Recertification needed for job?

[cameraGEEK]

Hey all, I have been working at a VA in California for the last couple years. I am wondering if I will need to take a re-certification board exam in a few years. No one has said anything about boards, and I never received a contract with information about it being required to maintain employment. I'd prefer not to ask them directly, since I don't want to draw attention or judgy-ness. No one had mentioned anything when I was hired. I know some states have laws about not allowing termination of physicians who do not have/pass recertification, not sure if California is one of them. Anyone have any ideas of thoughts? I seriously cannot imagine a lot of the physicians I see practicing taking these exams every few years.

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[jdh71]

The VA is a federal institution and will have its own rules. State laws won’t protect your job at a VA.

But why not just recertify? Like basically everyone else?

 

[drtofu66]

This is the subject of a rancorous debate that has reached a boiling point in the last couple of years. There's a lot to unpack but a decent starting point is this Newsweek article and the 3-4 follow-up articles by Kurt Eichenwald:
The Ugly Civil War in American Medicine

A more recent update on what's happened can be read here:
https://www.mdlinx.com/physiciansen...board-review-on-maintenance-of-certification/


"But why not just recertify? Like basically everyone else?"

Doing something solely because everyone else is doing it is probably not a great reason.

Also-- because there's no benefit to you or your patients. And it's going to cost you over $20,000 in fees and board prep course materials and time away from work/family/enjoyable acticvities to prepare to recertify:
Cost Analysis of the ABIM Maintenance-of-Certification Program | Annals of Internal Medicine | American College of Physicians

The only proven beneficiary in the recertification scheme is the ABIM and other boards in the fees you will have to pay to them in order for the board to report you as 'certified'.

The ABIM is finally being sued for tying their Maintenance of Certificiation product to their initial Certfication product:
https://www.medicaleconomics.com/article/docs-sue-board-internal-medicine-over-moc

To OP's original question: IMO you're best served to ask around at work about your specific situation. I had always thought that the VA system didn't require board certification (because to be hired by the VA you just need a medical license to practice medicine. And you don't need to be board certified for any state to issue you a medical license. For now, anyway...) but you should ask your co-workers. I agree with you not to ask your employer directly. No need to rock the boat.

 

[cameraGEEK]

This is the subject of a rancorous debate that has reached a boiling point in the last couple of years. There's a lot to unpack but a decent starting point is this Newsweek article and the 3-4 follow-up articles by Kurt Eichenwald:
The Ugly Civil War in American Medicine

A more recent update on what's happened can be read here:
https://www.mdlinx.com/physiciansen...board-review-on-maintenance-of-certification/


"But why not just recertify? Like basically everyone else?"

Doing something solely because everyone else is doing it is probably not a great reason.

Also-- because there's no benefit to you or your patients. And it's going to cost you over $20,000 in fees and board prep course materials and time away from work/family/enjoyable acticvities to prepare to recertify:
Cost Analysis of the ABIM Maintenance-of-Certification Program | Annals of Internal Medicine | American College of Physicians

The only proven beneficiary in the recertification scheme is the ABIM and other boards in the fees you will have to pay to them in order for the board to report you as 'certified'.

The ABIM is finally being sued for tying their Maintenance of Certificiation product to their initial Certfication product:
https://www.medicaleconomics.com/article/docs-sue-board-internal-medicine-over-moc

To OP's original question: IMO you're best served to ask around at work about your specific situation. I had always thought that the VA system didn't require board certification (because to be hired by the VA you just need a medical license to practice medicine. And you don't need to be board certified for any state to issue you a medical license. For now, anyway...) but you should ask your co-workers. I agree with you not to ask your employer directly. No need to rock the boat.

Exactly. Thank you - will have to see from other VA physicians. I wonder if anyone on SDN works at the VA and knows. I work at a satellite clinic and don't see the other clinicians much. I wonder if it is department based or state based, or same rules for all federally employed docs. I just wonder if they can ask me to recertify if it was never stated anywhere.

 

[cameraGEEK]

Or, are we able to see the year other physicians were last certified? That would probably clue me in.

 

[rokshana]

Or, are we able to see the year other physicians were last certified? That would probably clue me in.

You can go to the ABIM website and put in any name to see if they are certified.

 

[jdh71]

This is the subject of a rancorous debate that has reached a boiling point in the last couple of years. There's a lot to unpack but a decent starting point is this Newsweek article and the 3-4 follow-up articles by Kurt Eichenwald:
The Ugly Civil War in American Medicine

A more recent update on what's happened can be read here:
https://www.mdlinx.com/physiciansen...board-review-on-maintenance-of-certification/


"But why not just recertify? Like basically everyone else?"

Doing something solely because everyone else is doing it is probably not a great reason.

Also-- because there's no benefit to you or your patients. And it's going to cost you over $20,000 in fees and board prep course materials and time away from work/family/enjoyable acticvities to prepare to recertify:
Cost Analysis of the ABIM Maintenance-of-Certification Program | Annals of Internal Medicine | American College of Physicians

The only proven beneficiary in the recertification scheme is the ABIM and other boards in the fees you will have to pay to them in order for the board to report you as 'certified'.

The ABIM is finally being sued for tying their Maintenance of Certificiation product to their initial Certfication product:
https://www.medicaleconomics.com/article/docs-sue-board-internal-medicine-over-moc

To OP's original question: IMO you're best served to ask around at work about your specific situation. I had always thought that the VA system didn't require board certification (because to be hired by the VA you just need a medical license to practice medicine. And you don't need to be board certified for any state to issue you a medical license. For now, anyway...) but you should ask your co-workers. I agree with you not to ask your employer directly. No need to rock the boat.

If you are spending $20,000 on taking boards you are doing it wrong. Lol.

 

[chessknt]

If you are spending $20,000 on taking boards you are doing it wrong. Lol.

Step 1 and 2 ck-940x2=1880
Step 2 cs=1580+travel
Step 3=875
abim cert=1400 + lost day of work
Uworld qbank=400-500
Board prep course=800-900
Subspecialty exam fee=2300 + lost day or work
Qbank and board prep course similar to above
Abim Moc fee=155/yr x 20 year career=3100
Abim recert=650 (assuming you only recert once before retiring) + lost day of work(~1500)
Subspecialty recert=1200 + lost day of work.

All told the bare minimum over a 20 year career assuming no prep purchased would be:
9500 for no subspecialty + travel + 2 lost days of work.
Tack on another 500 or so for prep fees and assuming you make about 1500 per shift that adds up to 13k.

For subspecialty you are looking to add another 4k or so per board cert plus 2 additional days of work lost (and you probably make more) which puts you above 20k.

Costs increase even more if you recert a second time.

20k doesn't sound that far off to me unless you place a value of 0 on your time. I also agree it adds nothing to healthcare other than to increase our administrative bloat except this time it is other physicians ****ing us over instead of MBA *****s.

 

[rokshana]

Step 1 and 2 ck-940x2=1880
Step 2 cs=1580+travel
Step 3=875
abim cert=1400 + lost day of work
Uworld qbank=400-500
Board prep course=800-900
Subspecialty exam fee=2300 + lost day or work
Qbank and board prep course similar to above
Abim Moc fee=155/yr x 20 year career=3100
Abim recert=650 (assuming you only recert once before retiring) + lost day of work(~1500)
Subspecialty recert=1200 + lost day of work.

All told the bare minimum over a 20 year career assuming no prep purchased would be:
9500 for no subspecialty + travel + 2 lost days of work.
Tack on another 500 or so for prep fees and assuming you make about 1500 per shift that adds up to 13k.

For subspecialty you are looking to add another 4k or so per board cert plus 2 additional days of work lost (and you probably make more) which puts you above 20k.

Costs increase even more if you recert a second time.

20k doesn't sound that far off to me unless you place a value of 0 on your time. I also agree it adds nothing to healthcare other than to increase our administrative bloat except this time it is other physicians ****ing us over instead of MBA *****s.

You said 20k to REcertify not 20k over a medical career of testing and prep...there is a difference.

 

[chessknt]

You said 20k to REcertify not 20k over a medical career of testing and prep...there is a difference.

Ah you are correct, that is less costly.

My point still sands that this is an astronomical expense not seen in any other professional field (this is ignoring CME costs as well) with no discernible purpose. Just like JAHCO it exists by sheer force of tradition rather than any true need. Why should we have to pay ~1.5k + a lost day or work to satisfy this extraneous requirement? The state medical board already has its own requirements for continuing education, what does this do? Why would someone practicing regular medicine need to take tests repeatedly to demonstrate competence?

 

[jdh71]

Step 1 and 2 ck-940x2=1880
Step 2 cs=1580+travel
Step 3=875
abim cert=1400 + lost day of work
Uworld qbank=400-500
Board prep course=800-900
Subspecialty exam fee=2300 + lost day or work
Qbank and board prep course similar to above
Abim Moc fee=155/yr x 20 year career=3100
Abim recert=650 (assuming you only recert once before retiring) + lost day of work(~1500)
Subspecialty recert=1200 + lost day of work.

All told the bare minimum over a 20 year career assuming no prep purchased would be:
9500 for no subspecialty + travel + 2 lost days of work.
Tack on another 500 or so for prep fees and assuming you make about 1500 per shift that adds up to 13k.

For subspecialty you are looking to add another 4k or so per board cert plus 2 additional days of work lost (and you probably make more) which puts you above 20k.

Costs increase even more if you recert a second time.

20k doesn't sound that far off to me unless you place a value of 0 on your time. I also agree it adds nothing to healthcare other than to increase our administrative bloat except this time it is other physicians ****ing us over instead of MBA *****s.

You recert every 10 years (or every two now with a shorter smaller open book test). The study for these tests probably doesn’t change my day to day practice much but I always learn some new and I think valuable information. I mean I don’t know how long you think you need to study for these things but it’s not long. And board prep courses prey on insecurities and are for suckers. Get a question book. Spend a some evenings and weekends for a couple weeks. Take the test. Win. Don’t forget to credit your MOC hours. We aren’t victims of an evil board certification process. Ffs. Get a grip.

 

[chessknt]

You recert every 10 years (or every two now with a shorter smaller open book test). The study for these tests probably doesn’t change my day to day practice much but I always learn some new and I think valuable information. I mean I don’t know how long you think you need to study for these things but it’s not long. And board prep courses prey on insecurities and are for suckers. Get a question book. Spend a some evenings and weekends for a couple weeks. Take the test. Win. Don’t forget to credit your MOC hours. We aren’t victims of an evil board certification process. Ffs. Get a grip.

So you feel that recertification adds some kind of benefit to your patients and your career? Should it be mandatory for those who dont feel the same way? Should the ABIM president (whose salary is funded by these exam fees) be making more than 3x the average practicing IM physician despite seeing 0 patients?

 

[jdh71]

So you feel that recertification adds some kind of benefit to your patients and your career? Should it be mandatory for those who dont feel the same way? Should the ABIM president (whose salary is funded by these exam fees) be making more than 3x the average practicing IM physician despite seeing 0 patients?

If you don’t find some educational benefit you are either lying or too stupid to teach.

I don’t have a strong opinion on the salary of the ABIM. Baseball players make a lot of money and don’t see patients either. Hm. I don’t have a strong opinion on baseball players.

 

[chessknt]

If you don’t find some educational benefit you are either lying or too stupid to teach.

I don’t have a strong opinion on the salary of the ABIM. Baseball players make a lot of money and don’t see patients either. Hm. I don’t have a strong opinion on baseball players.

Tons of free educational resources, no reason to pay so much plus cme already provides ongoing educational benefit. Plus that isn't the question I asked.

A bizarre comparison that has nothing to do with this but I am not compelled to subsidize professional sports players.

 

[Raryn]

Ah you are correct, that is less costly.

My point still sands that this is an astronomical expense not seen in any other professional field (this is ignoring CME costs as well) with no discernible purpose. Just like JAHCO it exists by sheer force of tradition rather than any true need. Why should we have to pay ~1.5k + a lost day or work to satisfy this extraneous requirement? The state medical board already has its own requirements for continuing education, what does this do? Why would someone practicing regular medicine need to take tests repeatedly to demonstrate competence?

Cost to REcertify comes out to $128/year MOC fee plus $650/10 year (or $130/2 year - same price) testing fee for IM. For a subspecialty, can add $1200/10 year. There's also savings if you do more than one specialty (say, IM plus a subspecialty).

Lets say you're an interventional cardiologist who needs to recertify 3 fields and you pay after the deadline (so there's a couple hundred bucks extra fees) it's at most $5k per any given 10-year period. For most people maintaining only one certification and paying on time it's <$2k/10 years (for IM) or <$2500/10 years (for a single subspecialty). You can add the cost of a day off of work and a board review course if you want - but you have to take time for review of your field periodically regardless, so the latter is a bit disingenuous.

My initial 10 years isn't up yet but do I think studying for the boards made me a better internist (and endocrinologist)? Yes. Because it gave me incentive to study the rare **** that I don't typically look up. I do try to keep up with it at the various conferences as well, but I found it helpful.

Your employer can (and most do) require maintaining boards in your primary field as a quality marker. It's one that isn't particularly difficult to meet, and has only gotten easier in the last few years. All the whinging about it just brings about the meh reaction.

 

[jdh71]

Tons of free educational resources, no reason to pay so much plus cme already provides ongoing educational benefit. Plus that isn't the question I asked.

A bizarre comparison that has nothing to do with this but I am not compelled to subsidize professional sports players.

You aren’t forced to keep your boards up to date either.

And I did answer your question you just missed it.

 

[NotAProgDirector]

Even if recert isn't necessary for your current job, are you certain it isn't necessary for some future job? Hard to predict the future. The additional cost of recert is low, there is some value to it (albeit small), and the ABIM has made the process much less onerous over the last several years.

 

[DrMetal]

Let me ask a question....

It's clear that BC and MOC is here to stay (in some shape or form), and it has become the norm, the baseline. Whereas it was once optional, now you almost have to have it to practice.

I feel this is our own fault. We, as physicians, love to up our own mojo, adding on more credentials as time goes on. Just look at the history of training and credentialing in medicine (my timeline here are gross estimates):

- 60 years ago: Internship required, residency optional (lots of physician just recieved OJT in lieu of a residency).

- 40 years ago: Internship required, residency required, BC optional (and if obtained, is considered lifelong), no such thing as MOC

- 20-30 years ago. Intership/residency required, BC still optional but highly encouraged, no longer lifelong, MOC optional

- NOW: Internship/Residency required, BC and MOC required (essentially and practically).

What will be next, are we ever happy?! If BC/MOC is the new baseline, we can't use it to distninguish good doctors from bad ones (because everybody practicing will have it).

- 2030: Internship/Residency/BC/MOC all required + you have to be a fellow in your specialty (FACP, FACS).

- 2040: Internship/Residency/BC/MOC/Fellowship + Super Elite Board Certification (optional, to distinguish you)

- 2050: Internship/Residency/BC/MOC/Fellowship + Super Elite Board Certification (required)

- 2060: Intersnhip/Residency/BC/MOC/Fellowship/Super Elite BC + you have to repeat a year of residency

When will the madness end?

 

[drtofu66]

Ah you are correct, that is less costly.

My point still sands that this is an astronomical expense not seen in any other professional field (this is ignoring CME costs as well) with no discernible purpose. Just like JAHCO it exists by sheer force of tradition rather than any true need. Why should we have to pay ~1.5k + a lost day or work to satisfy this extraneous requirement? The state medical board already has its own requirements for continuing education, what does this do? Why would someone practicing regular medicine need to take tests repeatedly to demonstrate competence?

I don't think people realize how insidious this is.
I know that the $20,000 figure seems ridiculous but indeed, the annals.org article I linked concluded that on average it would cost a physician $20,000 per 10 year MOC cycle-- NOT over a career.
If you want to argue the point, take it up with the authors (a PDF link to the article is here https://mfprac.com/web2018/07literature/literature/Misc/ABIM-Cost_Sandhu.pdf ):

"The ABIM's 2015 MOC requirements will cost board-certified internal medicine physicians an average of $23 607 (95% CI, $5380 to $66 383) (Table 2) over 10 years, including $2349 (CI, $1705 to $4226) in fees to the ABIM and $21 259 (CI, $3560 to $62 840) in time costs. Costs of MOC vary substantially by physician specialty, ranging from $16 725 for general internists to $40 495 for hematologists-oncologists. In general, subspecialists will face greater costs than general internists or hospitalists (P < 0.001 for comparison). "

90% of that is loss obvious time costs, which is going to vary. Yeah, if you aren't a high-earner, it won't cost you as much.
Congratulations, I guess.
On the other hand, a hospitalist estimated that it would cost him more like $60,000 in time costs:
How Much Does the ABIM's MOC Program Really Cost? - The Hospital Leader - The Official Blog of the Society of Hospital Medicine

And don't forget how much the ABIM MOC fees will increase over the next 10 years and beyond. Because they will.

In 2010 it was $1570 in MOC fees alone for IM without a subspecialty
Enroll & Understand Policies for Maintenance of Certification | Maintain & Renew Your Certification | American Board of Internal Medicine

In 2012 it was $1675
Enroll & Understand Policies for Maintenance of Certification | Maintain & Renew Your Certification | American Board of Internal Medicine

in 2014 it was $1940
Enroll, Cost & Policies | Maintain & Renew Your Certification | American Board of Internal Medicine

If I'm paying for something that increases 24% in cost in only 4 years, it had better be something I need or want. Otherwise, I'd just as soon do without it.
[Note that the only reason fees for the overall MOC program cycle in 2019 seem to be in line with the costs in 2014 is because of the uproar that occurred in late 2014 and they had to bite the bullet and freeze fees for 2-3 years just for optics after their 'apology' in Feb 2015. They're back to increasing fees and you can expect that they'll increase yearly again, probably at an accelerated rate to make up for the lost revenue from 2015-2018 during the fee freeze).]

To answer DrMetal's question: When will the madness end?--

When you MAKE it end.

Spread the word. ABIM has gotten away with this for so long because of how disorganized and busy/easily distracted physicians collectively are.

Not any more.
Keep up with the brave docs who are leading the charge:
Dr. Wes

At the very least, tell your colleagues about this. Link to these articles:
Medical specialty certification in the United States—a false idol?
The Ugly Civil War in American Medicine

And keep tabs on the lawsuit:
https://www.abimlawsuit.com/

 

[Raryn]

I don't think people realize how insidious this is.
I know that the $20,000 figure seems ridiculous but indeed, the annals.org article I linked concluded that on average it would cost a physician $20,000 per 10 year MOC cycle-- NOT over a career.
If you want to argue the point, take it up with the authors (a PDF link to the article is here https://mfprac.com/web2018/07literature/literature/Misc/ABIM-Cost_Sandhu.pdf ):

"The ABIM's 2015 MOC requirements will cost board-certified internal medicine physicians an average of $23 607 (95% CI, $5380 to $66 383) (Table 2) over 10 years, including $2349 (CI, $1705 to $4226) in fees to the ABIM and $21 259 (CI, $3560 to $62 840) in time costs. Costs of MOC vary substantially by physician specialty, ranging from $16 725 for general internists to $40 495 for hematologists-oncologists. In general, subspecialists will face greater costs than general internists or hospitalists (P < 0.001 for comparison). "

90% of that is loss obvious time costs, which is going to vary. Yeah, if you aren't a high-earner, it won't cost you as much.
Congratulations, I guess.
On the other hand, a hospitalist estimated that it would cost him more like $60,000 in time costs:
How Much Does the ABIM's MOC Program Really Cost? - The Hospital Leader - The Official Blog of the Society of Hospital Medicine

And don't forget how much the ABIM MOC fees will increase over the next 10 years and beyond. Because they will.

In 2010 it was $1570 in MOC fees alone for IM without a subspecialty
Enroll & Understand Policies for Maintenance of Certification | Maintain & Renew Your Certification | American Board of Internal Medicine

In 2012 it was $1675
Enroll & Understand Policies for Maintenance of Certification | Maintain & Renew Your Certification | American Board of Internal Medicine

in 2014 it was $1940
Enroll, Cost & Policies | Maintain & Renew Your Certification | American Board of Internal Medicine

If I'm paying for something that increases 24% in cost in only 4 years, it had better be something I need or want. Otherwise, I'd just as soon do without it.
[Note that the only reason fees for the overall MOC program cycle in 2019 seem to be in line with the costs in 2014 is because of the uproar that occurred in late 2014 and they had to bite the bullet and freeze fees for 2-3 years just for optics after their 'apology' in Feb 2015. They're back to increasing fees and you can expect that they'll increase yearly again, probably at an accelerated rate to make up for the lost revenue from 2015-2018 during the fee freeze).]

To answer DrMetal's question: When will the madness end?--

When you MAKE it end.

Spread the word. ABIM has gotten away with this for so long because of how disorganized and busy/easily distracted physicians collectively are.

Not any more.
Keep up with the brave docs who are leading the charge:
Dr. Wes

At the very least, tell your colleagues about this. Link to these articles:
Medical specialty certification in the United States—a false idol?
The Ugly Civil War in American Medicine

And keep tabs on the lawsuit:
https://www.abimlawsuit.com/

$21 259 (CI, $3560 to $62 840) in time costs.

That's a great confidence interval.

They estimate a typical physician needs to spend 12.5 hours a year doing modules to keep up with ABIM MOC plus an additional 1.5 hours doing MOC related paperwork. Just about every legitimate source of CME counts for MOC these days, and all of us should be doing CME every year. I personally estimate the typical physician has to spend zero hours a year on additional CME to meet MOC requirements plus maybe 20 minutes a year clicking some buttons on the v arious CME sources websites to make sure it counts (with the longest time being looking up your ABIM number). As implemented today (the 2014 requirements were ****), the module requirements are trivial.

The only legitimate time costs are when you actually take the exam and any explicit preparation for that. The authors estimate that's 42 hours - which is a full work week assuming you take all that time off from work. Even with that generous assumption, that's 2% of 1 year of work - or ~$5k for the typical internist who makes on the order of $250k. Of course, no one just randomly loses 100% of productivity from taking a few days off of work - most people either get paid for CME (if they're employees) so they lose nothing, or move shifts/appointments around to make up for that productivity. I suppose if you make the economics argument that those are marginal hours you could use to pick up extra shifts (or see more patients) AND the person doesn't have reimbursed CME time, the full cost of $5k would be born by the internist.

So over a 10 year period that's $5k worth of time for the year you take the exam (presumably 1 dedicated day for the exam and 4 days for a board review course), 20 minutes here and there to click a few buttons (neglible), $2k for the actual ABIM costs, and maybe a couple grand for board review materials if you decide to buy a full course. <$10k total for sure - over 10 years.

It sucks. I don't want to pay it. But it's also not a huge deal - and I'd rather have the flexibility being certified affords me.

One last edit:

Increasing the proportion of CME activities that also earn MOC points would decrease demands on physician time and costs.

That's a quote directly from your article. Guess what has happened over the last 4 years since it was published?

 

[VA Hopeful Dr]

Let me ask a question....

It's clear that BC and MOC is here to stay (in some shape or form), and it has become the norm, the baseline. Whereas it was once optional, now you almost have to have it to practice.

I feel this is our own fault. We, as physicians, love to up our own mojo, adding on more credentials as time goes on. Just look at the history of training and credentialing in medicine (my timeline here are gross estimates):

- 60 years ago: Internship required, residency optional (lots of physician just recieved OJT in lieu of a residency).

- 40 years ago: Internship required, residency required, BC optional (and if obtained, is considered lifelong), no such thing as MOC

- 20-30 years ago. Intership/residency required, BC still optional but highly encouraged, no longer lifelong, MOC optional

- NOW: Internship/Residency required, BC and MOC required (essentially and practically).

What will be next, are we ever happy?! If BC/MOC is the new baseline, we can't use it to distninguish good doctors from bad ones (because everybody practicing will have it).

- 2030: Internship/Residency/BC/MOC all required + you have to be a fellow in your specialty (FACP, FACS).

- 2040: Internship/Residency/BC/MOC/Fellowship + Super Elite Board Certification (optional, to distinguish you)

- 2050: Internship/Residency/BC/MOC/Fellowship + Super Elite Board Certification (required)

- 2060: Intersnhip/Residency/BC/MOC/Fellowship/Super Elite BC + you have to repeat a year of residency

When will the madness end?

Its almost like the scope of medical knowledge increased exponentially 60 years ago compared to today.

Its also almost like someone finally noticed that lots of older doctors weren't keeping up with the times (Scrubs had an episode about that).

 

[DrMetal]

Its almost like the scope of medical knowledge increased exponentially 60 years ago compared to today.

Its also almost like someone finally noticed that lots of older doctors weren't keeping up with the times (Scrubs had an episode about that).

I think we'd all agree on some things: Internship, Residency, initial BC....these are all important in your training as a physician. I'd even argue to have the initial BC incorporated into residency, as an exit exam of some sort (analogous to a PhD student having to defend his dissertation before graduating). I'd also argue to have a larger oral component of the exam (some do).

But MOC is ridiculous, and who knows what's to come after that. I can see it now: you know that USMLE Step 1/2/3 you took 20 years ago and passed? That's no longer a 'lifelong' passage. We want you to retake it every 15 years or so, b/c it's really important for a doctor to know the Kreb cycle.

 

[VA Hopeful Dr]

I think we'd all agree on some things: Internship, Residency, initial BC....these are all important in your training as a physician. I'd even argue to have the initial BC incorporated into residency, as an exit exam of some sort (analogous to a PhD student having to defend his dissertation before graduating). I'd also argue to have a larger oral component of the exam (some do).

But MOC is ridiculous, and who knows what's to come after that. I can see it now: you know that USMLE Step 1/2/3 you took 20 years ago and passed? That's no longer a 'lifelong' passage. We want you to retake it every 15 years or so, b/c it's really important for a doctor to know the Kreb cycle.

I'm FM, our board exam is before residency graduation which means assuming we pass we are BC at the end of the last day of residency.

I personally find value in MOC for the most part - OK maybe not the practice improvement part, but the rest I do. And the ABFM MOC program is more involved than y'all's is.

I also think you're being a bit hysterical with the Steps

 

[DrMetal]

I also think you're being a bit hysterical with the Steps

Same was said in 1985 about the prospect of MOC, and about the Cubs winning the World Series......both became a reality in this decade.

 

[VA Hopeful Dr]

Same was said in 1985 about the prospect of MOC, and about the Cubs winning the World Series......both became a reality in this decade.

Tell you what, I figure on working about another 30 years (I'm 35). If we have to retake any of the Steps between now and then, feel free to say I told you so.

Until then, you're being hysterical.

 

[Splenda88]

Step 2CS is the perfect example of how important these exams are ...

If we don't take these exams, people will literally die.

 

[DrMetal]

Tell you what, I figure on working about another 30 years (I'm 35). If we have to retake any of the Steps between now and then, feel free to say I told you so.

Until then, you're being hysterical.

Well listen, of course I'm being facetious about the Steps.

But my point is this: We never seem to be happy with our professional stature. Every 20 years or so, we seem inclined to add on another layer of credentialing or requirement, to "up the ante" so to speak.

Here's what I see happening: By 2030, everyone will be BC'd and participating in MOC. Why? Because it'll become a prerequisite for employment and (probably) licensure. That ship has sailed, and it was our own fault for letting it get away.

So with everyone being BC'd and doing MOC (with that being the new baseline), how are we going to distinguish ourselves, how do we separate the good from the bad? (as if such a distinction is always necessary, but again, we like to "up the ante"). By 2040: we'll have a new requirement of some sort. Perhaps it'll be fellowship into your specialty's governing body, perhaps it'll be super-MOC (taking test every 5 years instead of 10), perhaps MOC/BC will become harder.....I don't know. But there will be something 'new'; and at first, it'll be optional, but then we'll make it required.

The doctor who takes care of my family and I is an FP. He's in his early 60s, he's a great physician. He's been doing this for 35 years, has great rapport with his patients (he has a very large panel, has 100s of patient encounters per month, does minor procedures, very active). Has never been disciplined.

I don't give 2 s#$%s about his board certification status, and I would never ask him to take another f#$%in multiple-choice test to somehow 'prove' that he's still a good doctor! I would expect him to do good CME, I would expect him to have experience taking care of patients (he certainly does), and I'd expect him to have a good track record (he does). And that's enough. . . .

To answer DrMetal's question: When will the madness end?--

When you MAKE it end.

Damn right . . .

 

[Raryn]

Well listen, of course I'm being facetious about the Steps.

But my point is this: We never seem to be happy with our professional stature. Every 20 years or so, we seem inclined to add on another layer of credentialing or requirement, to "up the ante" so to speak.

Here's what I see happening: By 2030, everyone will be BC'd and participating in MOC. Why? Because it'll become a prerequisite for employment and (probably) licensure. That ship has sailed, and it was our own fault for letting it get away.

So with everyone being BC'd and doing MOC (with that being the new baseline), how are we going to distinguish ourselves, how do we separate the good from the bad? (as if such a distinction is always necessary, but again, we like to "up the ante"). By 2040: we'll have a new requirement of some sort. Perhaps it'll be fellowship into your specialty's governing body, perhaps it'll be super-MOC (taking test every 5 years instead of 10), perhaps MOC/BC will become harder.....I don't know. But there will be something 'new'; and at first, it'll be optional, but then we'll make it required.

The doctor who takes care of my family and I is an FP. He's in his early 60s, he's a great physician. He's been doing this for 35 years, has great rapport with his patients (he has a very large panel, has 100s of patient encounters per month, does minor procedures, very active). Has never been disciplined.

I don't give 2 s#$%s about his board certification status, and I would never ask him to take another f#$%in multiple-choice test to somehow 'prove' that he's still a good doctor! I would expect him to do good CME, I would expect him to have experience taking care of patients (he certainly does), and I'd expect him to have a good track record (he does). And that's enough. . . .




Damn right . . .

It'll be a prerequisite for employment in the jobs that can afford to be picky, in bigger cities where physicians want to live. It will never be a prerequisite for licensure - the licensing boards have been crystal clear about that. But believe what you want if you disagree.

 

[DrMetal]

It will never be a prerequisite for licensure - the licensing boards have been crystal clear about that.

I hope you're right. This isn't something I want to be right about.

 

[VA Hopeful Dr]

Well listen, of course I'm being facetious about the Steps.

But my point is this: We never seem to be happy with our professional stature. Every 20 years or so, we seem inclined to add on another layer of credentialing or requirement, to "up the ante" so to speak.

Here's what I see happening: By 2030, everyone will be BC'd and participating in MOC. Why? Because it'll become a prerequisite for employment and (probably) licensure. That ship has sailed, and it was our own fault for letting it get away.

So with everyone being BC'd and doing MOC (with that being the new baseline), how are we going to distinguish ourselves, how do we separate the good from the bad? (as if such a distinction is always necessary, but again, we like to "up the ante"). By 2040: we'll have a new requirement of some sort. Perhaps it'll be fellowship into your specialty's governing body, perhaps it'll be super-MOC (taking test every 5 years instead of 10), perhaps MOC/BC will become harder.....I don't know. But there will be something 'new'; and at first, it'll be optional, but then we'll make it required.

The doctor who takes care of my family and I is an FP. He's in his early 60s, he's a great physician. He's been doing this for 35 years, has great rapport with his patients (he has a very large panel, has 100s of patient encounters per month, does minor procedures, very active). Has never been disciplined.

I don't give 2 s#$%s about his board certification status, and I would never ask him to take another f#$%in multiple-choice test to somehow 'prove' that he's still a good doctor! I would expect him to do good CME, I would expect him to have experience taking care of patients (he certainly does), and I'd expect him to have a good track record (he does). And that's enough. . . .




Damn right . . .

So even though lots (most?) board are actually moving away from the big 10 year exam and to a yearly/quarterly open book quiz you expect them to move to a big 5 year exam? Don't get me wrong, I get the anger especially for internists as your board did screw the pooch with the requirements in 2013-2014 (that they repealed due to the massive outrage). But from where I sit the boards saw that and are now trying a bit harder to improve things that we want improved.In the 6 years I've been certified through the ABFM, they've made 2 major changes that we asked for. MOC isn't going anywhere, but the various boards are responding to reasonable feedback pretty well to my eyes.

I expect my doctors to be board certified. Its not that onerous and if they can't be bothered to spend a few hours every year maintaining that, then I have no faith that they are staying current on anything else either.

Oh and speaking as an FP: good rapport, large patient panel, good monthly numbers, and involvement have nothing to do with competence. One of the worst doctors I've ever met (I covered her practice while she was out getting her cancer treated so I have very good insight into how she practices) is also super busy and loved by her patients. She was president of our state academy at one point. But I wouldn't ever let her care for me or anyone I cared about.

 

[chessknt]

I expect my doctors to be board certified. Its not that onerous and if they can't be bothered to spend a few hours every year maintaining that, then I have no faith that they are staying current on anything else either.

Oh and speaking as an FP: good rapport, large patient panel, good monthly numbers, and involvement have nothing to do with competence. One of the worst doctors I've ever met (I covered her practice while she was out getting her cancer treated so I have very good insight into how she practices) is also super busy and loved by her patients. She was president of our state academy at one point. But I wouldn't ever let her care for me or anyone I cared about.

Was she board certified participating in moc?

The tens of millions abim rakes in with fees on these overpriced programs have done nothing to combat mid-level encroachment. All it seems to do is encourage phsyicians to argue about its validity with the assumption that not participating is due to laziness or a rejection of learning rather to the principles described better above.

It seems like the best thing they have going for them is this misconception that passing the test implies competence that seems generates enough apathy or pride from other physicians toward its existence that a wide scale rejection cannot succeed.

The only reason the boards are responding to feedback is that community perception is the only thing that warrants their continued existence. If the physician community whole sale rejected board certification they would cease to exist with no consequences to medical practice in this country. You don't let $50MM a year go without fighting to keep it.

 

[DrMetal]

MOC isn't going anywhere, but the various boards are responding to reasonable feedback pretty well to my eyes.

There should be no MOC at all! It's like saying my abusive husband only beats me once a month, that's fine.

A thought. . .

If we, as a society, as interested in keeping some kind of surveillance over our physicians as they practice (which I'm all for), then we should come up with some governing body that actually investigates physicians, instead of simply asking them to pass a multiple-choice test.

By 'investigate', I mean we can actually look (say every 10 years) at the body of work of a physician: where are they credentialed, have they ever lost credentials, how many patients do they seen, how many procedures have they done (if a proceduralist), how much and what kind of CME have they done, have they ever been disciplined (either in the legal sense, or by their home institution), etc etc.

Yes such investigations would cost money, but I'd rather pay for that then MOC and test prep. It could be done in the same way that the gov't re-investigates every military or civilian official with respect to their security clearances....or in the same vein that other professional societies (lawyers, architects, engineers) keep tabs on their members.

Passage of a multiple-choice test exam means nothing. Any one of us could study for and pass a test if we wanted to, we've proven this already!

It seems like the NBPAS is taking this point to heart. And why btw don't we recognize the NBPAS? Who's to say that the ABMS should have a monopoly over all 'certification'?

I expect my doctors to be board certified.

So if you found out today that your favorite doctor is refusing to do MOC and get re-BCd', would you drop him/her? Would you drop your accountant if he refused to get some super special credential, despite the fact the he's a licensed CPA who has 30 years of experience and has always done great work for you?

Oh and speaking as an FP: good rapport, large patient panel, good monthly numbers, and involvement have nothing to do with competence.

Fair point, I don't mean my one anecdotal story represents ground truth.

 

[VA Hopeful Dr]

Was she board certified participating in moc?

The tens of millions abim rakes in with fees on these overpriced programs have done nothing to combat mid-level encroachment. All it seems to do is encourage phsyicians to argue about its validity with the assumption that not participating is due to laziness or a rejection of learning rather to the principles described better above.

It seems like the best thing they have going for them is this misconception that passing the test implies competence that seems generates enough apathy or pride from other physicians toward its existence that a wide scale rejection cannot succeed.

The only reason the boards are responding to feedback is that community perception is the only thing that warrants their continued existence. If the physician community whole sale rejected board certification they would cease to exist with no consequences to medical practice in this country. You don't let $50MM a year go without fighting to keep it.

Yes, she is.

Its not the ABIM's job to do anything about midlevels. That's the ACP or in my case the AAFP which actively is working against that. Not sure how active the ACP is on that front.

 

[VA Hopeful Dr]

There should be no MOC at all! It's like saying my abusive husband only beats me once a month, that's fine.

A thought. . .

If we, as a society, as interested in keeping some kind of surveillance over our physicians as they practice (which I'm all for), then we should come up with some governing body that actually investigates physicians, instead of simply asking them to pass a multiple-choice test.

By 'investigate', I mean we can actually look (say every 10 years) at the body of work of a physician: where are they credentialed, have they ever lost credentials, how many patients do they seen, how many procedures have they done (if a proceduralist), how much and what kind of CME have they done, have they ever been disciplined (either in the legal sense, or by their home institution), etc etc.

Yes such investigations would cost money, but I'd rather pay for that then MOC and test prep. It could be done in the same way that the gov't re-investigates every military or civilian official with respect to their security clearances....or in the same vein that other professional societies (lawyers, architects, engineers) keep tabs on their members.

Passage of a multiple-choice test exam means nothing. Any one of us could study for and pass a test if we wanted to, we've proven this already!

It seems like the NBPAS is taking this point to heart. And why btw don't we recognize the NBPAS? Who's to say that the ABMS should have a monopoly over all 'certification'?


So if you found out today that your favorite doctor is refusing to do MOC and get re-BCd', would you drop him/her? Would you drop your accountant if he refused to get some super special credential, despite the fact the he's a licensed CPA who has 30 years of experience and has always done great work for you?



Fair point, I don't mean my one anecdotal story represents ground truth.

I find my board's MOC informative personally (and I'm not the only one), so your analogy sucks.

Much of what you describe my state medical board does - they look into any disciplinary action by anyone: hospitals, insurance companies, malpractice suits. Their job is to make sure you are generally safe to be a doctor.

BC implies that you take your education in your chosen field seriously. Its not a guarantee of course, but its better than nothing. Its also constantly changing to try and improve which I find reassuring (although again the ABFM seems better about this than the ABIM).

I think NBPAS is a great idea, I am 100% always for more competition. That said, even if it became accepted everywhere tomorrow I would still stick with the ABFM at present. But that's just me.

Yes, I absolutely would leave my favorite doctor if his/her board certification lapsed. I'm also very leery of any lifetime boarded doctors, I have to approach them on a case by case basis. Accountants don't have anything like this to my knowledge, but if I got any sign at mine wasn't keeping up to date on any tax changes you bet I'd find a new one.

 

[Splenda88]

Yes, I absolutely would leave my favorite doctor if his/her board certification lapsed. I'm also very leery of any lifetime boarded doctors, I have to approach them on a case by case basis. Accountants don't have anything like this to my knowledge, but if I got any sign at mine wasn't keeping up to date on any tax changes you bet I'd find a new one.

This is just incredible...

 

[Anym]

I have a question to you all. A little urgent on this. So I have my abim certified but to apply for a new job( I am planning to move to a different state) they asked me to upload the residency certificate for IM . I do not find the certificate anywhere at my house. What can I do

 

[Raryn]

I have a question to you all. A little urgent on this. So I have my abim certified but to apply for a new job( I am planning to move to a different state) they asked me to upload the residency certificate for IM . I do not find the certificate anywhere at my house. What can I do

Let them know?

 

[rokshana]

I have a question to you all. A little urgent on this. So I have my abim certified but to apply for a new job( I am planning to move to a different state) they asked me to upload the residency certificate for IM . I do not find the certificate anywhere at my house. What can I do

Ask your residency PC to send you a copy.

 

[zeloc]

So my 10-yr recertification is approaching. I haven't enrolled in MOC or paid any fees. Can I just pay the $650 and take the IM recertification exam, or do I have to additionally pay a yearly "program fee" from now on? What happens if I don't pay it, do I lose my ABIM board certification status?

 

[Raryn]

So my 10-yr recertification is approaching. I haven't enrolled in MOC or paid any fees. Can I just pay the $650 and take the IM recertification exam, or do I have to additionally pay a yearly "program fee" from now on? What happens if I don't pay it, do I lose my ABIM board certification status?

To be considered maintaining, you must

A) Pay your yearly fee (may pay up to 10 years in advance)

B) Do a MOC-counting CME activity every 2 years

C) Do 100 points worth of MOC-counting CME activities every 5 years

D) Either do an exam every 10 years, a knowledge check in every 2 years, or (in 2022) the new "continuous" option yearly. The continuous option details are not yet available

I believe that if you don't do all four of the above, they will not count you as maintaining your certification.