Failed ABIM

[BillBill1219]

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This is a post-mortem analysis of what went wrong in the hopes that I can a) prevent others from suffering the same fate and b) keep myself honest and accountable. So here are the reasons in order why I will have to retake next August:

1) Poor attitude
During residency, I developed a major resentment toward training, medicine in general, and the ABIM. I went through a time where my hatred of the aforementioned clouded everything I did from studying to actual patient interaction. Despite this, I managed to obtain good reviews and did my best for the sake of the patient. I often thought that if patients knew how negatively I really viewed medicine, they would never want me as their physician. Regarding the ABIM, the constant refrain that would cycle through my mind was "I have a wife and family of my own with real-life, actual, adult responsibilities. I am utterly sick of studying and yet they still expect you to live your life like a med student and devote countless hours of exam prep when I had mouths to feed"

2) Poor, unaddressed mental health issues
There is no doubt I developed major depressive disorder and chronic insomnia during residency. I was also certainly burned out to a crisp. I did nothing to actively treat any of that. In fact, I did the opposite and allowed negativity to take root in my mind which is a problem I am still dealing with. I am now being treated for depression with CBT and it has been much better. I wish I had gotten help sooner.

3)Poor study plan
This is an important one. I basically tried to shotgun as many random questions as I could before the exam and thought that my existing knowledge base and test taking ability would suffice. I never failed a board exam and was always an adequate test taker. I went into ABIM with a false sense of confidence. That exam was HARD. It was like 240 questions of upper-tier UWorld questions. I did not read enough or structure my study strategy according to ABIM blueprint which I strongly suggest future test takers do. You have to have a 360 degree view of each topic to feel comfortable taking that exam. The breadth of the material is staggering

4)Logistical reasons
3 kids, new baby, new state, new job, first attending job. I placed this one last because if the 3 above items were in order, this probably would have only made things marginally more difficult. There is always someone in a more difficult circumstance than you who somehow found a way to make it work.

I am now in my first year of unsupervised practice as PCP with the additional weight of having to study for this exam all over again (not to mention pay for it.) I am reframing the situation in my mind as an extra opportunity to truly solidify the basics and prove myself as a competent internist. Already, I have applied the things I have read from Med Study to patient care with positive results. In the end, my resistance toward the process, hating and fighting it every step of the way was the reason for my ultimate ruin. I hope this can spare someone the same outcome or at least minimize the sufferings that come with our chosen path.

 

[DrMetal]

This is a post-mortem analysis of what went wrong in the hopes that I can a) prevent others from suffering the same fate and b) keep myself honest and accountable. So here are the reasons in order why I will have to retake next August:

1) Poor attitude
During residency, I developed a major resentment toward training, medicine in general, and the ABIM. I went through a time where my hatred of the aforementioned clouded everything I did from studying to actual patient interaction. Despite this, I managed to obtain good reviews and did my best for the sake of the patient. I often thought that if patients knew how negatively I really viewed medicine, they would never want me as their physician. Regarding the ABIM, the constant refrain that would cycle through my mind was "I have a wife and family of my own with real-life, actual, adult responsibilities. I am utterly sick of studying and yet they still expect you to live your life like a med student and devote countless hours of exam prep when I had mouths to feed"

2) Poor, unaddressed mental health issues
There is no doubt I developed major depressive disorder and chronic insomnia during residency. I was also certainly burned out to a crisp. I did nothing to actively treat any of that. In fact, I did the opposite and allowed negativity to take root in my mind which is a problem I am still dealing with. I am now being treated for depression with CBT and it has been much better. I wish I had gotten help sooner.

3)Poor study plan
This is an important one. I basically tried to shotgun as many random questions as I could before the exam and thought that my existing knowledge base and test taking ability would suffice. I never failed a board exam and was always an adequate test taker. I went into ABIM with a false sense of confidence. That exam was HARD. It was like 240 questions of upper-tier UWorld questions. I did not read enough or structure my study strategy according to ABIM blueprint which I strongly suggest future test takers do. You have to have a 360 degree view of each topic to feel comfortable taking that exam. The breadth of the material is staggering

4)Logistical reasons
3 kids, new baby, new state, new job, first attending job. I placed this one last because if the 3 above items were in order, this probably would have only made things marginally more difficult. There is always someone in a more difficult circumstance than you who somehow found a way to make it work.

I am now in my first year of unsupervised practice as PCP with the additional weight of having to study for this exam all over again (not to mention pay for it.) I am reframing the situation in my mind as an extra opportunity to truly solidify the basics and prove myself as a competent internist. Already, I have applied the things I have read from Med Study to patient care with positive results. In the end, my resistance toward the process, hating and fighting it every step of the way was the reason for my ultimate ruin. I hope this can spare someone the same outcome or at least minimize the sufferings that come with our chosen path.

Take of your mental health needs, study, prepare (I highly recommend UW --- their ability to predict content and questions on the actual was uncanny, I think there may even be an "inside job"). Take it again, you'll pass.

And don't let this mild setback thwart your resentment for the ABIM, which we all know is a monopolistic, totalitarian entity that only hinders physicians and does nothing to promote their well-being.

 

[dozitgetchahi]

This is a post-mortem analysis of what went wrong in the hopes that I can a) prevent others from suffering the same fate and b) keep myself honest and accountable. So here are the reasons in order why I will have to retake next August:

1) Poor attitude
During residency, I developed a major resentment toward training, medicine in general, and the ABIM. I went through a time where my hatred of the aforementioned clouded everything I did from studying to actual patient interaction. Despite this, I managed to obtain good reviews and did my best for the sake of the patient. I often thought that if patients knew how negatively I really viewed medicine, they would never want me as their physician. Regarding the ABIM, the constant refrain that would cycle through my mind was "I have a wife and family of my own with real-life, actual, adult responsibilities. I am utterly sick of studying and yet they still expect you to live your life like a med student and devote countless hours of exam prep when I had mouths to feed"

2) Poor, unaddressed mental health issues
There is no doubt I developed major depressive disorder and chronic insomnia during residency. I was also certainly burned out to a crisp. I did nothing to actively treat any of that. In fact, I did the opposite and allowed negativity to take root in my mind which is a problem I am still dealing with. I am now being treated for depression with CBT and it has been much better. I wish I had gotten help sooner.

3)Poor study plan
This is an important one. I basically tried to shotgun as many random questions as I could before the exam and thought that my existing knowledge base and test taking ability would suffice. I never failed a board exam and was always an adequate test taker. I went into ABIM with a false sense of confidence. That exam was HARD. It was like 240 questions of upper-tier UWorld questions. I did not read enough or structure my study strategy according to ABIM blueprint which I strongly suggest future test takers do. You have to have a 360 degree view of each topic to feel comfortable taking that exam. The breadth of the material is staggering

4)Logistical reasons
3 kids, new baby, new state, new job, first attending job. I placed this one last because if the 3 above items were in order, this probably would have only made things marginally more difficult. There is always someone in a more difficult circumstance than you who somehow found a way to make it work.

I am now in my first year of unsupervised practice as PCP with the additional weight of having to study for this exam all over again (not to mention pay for it.) I am reframing the situation in my mind as an extra opportunity to truly solidify the basics and prove myself as a competent internist. Already, I have applied the things I have read from Med Study to patient care with positive results. In the end, my resistance toward the process, hating and fighting it every step of the way was the reason for my ultimate ruin. I hope this can spare someone the same outcome or at least minimize the sufferings that come with our chosen path.

First, chill out. You have seven years to pass this thing, and nobody else will even know you failed it. This wasn’t a life changing event.

Second, I can totally relate to how you felt about training. I didn’t hate medicine itself, but boy oh boy by the end of fellowship did I ever hate the song and dance of training, academic medicine in general, dealing with attendings (and my fellowship was malignant, so I had a lot of attendings with ****ty attitudes), the research pressure, being chronically broke because we choose to pay trainees peanuts in this country, having to do all sorts of bull**** assignments (tons and tons of presentations), etc. I was also dealing with a divorce during that time, so “burnt out” was putting it mildly. At the end of training, I actually took two months off - which helped enormously.

Third, I also didn’t take ABIM rheumatology boards until 4 years after I finished fellowship (I did take the IM boards during residency). I had too many things like job changes, moves, getting remarried, continuing court stuff relating to my divorce, the CoVID pandemic, etc going on. In retrospect, you may have benefited from delaying the test also. There is this perception that you “must” take the test as soon as you graduate - but you don’t have to.

Fourth (as stated above): ABIM is an extortionate institution, and their test is poorly written trash. (The rheumatology boards had way more typos and errors than any other standardized test I’ve ever seen.) Don’t let them influence how you feel about yourself and your capabilities as a physician.

 

[gutonc]

Third, I also didn’t take ABIM rheumatology boards until 4 years after I finished fellowship (I did take the IM boards during residency). I had too many things like job changes, moves, getting remarried, continuing court stuff relating to my divorce, the CoVID pandemic, etc going on. In retrospect, you may have benefited from delaying the test also. There is this perception that you “must” take the test as soon as you graduate - but you don’t have to.

I have been saying this for years and nobody will listen to me. If you're going into a fellowship, it makes some sense to take ABIM before you dive deep into your sub-specialty and forget all of your IM training (I say this from personal experience not taking it right away). But if you're not doing a fellowship, or once you finish your fellowship, I think it makes total sense to take a year or two to learn actual practice and commit data/guideline supported practice to memory and make it second nature, rather than having to guess what nonsense your attending for the month has adopted as gospel based on some other nonsense they learned from their attending 20 years ago.

I took Onc boards after 2y in practice in a generalist job and, while I won't pretend that I didn't study at all, I didn't study nearly as much for Onc as I did for IM and I did much better.

To the OP, unless you're in an employed position that requires you to pass it by next year (I've never seen that as a requirement based on having/had staff privileges at 10+ hospitals in 5 different hospital systems over the past 15 years), I recommend you take a year off of this nonsense, practice medicine, stay current on new data and then fire this back up for the next cycle.

 

[BillBill1219]

There is definitely a sense of relief that comes with the idea of waiting an additional year. In hindsight, I briefly considered postponing the exam, but I listened to people who encouraged me to "just get it over with." One of the reasons I dreaded failing this exam was that I knew it meant I'd have to study as a busy attending. My practice will eventually be around 20-25 encounters daily and the thought of studying when things are fully ramped up is daunting. But I guess those who take the 10-year MOC exam are in the same situation and even further removed from the material ABIM tests.

 

[anonperson]

There is definitely a sense of relief that comes with the idea of waiting an additional year. In hindsight, I briefly considered postponing the exam, but I listened to people who encouraged me to "just get it over with." One of the reasons I dreaded failing this exam was that I knew it meant I'd have to study as a busy attending. My practice will eventually be around 20-25 encounters daily and the thought of studying when things are fully ramped up is daunting. But I guess those who take the 10-year MOC exam are in the same situation and even further removed from the material ABIM tests.

Studying is fine as an attending. It is annoying but doable.

I had to take two oral board exams as an attending while still operating and taking in house call. Had to travel to Dallas for one of them. The other was virtual which was easier logistically. Just make a regular study schedule for a couple of months and stick to it.

Use whatever resources people recommend for your specialty and commit to it. Don't get bogged down by too many resources. Do practice questions consistently

You have made it this far. You can get this done.

 

[Prehealth1011]

Use whatever resources people recommend for your specialty and commit to it. Don't get bogged down by too many resources. Do practice questions consistently.

The bolded definitely affected my Step 1 scores. I kept it simple for the ABIM and used only UWorld. I knew every single word from the QBank and passed easily. I can’t comment on other resources since I haven’t used them, but whichever one they choose, recommend knowing it inside and out.

 

[dozitgetchahi]

I have been saying this for years and nobody will listen to me. If you're going into a fellowship, it makes some sense to take ABIM before you dive deep into your sub-specialty and forget all of your IM training (I say this from personal experience not taking it right away). But if you're not doing a fellowship, or once you finish your fellowship, I think it makes total sense to take a year or two to learn actual practice and commit data/guideline supported practice to memory and make it second nature, rather than having to guess what nonsense your attending for the month has adopted as gospel based on some other nonsense they learned from their attending 20 years ago.

I took Onc boards after 2y in practice in a generalist job and, while I won't pretend that I didn't study at all, I didn't study nearly as much for Onc as I did for IM and I did much better.

To the OP, unless you're in an employed position that requires you to pass it by next year (I've never seen that as a requirement based on having/had staff privileges at 10+ hospitals in 5 different hospital systems over the past 15 years), I recommend you take a year off of this nonsense, practice medicine, stay current on new data and then fire this back up for the next cycle.

Yes, I totally agree that actually being a rheumatologist for a bit helped with the boards. The ABIM rheum boards are full of vague situations where they barely (or basically don’t) give you enough info to discern what’s actually going on. I felt that practicing rheumatology for several years gave me a lot of “rheumatology instincts” that helped me sort out those qs (and those instincts wouldn’t have been there if I had taken the boards 2 months after finishing fellowship).

 

[dgdg]

You're not alone in your experiences, but many will not share it.

20 years ago at least, residency was a dysfunctional program of high pressure, 90 hour work weeks, and field promotion managers (senior residents and attendings) some of whom knew little or cared little how to actually manage their juniors. For those with mood disorders, I suspect it can be impossibly tough with lots of fallout.

At the core, you have to love medicine in order to tolerate all the other external forces against you which can be enumerated by reading all the comments in this forum over the years.

Yeah, it is hard studying for recerts too if you still have an active family that depends on you. You have to make a cogent long term study plan with good spirits and just do it. I devoted at least 1 hour most nights after everyone was settled down for the evening.

I recommend you look back to some of my summary posts about how I actively studied for my recert 2 years ago. You need to actively learn AND remember new information, not just plough through questions. The former improves your score, the latter (in my opinion) is mostly just a pre-test.

Good luck! You are a value to society, doing something meaningful and impactful in others' lives. Not everyone cares to do that.

Ok, there's my pep talk. Now get to work and study!!!

 

[BillBill1219]

At the core, you have to love medicine in order to tolerate all the other external forces against you which can be enumerated by reading all the comments in this forum over the years.

And the truth is I do not love it enough to tolerate all the other external forces. My struggle is that on one hand, I truly felt called to this profession and on the other, feel like it was the biggest mistake I have ever made. The effort/reward ratio is nowhere near worth it. The actual practice of medicine does not excite me. I do not geek out over new data showing how Repatha reduced cardiovascular deaths. I certainly do not like committing 8,000,000+ nitty gritty facts to memory. I used to stand in awe at the human body and loved physiology and biochemistry but now I just do not care. I hate dealing with nonspecific complaints all day long, most of which have 3-5 (or more) possibilities and usually go away on their own anyway. My attending salary has made life more comfortable but nowhere near living it up because most of my money goes towards student loans and savings/investments. After all this hell, I am comfortably middle class. I can scarcely think of any reason why I would choose this path again.

 

[anonperson]

And the truth is I do not love it enough to tolerate all the other external forces. My struggle is that on one hand, I truly felt called to this profession and on the other, feel like it was the biggest mistake I have ever made. The effort/reward ratio is nowhere near worth it. The actual practice of medicine does not excite me. I do not geek out over new data showing how Repatha reduced cardiovascular deaths. I certainly do not like committing 8,000,000+ nitty gritty facts to memory. I used to stand in awe at the human body and loved physiology and biochemistry but now I just do not care. I hate dealing with nonspecific complaints all day long, most of which have 3-5 (or more) possibilities and usually go away on their own anyway. My attending salary has made life more comfortable but nowhere near living it up because most of my money goes towards student loans and savings/investments. After all this hell, I am comfortably middle class. I can scarcely think of any reason why I would choose this path again.

Median household income in the United States is ~$80k a year.

A physician in basically any specialty is making at least 3 to 4 times that amount as a solo earner.

Not saying medicine doesn't have its issues but it's not a bad gig

Good cash compensation with generally reasonable hours and job security. Most physicians without some massive personality issue or drug addiction can easily find work anywhere and everywhere.

Also will guarantee a net worth in the millions without doing anything special.

 

[dgdg]

And the truth is I do not love it enough to tolerate all the other external forces. My struggle is that on one hand, I truly felt called to this profession and on the other, feel like it was the biggest mistake I have ever made. The effort/reward ratio is nowhere near worth it. The actual practice of medicine does not excite me. I do not geek out over new data showing how Repatha reduced cardiovascular deaths. I certainly do not like committing 8,000,000+ nitty gritty facts to memory. I used to stand in awe at the human body and loved physiology and biochemistry but now I just do not care. I hate dealing with nonspecific complaints all day long, most of which have 3-5 (or more) possibilities and usually go away on their own anyway. My attending salary has made life more comfortable but nowhere near living it up because most of my money goes towards student loans and savings/investments. After all this hell, I am comfortably middle class. I can scarcely think of any reason why I would choose this path again.

Well, pass the initial board certification and obtain a single state licensure despite the misery of it. Then decide what you are going to do to earn an income.

I believe IMHO that must become board certified to open up doors to you outside of clinical medicine. Find something non clinical using your resume which includes M.D/D.O. PLUS initial board certification. Otherwise, as far as employment, you may have nothing to show for it.
Unless you are just wholly and permanently unhappy with all of medicine, you should be able to find something personally meaningful that is non clinical using your degree and certifications. Many work just to survive, without any passion for what they generally do. It is wonderful to have joy a for one's profession (the pure basic part of it, not the all the other stuff) and be able to earn a living wage. Find it for yourself using your certifications as leverage.

Comfortable middle class in the USA is probably upper class rich for much of the world. After that, happiness is not found with a larger bank account.

It sounds like you need mental health care, at least temporarily. I hope you have it already, or are seeking it. You can be happier.

 

[BillBill1219]

You are right. A lot of that was my depression talking. It clouds my thinking and places me in terrible self-pity. I am so much to appreciate and be thankful for.

 

[dozitgetchahi]

And the truth is I do not love it enough to tolerate all the other external forces. My struggle is that on one hand, I truly felt called to this profession and on the other, feel like it was the biggest mistake I have ever made. The effort/reward ratio is nowhere near worth it. The actual practice of medicine does not excite me. I do not geek out over new data showing how Repatha reduced cardiovascular deaths. I certainly do not like committing 8,000,000+ nitty gritty facts to memory. I used to stand in awe at the human body and loved physiology and biochemistry but now I just do not care. I hate dealing with nonspecific complaints all day long, most of which have 3-5 (or more) possibilities and usually go away on their own anyway. My attending salary has made life more comfortable but nowhere near living it up because most of my money goes towards student loans and savings/investments. After all this hell, I am comfortably middle class. I can scarcely think of any reason why I would choose this path again.

Look, so I’m just going to say that I feel you on some of this. You’re not wrong that the training process of medicine is long and unpleasant. I too experienced enthusiasm waning towards dealing with the endless learning and memorizing towards the end of fellowship. I keep up with the literature, but I don’t have the hardcore passion for reading every single new paper out there like some academics do…there is simply too much else to do, and too much life to live that I still feel like I missed out on during training. If you did a survey of docs out there, you’d find more docs than you might think that agree with you about these things. It’s one of the reasons an increasing number of docs are leaving medicine.

As far as the financial end of it goes…at my first poorly paid hospital job, I could have echoed you 100%. Almost everything I had left over was going to student loan payments and investments (and not as much into the latter as I would have hoped). I didn’t feel like I was getting ahead at all. Later on, I went PP and started making 3x what I made at the hospital job, which made life much better. So you may want to look around and see if there’s a way you can be compensated better for your time and expertise.