come on!!

[topwise]

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I just paid $1870 for my Part 2 application. That's not including what it will cost to fly to Rochester and the hotel bills. This feels soooo wrong, especially after shelling out $1300 for part 1.

Do you think PM&R will ever get rid of the oral boards, like neurology?

 

[oreosandsake]

Ouch! that's a lot of money. sorry to hear that.

hopefully they do stop the requirement, and soon enough so that I won't have to take them 😛

 

[drusso]

But, it's a once in a lifetime opportunity to visit Rochester, MN.

 

[RUOkie]

But, it's a once in a lifetime opportunity to visit Rochester, MN.

Nothing better than spending a spring weekend in Rochester! A nice stress filled weekend with nothing to do to get your mind off it! I'm glad that's long over with!

 

[rysa4]

Nothing better than spending a spring weekend in Rochester! A nice stress filled weekend with nothing to do to get your mind off it! I'm glad that's long over with!

I agree that the process is a bit expensive, to be sure.

 

[topwise]

But, it's a once in a lifetime opportunity to visit Rochester, MN.

All right, despite everything, that got a laugh out of me. 🙂

 

[Finally M3]

But, it's a once in a lifetime opportunity to visit Rochester, MN.

Or to drive there from Minneapolis.

And eat crappy carry-out for a night.

 

[PMR 4 MSK]

I just paid $1870 for my Part 2 application. That's not including what it will cost to fly to Rochester and the hotel bills. This feels soooo wrong, especially after shelling out $1300 for part 1.

Do you think PM&R will ever get rid of the oral boards, like neurology?

No - money to be made, and legitimizing to be done.

I agree with having oral boards. Not with the cost, just the process.

 

[drusso]

No - money to be made, and legitimizing to be done.

I agree with having oral boards. Not with the cost, just the process.

But, oral exams are have shown to improve competence nor prevent impaired physician performance.

My vote: Get rid of it. Pearson has revolutionized testing!

 

[Ludicolo]

Remember reading somewhere that the first PM&R board exam in 1947, both written and oral, cost applicants $75. Adjusted for inflation, that’s about $730 today. Food for thought.

IMHO, I think it was a mistake for the neurologists to drop their oral boards. Some of the skills that used to be assessed during the oral board process – physical exam skills, communication, professionalism, etc. – are now being left to the individual program’s faculty to document competency during residency. Yeah, that’ll work across all programs. No bias or conflict of interest there.

So I vote to keep it, but also agree - would it kill the ABPMR to move it out of Rochester once in a while?

 

[topwise]

I don't mind taking the exam (well, I mind a little), but the cost and the travel is ridiculous. I was also in the first class forced to take the Step 2 CS, i.e. $1000 for an English competency exam.

I think the things the oral boards test are very important, but I also think it's an insult to the accredited residency programs to suggest that they're graduating students who aren't competent at taking a history, doing a physical, being professional, etc. (Also, the oral boards doesn't test physical exam skills, does it?)

I also happen to think that part 1 was not the best test of general PM&R knowledge. Maybe the solution is to have part 1 be more clinically oriented and perhaps have an open-ended section like Step 3?

 

[PMR 4 MSK]

I think the things the oral boards test are very important, but I also think it's an insult to the accredited residency programs to suggest that they're graduating students who aren't competent at taking a history, doing a physical, being professional, etc. (Also, the oral boards doesn't test physical exam skills, does it?)

There are programs graduating residents who are not competant, and many who are not professional, and it's not limited to PM&R by any stretch of the imagination.

However, I agree oral exams may not pick that up. On the flip side, many of the written questions were so esoteric and/or obscure as to make one go "WTF?!?" many times during testing.

The professionalism of many physicians is abysmal. we see it here online and in the offices and hospitals.

PM&R needs a revolution of training and standards, to catch up at least to the 90's, if not the 21st century. The concept of spending 1/2 your time or more doing inpt rehab does not reflect the reality of practice for most physiatrists. Programs that won't or can't train in interventional procedures will find themselves at the bottom of our artifical "tier" system referred to often here. They are graduating residents who are often at a significant disadvantage in the job market, or are forced to do a fellowship.

 

[Disciple]

PM&R needs a revolution of training and standards, to catch up at least to the 90's, if not the 21st century. The concept of spending 1/2 your time or more doing inpt rehab does not reflect the reality of practice for most physiatrists. Programs that won't or can't train in interventional procedures will find themselves at the bottom of our artifical "tier" system referred to often here. They are graduating residents who are often at a significant disadvantage in the job market, or are forced to do a fellowship.

This is what I don't understand.

The ABPMR has instituted a pretty rigorous MOC process (which included a practice improvement project), to keep up with what other specialties have done, and so that we can say we adhere to the same standards and levels of professionalism as other specialties.

However, when it comes to post-graduate training, the first step in this whole process, complete opposite.

 

[Gauss]

it's the cost that irks me, the rest of it is just another hoop. Explain to me the $600 processing fee...

 

[Ludicolo]

This is what I don't understand.

The ABPMR has instituted a pretty rigorous MOC process (which included a practice improvement project), to keep up with what other specialties have done, and so that we can say we adhere to the same standards and levels of professionalism as other specialties.

However, when it comes to post-graduate training, the first step in this whole process, complete opposite.

I don’t think MOC is that rigorous. Annoying hoop jumping, yes. Sucks most definitely. But not rigorous. Nonetheless, your point is well taken.

You could actually consider taking it a step further, with standardized, basic MSK and neuromuscular physical examination assessments (like an OSCE), basic procedure evaluations (like the EMG oral and waveform sections of the ABEM boards). I wouldn’t be against this. Ensure that we as a field are putting out a good, solid product that represents PM&R well. If a program can’t consistently produce residents who can take an appropriate pain/functional history, or perform an adequate, focused MSK exam, that program should be held accountable. I would also vote to get rid of grandfathering when it comes to the MOC. Sure, it’s a PITA, but if the old-timers (no offense) are still clinically active, why shouldn’t they be held to the same standards as everyone else?

I think the things the oral boards test are very important, but I also think it's an insult to the accredited residency programs to suggest that they're graduating students who aren't competent at taking a history, doing a physical, being professional, etc. (Also, the oral boards doesn't test physical exam skills, does it?)

I also happen to think that part 1 was not the best test of general PM&R knowledge. Maybe the solution is to have part 1 be more clinically oriented and perhaps have an open-ended section like Step 3?

It’s nice to think that all residency programs impart the skills and ethos necessary to be a successful general physiatrist. And most of them do. I firmly believe that the bulk of graduating residents are baseline competent. But some most definitely are not, and we need to catch them. There is an inherent bias and conflict of interest in the self-reporting of competency and professionalism. The stakes are too high to rely on the honor system.

Having counseled many graduating residents through both parts of the boards, I know that oral boards have changed significantly since some of us took them way back when. They are more standardized now (clinical case based), and the board at least seems to be trying to better evaluate competencies like diagnostic/therapeutic acumen, professionalism, and communication. How successful they are at this point in time is another issue.

What they’re seemingly trying to evaluate with oral boards is this: does this potentially certifiable physiatrist not only have the required smarts and knowledge base (having passed part I), but does he/she have other skills necessary to survive in practice? Do they have the ability to assess a variety of patients and maintain relationships with them? Can they generate a differential diagnosis, come up with a reasonable diagnostic/treatment plan based on that DDx, and communicate/justify said plan to patients, therapists, referral sources, third party payers? Can they adapt when things don’t go according to plan? Break bad news? Motivate patients? Provide tough love? Ask for help if indicated? Can they do all of this in a timely fashion, much like how a successful practice is expected to flow? Hard to assess these skills with just a written test.

 

[topwise]

What they’re seemingly trying to evaluate with oral boards is this: does this potentially certifiable physiatrist not only have the required smarts and knowledge base (having passed part I), but does he/she have other skills necessary to survive in practice? Do they have the ability to assess a variety of patients and maintain relationships with them? Can they generate a differential diagnosis, come up with a reasonable diagnostic/treatment plan based on that DDx, and communicate/justify said plan to patients, therapists, referral sources, third party payers? Can they adapt when things don’t go according to plan? Break bad news? Motivate patients? Provide tough love? Ask for help if indicated? Can they do all of this in a timely fashion, much like how a successful practice is expected to flow? Hard to assess these skills with just a written test.

I agree. However, aren't the people taking Part 2 already practicing? That used to be required. And even if they fail, they will still get to keep practicing, and get to keep shelling out money for another exam, which their chances of passing on the second go are not so good. Is there a point when an attending who can't pass Part 2 is taken out of the game?

I think that instead of saying that a PM&R attending who has had 8+ years of medical training is incapable of practicing, it would be great if the standards for residency programs were raised to ensure everyone who graduates is capable of passing. I'd say an attending working with a resident on a daily basis is better at assessing their competency than a one day nerve-wracking exam.

Eh, it's a hard point to argue, considering so many specialties require an oral exam, so it's the standard. Also, I recent discovered that now that neurology eliminated their oral exam, they charge $3000 for the written alone.

 

[Ludicolo]

I agree. However, aren't the people taking Part 2 already practicing? That used to be required. And even if they fail, they will still get to keep practicing, and get to keep shelling out money for another exam, which their chances of passing on the second go are not so good. Is there a point when an attending who can't pass Part 2 is taken out of the game?

Technically, no. Board certification isn’t mandatory, and multiple people in multiple specialties are out there practicing w/o ABMS certification. Practically speaking though, most hospitals, insurance plans, and managed care companies require it. There is also the public and legal perception that certification = quality. Case in point: we don't take the EMG boards (which isn't recognized by the ABMS) because it's required. We take them because it makes us look good. If someone keeps failing the boards due to lack of knowledge, poor professionalism, inadequate communication skills, or performance anxiety, we can’t stop them from practicing so long as they’re licensed. But we can certainly make it difficult for them.

I think that instead of saying that a PM&R attending who has had 8+ years of medical training is incapable of practicing, it would be great if the standards for residency programs were raised to ensure everyone who graduates is capable of passing. I'd say an attending working with a resident on a daily basis is better at assessing their competency than a one day nerve-wracking exam.

Agree that programs should be monitoring resident progress, assessing them along the way (using the SAE-R, mock orals, procedure and case logs, or in-house physical exam/anatomy practical exams). But IMHO the individual’s progress and achievements should also be checked and evaluated by someone impartial. The pressure to make sure residents pass their rotations, graduate and pass their boards isn’t trivial.

Eh, it's a hard point to argue, considering so many specialties require an oral exam, so it's the standard. Also, I recent discovered that now that neurology eliminated their oral exam, they charge $3000 for the written alone.

Now that's just wrong.

 

[topwise]

Now that's just wrong.

I know. And I feel guilty saying that it made me feel a little better. 🙂

And apparently, the neurology board is making a lot more money from the deal, since they don't have to pay to set up the oral boards. If anyone from ABPM&R is reading this, maybe that's something to consider? Before May perhaps? 😉

 

[SSdoc33]

to the graduating residents: get used to these types of fees. there is no reason why a written exam should cost 1500 bucks. just like everywhere else, these services will charge as much as they can. you essentially dont have a choice in the matter.

state license fees, professional membership fees, license renewal fees, subspecialty certification and renewal fees (sports, SCI, pain) etc all add up after a while. if someone has a way to avoid this, id love to hear it.

 

[LTS6776]

I actually felt like Part I was more of a rip off - it wasn't very PM&R focused and the questions seemed very outdated - it was as if nothing new had been written in the past 20 years or so. The part II questions were a lot more relevant. I do wish, however, they would have moved the test someplace a little easier and less expensive to get to like Chicago. I could have done without the stopovers and $600 flight from the East Coast.