MOC. im sure their budget accounts for this...and that they did not implement all these charges just for their working conference. also, if you know anyone in the abr, they routinely work for 12-15 hours/day...its not just for fun, like many other conferences are.

second, organizations offer SAMs for no charge if you are a member of their organization, like the RSNA. also, SAM's count as CME, depending on the sponsoring organization. True, state licenses do require CME's...but many do not check up on them, and only audit a percentage of their license holders.

PQI is a joke? what is a joke is that only 69% of patients in ASCO's QOPI had pain recorded in the patients last visit before death or that only 92% (not 100%) had chemotherapy consent in the chart. not only will PQI improve quality, but it provides physicians some method of identifying medico-legal liabilities. MOC was just implemented in the past 2 years, and it will take time for PQI to catch up with it.

pqi can take the following formats, and this is what is being proposed by the abr for type 1 pqi:

Proposed Type 1 project-National Protocol Enrollment. A Type 1 project is envisioned for physicians enrolling patients on national protocols in which central quality assessment of radiotherapy includes feedback to the individual or department.

Proposed Type 1 project-Prostate Implants: Postimplant Dosimteric Assessment. A second Type 1 PQI example has been suggested by the American Brachytherapy Society (ABS) related to permanent source prostate brachytherapy

Proposed Type 1 project-retrospective review. A third Type 1 project might focus on a retrospective review of treatment policies and/or outcomes related to a practitioner's practice in a specific disease setting

Type 2 pqi compares a treating physicians record with that of evidence-based guidelines, consensus statements, or peer comparisons.

yes MOC is a pain in the arse. yes it is expensive. yes it may not make complete sense to people. but can you put a price tag on treating a patient properly? or a future lawsuit that may arise from improper documentation or treatment?

 

[xraydude]

First, the ABR has been having their retreats at 'expensive' locations for many years now, not just since the implementation of MOC. im sure their budget accounts for this...and that they did not implement all these charges just for their working conference. also, if you know anyone in the abr, they routinely work for 12-15 hours/day...its not just for fun, like many other conferences are.

second, organizations offer SAMs for no charge if you are a member of their organization, like the RSNA. also, SAM's count as CME, depending on the sponsoring organization. True, state licenses do require CME's...but many do not check up on them, and only audit a percentage of their license holders.

PQI is a joke? what is a joke is that only 69% of patients in ASCO's QOPI had pain recorded in the patients last visit before death or that only 92% (not 100%) had chemotherapy consent in the chart. not only will PQI improve quality, but it provides physicians some method of identifying medico-legal liabilities. MOC was just implemented in the past 2 years, and it will take time for PQI to catch up with it.

pqi can take the following formats, and this is what is being proposed by the abr for type 1 pqi:

Proposed Type 1 project-National Protocol Enrollment. A Type 1 project is envisioned for physicians enrolling patients on national protocols in which central quality assessment of radiotherapy includes feedback to the individual or department.

Proposed Type 1 project-Prostate Implants: Postimplant Dosimteric Assessment. A second Type 1 PQI example has been suggested by the American Brachytherapy Society (ABS) related to permanent source prostate brachytherapy

Proposed Type 1 project-retrospective review. A third Type 1 project might focus on a retrospective review of treatment policies and/or outcomes related to a practitioner's practice in a specific disease setting

Type 2 pqi compares a treating physicians record with that of evidence-based guidelines, consensus statements, or peer comparisons.

yes MOC is a pain in the arse. yes it is expensive. yes it may not make complete sense to people. but can you put a price tag on treating a patient properly? or a future lawsuit that may arise from improper documentation or treatment?

-------------------------
Radonc...I'm not trying to flame anyone here. Certainly, with your staunch defense, I have to believe in someway you are an ABR or former ABR rep.

Whether exquisite travel was built into the ABRs budget before or after MOC went into effect is irrelevant. The ABR should not be wasting it's members money on hotels that most of us would not stay in on a regular basis. Defense of that is like telling a government worker that a $10,000 plunger is ok - wasting of taxpayer dollars....or in this case, diplomate's dollars. Whether they work 12-15 hours or not, doesn't mean they should go to one of the most expensive places in this country for their retreat. Why bother if they are working so 'hard.' I've been to many COG, RTOG, CALGB meetings where I've worked 12 hour days on committees at 2nd rate hotels.

As for SAMs, why is it that ASTRO, of which I am a member, still makes me pay for SAMs.....if other societies are including this, perhaps ASTRO should as well.

As for PQI - sure it has a meaning, but I know hundreds of radoncs who basically think it is a joke (I hate to tell you you're more likely in the minority). While the intent is great, the reality of the busy work for those of us who are in practice seems a bit out of proportion. Sure an academician can use one of their residents retrospective reviews to do their PQI. As for our practice, we are active in ACR and I know this will count for one PQI, as does my national protocol enrollment. But the fact that the type 2 PQI is still vague, and no actual program is up and running is always a concern when the ABR is currently mandating this.

I am fortunate in that I am in a progressive practice, and prominent NCI cancer center where we are forced to constantly evaluate our practice for our patients and for our professional development, but if the ABR thinks I'm going to write up a written report so that no one can look at it, they're wrong - I don't believe in that busy work.

The MOC process is a reasonable one, but the ABR went full throtle, without examing the consequences of it, and with out examining how all the components would work. And it's not based on any validated model - just what some administrators thought would be a way to justify core principles in life long learning. Unfortunately, the MOC process will inconvenience many who already do what MOC is asking because a few old school practioners who don't keep up to date don't do (and incidentally are exempt from MOC).

Finally, the price............I still don't see the justification of where all the money is going. I'd love for the ABR to present this to all diplomates.....my hospital would this if a patient questioned the charges. I would think this process could be done for at least half the current ABR cost.
my 2 cents

 

[stephew]

moc is here to stay, so people should stop complaining about it and just accept it.

So not a revolutionary then.
Actually I have no problem with MOC. I support the concept. The cost are not justified however. A very good ex-resident I know did the calculations and came up with a compelling argument for as much. Recertification may indeed keep patients safer and help to ensure they're treated safely more often than not. But I dont believe paying for the cert that it costs to conduct in a reasonable improves patient care. Except insofar as the folks getting the nice trips may come back more relaxed and prepared to do their day job.

 

[stephew]

-------------------------
if the ABR thinks I'm going to write up a written report so that no one can look at it, they're wrong - I don't believe in that busy work.

Xdude: you dont believe in that sort of busy work? Trust me it exists; Ive seen it with my own eyes. 😉