Board Recertification

[neurodoc]

Like other specialty boards, the ABPN has adopted recertification (MOC-maintenance of certification). For ABPN diplomates in Neurology and Psychiatry, this entails taking an exam every 10 years. I took my recertification exam in August, and I actually enjoyed the experience (I'm one of those who like to take tests). I didn't like the fact that I had to write a check for about $2000 for the privilege...

I have no beef with the idea of the board recertification, but I do have a serious beef with the fact that the ABPN has decided to "grandfather" all those who were certified prior to mid-1994.

If the main reason for MOC is to assure that specialists remain competent and current in their knowledge, then why exempt the pre-1994 diplomates from the requirement? It would seem that this older group would be the most in need of such testing...ever hear of senile dementia?

The ABPN cannot argue that the initial cerifying exams I took in 1996 and 1997 (Parts 1 & 2) were any different or less stringent than the ones given in 1994 and earlier... I know that other boards have dropped their oral exam component, but the ABPN has not.

I can understand why those with lifetime certification (still the majority of ABPN diplomates, but that will eventually change) would not want to go through the trouble and expense (not to mention the possibility of losing their certification), but frankly my heart does not bleed for them....

I view their decision to grant lifetime certification to some of their members as grossly unfair. Maybe it is time for someone to file a class-action lawsuit against the boards. If the purpose of MOC is to guarantee physician competence, MOC should be applied to all diplomates. Why hasn't anyone done this yet? Maybe someone has, but I'm not aware of it.

Nick

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[neurologist]

Like other specialty boards, the ABPN has adopted recertification (MOC-maintenance of certification). For ABPN diplomates in Neurology and Psychiatry, this entails taking an exam every 10 years. I took my recertification exam in August, and I actually enjoyed the experience (I'm one of those who like to take tests). I didn't like the fact that I had to write a check for about $2000 for the privilege...

I have no beef with the idea of the board recertification, but I do have a serious beef with the fact that the ABPN has decided to "grandfather" all those who were certified prior to mid-1994.

If the main reason for MOC is to assure that specialists remain competent and current in their knowledge, then why exempt the pre-1994 diplomates from the requirement? It would seem that this older group would be the most in need of such testing...ever hear of senile dementia?

The ABPN cannot argue that the initial cerifying exams I took in 1996 and 1997 (Parts 1 & 2) were any different or less stringent than the ones given in 1994 and earlier... I know that other boards have dropped their oral exam component, but the ABPN has not.

I can understand why those with lifetime certification (still the majority of ABPN diplomates, but that will eventually change) would not want to go through the trouble and expense (not to mention the possibility of losing their certification), but frankly my heart does not bleed for them....

I view their decision to grant lifetime certification to some of their members as grossly unfair. Maybe it is time for someone to file a class-action lawsuit against the boards. If the purpose of MOC is to guarantee physician competence, MOC should be applied to all diplomates. Why hasn't anyone done this yet? Maybe someone has, but I'm not aware of it.

Nick

Well, since I am looking forward to my first recert in a few years, it's nice to hear that the experience wasn't all that horrendus (well, except for the $$$ -- $2000

As for why people are exempted, I'd hazard two guesses. The first would be just to minimize the logistics of having to test that many people. By limiting the numbers, it makes things easier for the ABPN to track. Even at $2000 a pop, this is not a cheap thing to do. Logistics, time and money are, after all, the reasons oral boards are history now.

The second, more cynical, thought is simply that the "old fogeys" are the ones in charge, and they ain't gonna test themselves.

I think a lawsuit is a bit over the top. Eventually the old guard will retire and we'll all be treated the same. Of course, by then our generation will be in charge, and we can place some new and onerous requirement on our younger brethren!

 

[neurodoc]

... Logistics, time and money are, after all, the reasons oral boards are history now.

The second, more cynical, thought is simply that the "old fogeys" are the ones in charge, and they ain't gonna test themselves.

I think a lawsuit is a bit over the top. Eventually the old guard will retire and we'll all be treated the same. Of course, by then our generation will be in charge, and we can place some new and onerous requirement on our younger brethren!

Well, the ABPN still uses the oral exam. If they had eliminated it for post-1994diplomates, that might have made their decision to have a two-tier system of certification defensible (on the grounds that pre-1994 diplomates had a "harder" exam). But that was not the case.

And I don't think a lawsuit is "over the top." We're talking BIG money here for recertification, and the the "grandfather" policy is patently unfair and illogical. I for one would be happy to sign on as a plaintiff against the ABPN and ABMS for their grossly unfair "grandfather" policy.

BTW, this has nothing to do with my recent experience with the recertification exam. I think I did well on the exam and I expect to pass. I resewted having to spend about $2000 of my hard-earned money to take this exam and I resent the sanctimonious arguments of the ABPN that this MOC is really "voluntary" and their tap-dancing around the illogic and unfairness of MOC being required only for post-1994 diplomates. You comment about the "old fogeys" may be "cynical," but it is clearly correct.

I'm not a fan of lawyers or class-action lawsuits, but this is a situation that cries out for a law suit. And you know what? In my opinion, res ipsa loquitur in this case, and such a suit would stand a very good chance of winning a judgment that required the ABPN to recertify all diplomates.

Sheep will ever be treated like sheep. Are you a man or are you a sheep?

 

[neurologist]

Sheep will ever be treated like sheep. Are you a man or are you a sheep?

Ha! You can't pull the wool over my eyes! In addition to being a Neurodoc, you also obviously have a sheepskin from some law school, and are just trying to herd up business for your flock of lawyers. Sorry, but I will not be fleeced by you and become a sacrificial lamb for this baaaaaaaad idea!

Sorry, I just couldn't help myself there . . .

Look, is it fair? Probably not. But "if you want to dance, you gotta pay the band . . ." Someone is supposed to ensure our competency, and in the absence of some national government-type specialty certification, that chore has been devolved to the various medical specialty boards. I don't see any court taking this on jurisdiction-wise . . .

Well, the ABPN still uses the oral exam.

I believe the residents finishing up in 2008 will be the final class to take the oral boards as we've known them. Subsequently, residents will be tested internally by their residency programs. This, of course, opens a whole new can of worms (what residency will actually start flunking their residents?) but that's for a whole different thread . . .

 

[neurodoc]

Ha! You can't pull the wool over my eyes! In addition to being a Neurodoc, you also obviously have a sheepskin from some law school, and are just trying to herd up business for your flock of lawyers. Sorry, but I will not be fleeced by you and become a sacrificial lamb for this baaaaaaaad idea!

And not to mention that my ABPN diploma is just another sheepskin I've got framed and hanging in my office...

OK, I see your point, and maybe it's better to approach this recertification/grandfathering stuff with humor rather than letting it get you all frustrated and angry. And I guess it is better to leave specialty certification up to physician groups rather than give that job to the government, on the principle that I'd rather be judged by my professional peers than by non-medical bureaucrats and politicians.

On the other hand, as you acknowledge, grandfathering IS unfair and as I also said it runs counter to the major purpose of recertification, which is to assure continued physician competence.

I disagree that a suit against grandfathering would stand little chance of success in court. I think it would stand a very good chance of success. The Plaintiffs would argue that: 1) it violates equal protection; 2) it imposes unfair hardship and financial burden on those not grandfathered (these are grievable damages); 3) it undermines the major goal of recertification to assure ongoing physician competence (that is a "public interest" argument); and, 4) on its face grandfathering is offensive to the common-sense value of "fair play." #4 is a very strong argument that would have some sway were the case to be tried with a jury, which is how it should be tried.

As to the oral exams, I didn't realize they were being phased out after 2008. Actually, I think this is a bad idea, for the reason you mentioned. The ABPN may say that they are phasing out oral exams due to their "expense," but as you know these exams were subsidized by our exam fees. Call me paranoid, but I think another reason for phasing out the orals would be to allow the ABPN to say, "Well, you see the "Grandfathers" had to pass oral exams, so they really had a more difficult test than the newbies...so it's really OK not to have to make them recertify." Problem with that is that you and I and all those neurologists who got certified bewteen 1994-2008 had to go through the same hoops as the Grandfathers...

Finally, you will note that the ABPN has been somewhat hypocritical in its arguments about why people like you and I should not complain about grandfathering. The #1 argument is that board certification is "voluntary." Well, that is true, but it is also true that current Board certification is required by hospitals and insurance companies. In order to remain in good standing with these entities, I have to spend a lot of money and take an exam that my granfathered colleagues need not worry about. So much for the "voluntary" aspect of recertification.

I'm quite sure that the main reason that the ABPN has not been taken to court on grandfathering is the reluctance and fear that we younger neurologists feel when faced with the idea of confronting the folks who have the power to decide whether we are "worthy" to call ourselves Board Certified neurologists....If we piss these guys off too much they might decide we are unworthy.

Nick

 

[Faebinder]

If you were going to gather people to sue for something like that, your best bet is to get people who only recently passed the recertification.... that way they wont be worried about being recertified while the lawsuit is on going.

I am anti grandfathering in any field... I think it keeps the field less competent. The grandfathers don't have to learn the latest and well known techniques because they will never be questioned about it in an exam. If they claim that htey are so competent after years and years of practice then fine, they should have no trouble passing the exam.

Till now, some surgeons don't do laparoscopic operations and prefer open despite everyone new commonly doing them for same or better results. While neurology is not surgery, I would hate to see newly discovered great treatments and procedures concentrated in different pockets of the US map.

 

[neurodoc]

Well,

ABPN notified me that I passed my 2006 recert exam, with an overall score of 93% answeres correct. There were 20 subtopics. I got 100% correct on 10/20, >90% correct on 6/20, > 80% correct on 3/20, and an abysmal 75% correct on neurogenetics. Candidates needed >64% overall correct to pass. I don't know if any failed... Oh...I studied about two weeks prior to the test by reading one of the board review books from Barnes and Noble.

I still am pissed off that they "grandfather" anyone. If they want to recertify folks, let them do it for everyone. Why should some of us, who took the same exam (orals and written) that the grandfathers did have to spend over $2000 to be recertified? ABPN may be phasing out orals after 2008, I think to provide some "justification" for recertifying "newbies." That won't wash for those of us who certified between 1995-2008. I think we've got a legitimate gripe and I'd like us to take it to court.

Nick