Thinking about quitting after 1st year residency

[Ericslv]

Because it's been a brutal ******* - ish type of week. I had an orthopedic surgeon bitch me over the phone for "refusing care" on a patient (who was a friend of his) who wasn't even checked into urgent care and I was trying to help the mom after hours on a film that was done as an out patient but the kid had a fracture and no plan if that happened. I got talked to by the clinic manager about being short with the surgeon.

Or how about the stupid waste of space locum doctor I have had to work with the past 8 weeks who knows NOTHING (I am locum too) who sent my triaged patient to the ER for "chest pain" after I determine that it's not that that. I had to sent the MA to the ER to retrieve the patient and see him since he had the full cardiac workup 2 weeks prior. He had rib dysfunction which I fixed in the office with some OMT and he left pain free.

So, yes, I'm tired - I worked 8 days in a row - 97 hours. I am doing my best to hold it together. SOOOOO if I sound angry. WHATEVER!!!!!!. Just please try to sound like you know what you are talking about because my patience is ZERO and I don't have time to ***** foot someone else's feelings. PERIOD.

I'm sorry your having such a tough week. But it's you tough week. Your anger. That does not mean you get to take your anger out on others or tell them they don't know what they are talking about. I do know. I also know about brutal weeks at work. Your not the only one. Not even close.

If you have time to post in here you certainly have to to post properly and not be rude to others. Your taking your anger out on the net because you can't take it out on the ortho or the other doctor or the administration.

These are signs of burnout.

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[Makati2008]

Not being a tough guy. It's just that if an attending physician wants to yell at me (another attending physician that does not work for him) then he is going to get the same. I have no obligation to him. They want my business. They act like they don't but it keeps the revenue coming in.

There are countless urgent care centers with countless FP's working in them with various degrees of skill.
Some are great at laceration repair up to a point and some are great at fracture care until it comes to a more complicated case. So, they will refer out.

Urgent care cases vary by season and location. I once had a guy come in at close to midnight because he was drinking with his buddies and playing with a pellet gun and shot himself in the side of the face. I had to spend 1/2 hour digging it out. It was close to closing time and I was very tempted to send him to the ER.

If the urgent care is attached to a hospital then there is going to be more equipment and expectations.

Why is everyone so touchy and angry in here?

I agree with the majority of your statement except EDs NEED your referrals. If you go to many of EDs they are bursting at the seams with patients(look at the wait times to be seen).

Also if you decided to have your patients avoid a closer ED because you don't like the doctor (I am talking about ones that require EMS transfer) and you had bad outcome, that would be on you......

 

[cabinbuilder]

@cabinbuilder Look at the bright side: You make over 12k in 8 days if your hourly rate is $125/hr

NO, I don't make that much.

 

[Ericslv]

I agree with the majority of your statement except EDs NEED your referrals. If you go to many of EDs they are bursting at the seams with patients(look at the wait times to be seen).

Also if you decided to have your patients avoid a closer ED because you don't like the doctor (I am talking about ones that require EMS transfer) and you had bad outcome, that would be on you......

I wouldn't avoid the closer ED. Just because the doctor does not like me doesn't mean he is not obligated to treat the patient. Most of the time it's not my decision which ED a patient get to go to. It's between them and their insurance unless its a medicare case and then they can go to any ED (most of the time).

Your right that they are bursting at the seems but all businesses need the business and have to take the patient and be as nice as possible to them. No one is immune to poor customer service. Thats why now I see signs on the freeway advertising ED wait times. Hospital compete with other hospitals.

You know I've been doing this a long time. I respect other doctors and their decisions because I'm not there when they make their decisions. I only see the end point (you know he said she said etc). So when a doctor (any doctor) is rude to me I let them know their behavior is not appropriate. They wouldn't be able to get away with it in the real world and shouldn't act that way with their colleagues and other staff. I've learned that the hard way.

If another doctor is arrogant enough to think their colleague is stupid or incompetent it's on them. Perhaps that doctor is better than them in another arena. Who knows.

Medicine should be a field of learning and compassion not egos and arrogance. However, the field is filled with narcissists and sociopaths. There is strong evidence to support that. There is evidence that many surgeons personalities qualify as sociopath. Not in the serial killer type but in the most other aspect of it.

For most doctors the reason they act poorly is due to stress and burnout. Even the best coping skills may not be enough to deal with those issues. Physicians have one of the highest rates of suicide mostly due to feeling trapped and burnt out.

I see that your are a medical student. I suggest you take a close look at what you want your future to look like and work toward avoiding those issues so you can achieve your goals.

 

[cabinbuilder]

I'm sorry your having such a tough week. But it's you tough week. Your anger. That does not mean you get to take your anger out on others or tell them they don't know what they are talking about. I do know. I also know about brutal weeks at work. Your not the only one. Not even close.

If you have time to post in here you certainly have to to post properly and not be rude to others. Your taking your anger out on the net because you can't take it out on the ortho or the other doctor or the administration.

These are signs of burnout.

Thanks for the parenting psychiatric tips.

 

[W19]

NO, I don't make that much.

My classmate's dad got $180/hr working in a small ER in rural CA... He works 2-24hrs/wk (total 48 hrs)! He can sleep on the job... I never knew these opportunities existed.

 

[Ericslv]

My classmate's dad got $180/hr working in a small ER in rural CA... He works 2-24hrs/wk (total 48 hrs)! He can sleep on the job... I never knew these opportunities existed.

MN has several of those offerings. Very rural areas.

 

[cabinbuilder]

MN has several of those offerings. Very rural areas.

I don't work ER anymore. Don't like the crash and burn or codes.

 

[Goro]

Why on Earth have you wasted three years of your life??? You should have bailed when you realized you weren't on the right track.

Try teaching.

So I'm almost done with first year residency. I've felt that medicine wasn't for me since 2nd year medical school. I thought that one I started practicing, I would enjoy it more. Although I enjoy the knowledge learned, I can't get over the work requirement, not only in residency, but even with practicing doctors. It also doesn't help that I feel like I'm not really helping patients. I prescribe medications, antibiotics, teach them how to use insulin, but I'm a firm believer that our job should be lifestyle changes. Ive always wanted to go to a patients home, clean out there refrigerator, or even stay with them for a few days and check up on them regularly.
Anyways, I'm just not sure about the choice I made. I'm now 300k in the hole, and I'm wondering if anyone can help me with options I have or tips for anyone who has gone through a similar experience...

Thanks,
Someone feeling lost

 

[JustPlainBill]

Nice to see everyone's working and playing well with the other kiddos in the sandbox -- never thought I'd see attending physicians get into a corpus callosum measuring contest but hey, whatever ---

Agree with EricLV that medicine is full of narcissists and sociopaths (but recognize there's a nice, locker room, one man rolling frat party feel to the FM forum -- cabinBuilder has some great experience, has pulled my chestnuts out of the fire more than once and is really a nice person -- don't know that they were being aggressive/rude but most likely just didn't have time to screw around with the touchy/feely stuff)-- went to a residency full of them on the attending physician side -- the residents were so new at life that they expected it to remain this way and adopted Stockholm syndrome -- and yes, I was actually slapped in the head by an Ob attending one night and told by a renal fellow I was too stupid to read the English language -- whatever -- I've been a victim of an attempted mugging in the hospital cafeteria, sent as a gofer for soup as an off service intern, set up to get a spray of abscess material during a labial I&D by the OB resident, told that I shouldn't come in if I was running a fever and too weak to stand without getting light headed but then penalized for not coming in by being placed on call over Christmas, chastised because one of my seniors ordered the wrong medicine/gave me the wrong info and then refused to own up to the mistake when I was getting shark tanked by the attending -- yeah, it sucked and I learned very little -- I'm paying for it now in terms of being able to do procedures that most take for granted and questioning my knowledge of medicine due to the conflicting things I was told -- most people could care less that Zofran can cause long QT -- as a test, I mentioned it to another resident --- within 2 weeks that became the latest EBM "nugget" that went forth throughout the inpatient service ---

But -- bottom line -- I'm now board certified, recognize that I'm right, just need to build my confidence, more than I am wrong, caution is good --- my advice, again -- don't quit the residency if you can possibly avoid it. It's hard to recover from --I know of one guy that did it -- he can only see medicare/Medicaid and cash pay -- his office is in his house but he makes a good living, loves his work, especially the drive (wink, wink) and he's happy....damn good doctor tho -- and come to think of it, he did work in some rural ERs without being board certified although this was a few years back...

 

[Ericslv]

Nice to see everyone's working and playing well with the other kiddos in the sandbox -- never thought I'd see attending physicians get into a corpus callosum measuring contest but hey, whatever ---

Agree with EricLV that medicine is full of narcissists and sociopaths (but recognize there's a nice, locker room, one man rolling frat party feel to the FM forum -- cabinBuilder has some great experience, has pulled my chestnuts out of the fire more than once and is really a nice person -- don't know that they were being aggressive/rude but most likely just didn't have time to screw around with the touchy/feely stuff)-- went to a residency full of them on the attending physician side -- the residents were so new at life that they expected it to remain this way and adopted Stockholm syndrome -- and yes, I was actually slapped in the head by an Ob attending one night and told by a renal fellow I was too stupid to read the English language -- whatever -- I've been a victim of an attempted mugging in the hospital cafeteria, sent as a gofer for soup as an off service intern, set up to get a spray of abscess material during a labial I&D by the OB resident, told that I shouldn't come in if I was running a fever and too weak to stand without getting light headed but then penalized for not coming in by being placed on call over Christmas, chastised because one of my seniors ordered the wrong medicine/gave me the wrong info and then refused to own up to the mistake when I was getting shark tanked by the attending -- yeah, it sucked and I learned very little -- I'm paying for it now in terms of being able to do procedures that most take for granted and questioning my knowledge of medicine due to the conflicting things I was told -- most people could care less that Zofran can cause long QT -- as a test, I mentioned it to another resident --- within 2 weeks that became the latest EBM "nugget" that went forth throughout the inpatient service ---

But -- bottom line -- I'm now board certified, recognize that I'm right, just need to build my confidence, more than I am wrong, caution is good --- my advice, again -- don't quit the residency if you can possibly avoid it. It's hard to recover from --I know of one guy that did it -- he can only see medicare/Medicaid and cash pay -- his office is in his house but he makes a good living, loves his work, especially the drive (wink, wink) and he's happy....damn good doctor tho -- and come to think of it, he did work in some rural ERs without being board certified although this was a few years back...

So true, So true.

But now you are an attending. Confidence will come from reading and doing and continued training. It's great that you are now board certified but don't put too much weight on it. The insurance company will but you should put your weight on reading, doing and training.

 

[deleted87716]

It's great that you are now board certified but don't put too much weight on it.

Where did he say that...?

IMO, if you aren't board certified in this day and age, there are only two possible reasons...you're either too lazy, or too stupid. Neither looks good on your resume.

 

[JustPlainBill]

So true, So true.

But now you are an attending. Confidence will come from reading and doing and continued training. It's great that you are now board certified but don't put too much weight on it. The insurance company will but you should put your weight on reading, doing and training.

Yes, Mommy --- and I'm not sure you want me putting my weight, which is considerable, on anything that shouldn't be reduced to a pile of balsa wood splinters -- A friendly word of advice, you're a new member here on SDN (or at least you are under this userid) and while you may not intend it this way, you really do come off as a condescending, self-important twit.

I think most of us here, given that in order to screen for medical school you have to be in the top 2% of the nation, can figure out by now, that medicine is a profession of perpetual learning and growing from case centered reading and properly supervised practice -- the main problem is getting the unchecked egos to admit 3 fatal words,"I don't know" and ask for help. I can teach a monkey how to do surgery, I can't teach a monkey when not to do surgery -- most of the bad outcomes happen when people "Cowboy Up" and forget that they CAN make mistakes. Part of being a mature individual, to quote Dirty Harry," A man's got to know his limitations"....

Sounds like you might have something of value to offer on this forum but you may want to check the tone...or at least be sure that you don't come across as offensive when you're pointing out another's perceived "rude" attitude -- and I'm talking about your response to Cabinbuilder to be blunt.

 

[MDROBIN001]

Because it's been a brutal ******* - ish type of week. I had an orthopedic surgeon bitch me over the phone for "refusing care" on a patient (who was a friend of his) who wasn't even checked into urgent care and I was trying to help the mom after hours on a film that was done as an out patient but the kid had a fracture and no plan if that happened. I got talked to by the clinic manager about being short with the surgeon.

Or how about the stupid waste of space locum doctor I have had to work with the past 8 weeks who knows NOTHING (I am locum too) who sent my triaged patient to the ER for "chest pain" after I determine that it's not that that. I had to sent the MA to the ER to retrieve the patient and see him since he had the full cardiac workup 2 weeks prior. He had rib dysfunction which I fixed in the office with some OMT and he left pain free.

So, yes, I'm tired - I worked 8 days in a row - 97 hours. I am doing my best to hold it together. SOOOOO if I sound angry. WHATEVER!!!!!!. Just please try to sound like you know what you are talking about because my patience is ZERO and I don't have time to ***** foot someone else's feelings. PERIOD.

---------------------------------------------
I too work at several very busy urgent care clinics, but I guess I'm just a machine! I often work much longer than 8 days in a row.. last month I worked 66 days in a row.. 12h + daily .. I think it's just because I've been in two wars, now I have a roof over my head, AC, clean drinking water, clean bathroom and a supportive amazing wifey this makes it all feel like I live in the Sheraton !

 

[Makati2008]

---------------------------------------------
I too work at different busy urgent care clinics, but I guess I'm just a machine! I often work much longer than 8 days in a row.. last month I've worked 66 days in a row.. 12h + daily .. I think it's just because I've been in two wars, so a roof over my head, an AC, a clean drinking water, and a supportive amazing wifey makes it all look like I'm in a Sheraton !

Long month....66 days....I'm smelling something...

 

[MDROBIN001]

Long month....66 days....I'm smelling something...

You just smell your laziness and shallowness
compared to my work ethic, so go hit your head on a rock and hopefully this will knock some work ethic into you

 

[Makati2008]

You just smell your laziness and shallowness
compared to my work ethic, so go hit your head on a rock and hopefully this will knock some work ethic into you

Seems like I hit a nerve there. I wonder why......

 

[MDROBIN001]

Seems like I hit a nerve there. I wonder why......

lol .. you still can't get it

 

[Ericslv]

Yes, Mommy --- and I'm not sure you want me putting my weight, which is considerable, on anything that shouldn't be reduced to a pile of balsa wood splinters -- A friendly word of advice, you're a new member here on SDN (or at least you are under this userid) and while you may not intend it this way, you really do come off as a condescending, self-important twit.

I think most of us here, given that in order to screen for medical school you have to be in the top 2% of the nation, can figure out by now, that medicine is a profession of perpetual learning and growing from case centered reading and properly supervised practice -- the main problem is getting the unchecked egos to admit 3 fatal words,"I don't know" and ask for help. I can teach a monkey how to do surgery, I can't teach a monkey when not to do surgery -- most of the bad outcomes happen when people "Cowboy Up" and forget that they CAN make mistakes. Part of being a mature individual, to quote Dirty Harry," A man's got to know his limitations"....

Sounds like you might have something of value to offer on this forum but you may want to check the tone...or at least be sure that you don't come across as offensive when you're pointing out another's perceived "rude" attitude -- and I'm talking about your response to Cabinbuilder to be blunt.

She was rude, just like you are being now. I let her know and I'm letting you know.

 

[Ericslv]

Where did he say that...?

IMO, if you aren't board certified in this day and age, there are only two possible reasons...you're either too lazy, or too stupid. Neither looks good on your resume.

I'm Board certified but to me it's just a piece of paper. There is no evidence it is a sign of quality. There is a massive battle right now with the abim and abms about this. where have you been. Other specialist are joining in. Board certification is just a scam to make more money form doctors. You need just to get paid by the insurance companies.

 

[deleted87716]

I'm Board certified but to me it's just a piece of paper.

Regardless, you can bet there's hardly anyone out there who isn't board certified who doesn't wish they were. That's the reason are so many non-ABMS "boards."

Board certification doesn't guarantee competency, but lack of board certification should certainly call it into question.

 

[Ericslv]

Regardless, you can bet there's hardly anyone out there who isn't board certified who doesn't wish they were. That's the reason are so many non-ABMS "boards."

Board certification doesn't guarantee competency, but lack of board certification should certainly call it into question.

See I don't really agree with that. There are surveys that say if physicians weren't forced to do it many, many wouldn't. The ones who do wish they were wish it because insurance and hospital currently force them to be in order to get paid.

But it's not so much board certification it's more what the board require to get certified and how they have (in my opinion) overstayed they welcome. They are private organizations that have lobbied and marketed themselves to be the standard of quality without any real proof. MOC, 10 year testing cycles don't improve patient care or quality. That's what I was eluding to in the post before. It's more a way to control and maintain revenue. Millions of dollars of revenue for them.

The other boards and especially the new one (national physicians) focuses more on CME relevant to each doctor practice. They do require that you have an initial ABMS board and then continue with CME (cat. 1.). I believe that is an efficient and effective learning tool and repeated testing and MOC are not needed. Even as we speak there are colleges looking into dropping the SAT. They are doing that because recent research has shown that it doesn't test someone ability to learn do do well in college or life.

There are differing opinions on this and I respect that but I don't feel that it helps or is appropriate to call your colleagues lazy or stupid or incompetent because they don't have board certification. There is no evidence to support they are incompetent at their jobs. There are plenty of board certified doctors who may also be poor physicians and just because they passed an exam they may seen as competent.

 

[VA Hopeful Dr]

See I don't really agree with that. There are surveys that say if physicians weren't forced to do it many, many wouldn't. The ones who do wish they were wish it because insurance and hospital currently force them to be in order to get paid.

But it's not so much board certification it's more what the board require to get certified and how they have (in my opinion) overstayed they welcome. They are private organizations that have lobbied and marketed themselves to be the standard of quality without any real proof. MOC, 10 year testing cycles don't improve patient care or quality. That's what I was eluding to in the post before. It's more a way to control and maintain revenue. Millions of dollars of revenue for them.

The other boards and especially the new one (national physicians) focuses more on CME relevant to each doctor practice. They do require that you have an initial ABMS board and then continue with CME (cat. 1.). I believe that is an efficient and effective learning tool and repeated testing and MOC are not needed. Even as we speak there are colleges looking into dropping the SAT. They are doing that because recent research has shown that it doesn't test someone ability to learn do do well in college or life.

There are differing opinions on this and I respect that but I don't feel that it helps or is appropriate to call your colleagues lazy or stupid or incompetent because they don't have board certification. There is no evidence to support they are incompetent at their jobs. There are plenty of board certified doctors who may also be poor physicians and just because they passed an exam they may seen as competent.

Well, there's a few different ways to look at this.

First, I don't care what anyone says - if you didn't get initial board certification after residency, something is wrong. Literally all you have to do is complete residency and, in our case, pass a test with a greater than 90% first time pass rate.

Second, folks who have trouble passing the recertification test. I am going to cut you a little slack there. 20-30 years out of residency, it can be hard to keep up with the broad scope of family medicine. That said, the several day board review courses work pretty well - and give you lots of CME in the process.

Third, if you got certified initially then decided not to do the MOC stuff - I get that. I think its foolish given the present environment, but I can understand the reasoning.

 

[deleted87716]

I don't feel that it helps or is appropriate to call your colleagues lazy or stupid ... because they don't have board certification.

So, what's a third possibility...?

 

[Ericslv]

Well, there's a few different ways to look at this.

First, I don't care what anyone says - if you didn't get initial board certification after residency, something is wrong. Literally all you have to do is complete residency and, in our case, pass a test with a greater than 90% first time pass rate.

Second, folks who have trouble passing the recertification test. I am going to cut you a little slack there. 20-30 years out of residency, it can be hard to keep up with the broad scope of family medicine. That said, the several day board review courses work pretty well - and give you lots of CME in the process.

Third, if you got certified initially then decided not to do the MOC stuff - I get that. I think its foolish given the present environment, but I can understand the reasoning.

I agree. You should get board certified right out of residency. No question about it. It's the best time to do it and it's the final step you might say for closure at the end of residency.

Down the road just keep up with CME and keep getting better. Our patients teach us and demand it.

 

[Ericslv]

So, what's a third possibility...?

The third possibility is what I responded to above to the other post. People have different priorities when they finish residency. Many will narrow their practice down. You know, no ob or peds etc. Some go into something else and get trained for other procedures. Some of those procedures are reimbursed by insurance and require that they stay board certified even though what they do is not even relevant to the initial certification. Those who do continue with FM and narrow their practice find that the board exam is not relevant to them anymore.

This is happening throughout medicine and specialties. Let say your an endocrinologist and in residency you get trained in pediatric and adult endocinology. You go in to private practice and stop doing ped endocrine. 10 years later they want you to pass both the IM exam and the Endocrine exam that has both peds, adult etc. Now the guy has to study for the regular IM exam (that he does not do), the peds exam and the adult. It doesn't make sense. He is not lazy or stupid. There is just no need to do all this to be good at what he does. The fact that his patient are doing well, are healthy and he keeps up with proper CME should be enough proof that he is doing a good job.

 

[deleted87716]

The third possibility is what I responded to above to the other post. People have different priorities when they finish residency. Many will narrow their practice down. You know, no ob or peds etc. Some go into something else and get trained for other procedures. Some of those procedures are reimbursed by insurance and require that they stay board certified even though what they do is not even relevant to the initial certification. Those who do continue with FM and narrow their practice find that the board exam is not relevant to them anymore.

This is happening throughout medicine and specialties. Let say your an endocrinologist and in residency you get trained in pediatric and adult endocinology. You go in to private practice and stop doing ped endocrine. 10 years later they want you to pass both the IM exam and the Endocrine exam that has both peds, adult etc. Now the guy has to study for the regular IM exam (that he does not do), the peds exam and the adult. It doesn't make sense. He is not lazy or stupid. There is just no need to do all this to be good at what he does. The fact that his patient are doing well, are healthy and he keeps up with proper CME should be enough proof that he is doing a good job.

Sounds like all of that would be covered by "lazy."

 

[Ericslv]

Sounds like all of that would be covered by "lazy."

Im my book it's covered by lack of need so why do it to make someone else rich. If it's not broke, don't fix it.

 

[deleted87716]

Im my book it's covered by lack of need so why do it to make someone else rich. If it's not broke, don't fix it.

So...why did you bother to get board certified if you think it's "just a piece of paper?" Either you think it's BS, or you don't.

 

[Ericslv]

So...why did you bother to get board certified if you think it's "just a piece of paper?" Either you think it's BS, or you don't.

I think the initial boards is important. Right out of residency. After that it's not relevant. I got board certified initially to complete what I started. I got re-certified to get paid by insurance. The rest is BS.

 

[JustPlainBill]

---------------------------------------------
I too work at several very busy urgent care clinics, but I guess I'm just a machine! I often work much longer than 8 days in a row.. last month I worked 66 days in a row.. 12h + daily .. I think it's just because I've been in two wars, now I have a roof over my head, AC, clean drinking water, clean bathroom and a supportive amazing wifey this makes it all feel like I live in the Sheraton !

That does have a way of changing perspectives, doesn't it....while being a military brat in no way compares to being on Uncle Sugar's payroll as part of the green machine, cake eating civilians think I'm making up having to draw water from the base water point because you couldn't brush your teeth in the local national water, riding to school in buses with grenade screens over the windows, being told to NEVER go off base in groups of less than 3, having security police take up OPs on top of your house since it was near the perimeter and intruders were coming over the wire to rob and plunder, waking up on the couch and almost stepping on a HUGE german shepherd guard dog, watching the base go on lock down when the local communist party of the host country decided to hold a demonstration outside all the checkpoints and watching the troops man the perimeter just in case with F4's over head on CAP, having the bug-out bag in the closet and knowing where the rally point was both on base, at the flightline and then back in the world, eating marvelous mystery meat on a stick and really, really hoping it was chicken....I feel your pain ...watched Dad get on the aircraft a few times and spent the nights praying he would come back standing up with everything attached ---- should we ever meet in person, I owe you a frosty one....

 

[JustPlainBill]

She was rude, just like you are being now. I let her know and I'm letting you know.

Good. I like consistency, in all types of people. And since you're all about letting people know how they come off --- I'm letting you know that you come off not so much as a twit any more -- more like a pompous a$$ with a touch of control freak thrown in with just a dash of condescension for good measure.

Back to the discussion --- I found board certification to be rather interesting, almost like elementary school competence testing --- some residencies, like mine, were all about the test -- heck they tied passing the in training exam within a certain percentile to advancement through the PGY ranks and put people on remediation who had not failed anything other than the ITE -- but then again, these were the idiots that put an intern on probation for lack of clinical judgment ( yo, numbnuts -- they're interns and by definition have no clinical judgement, dork) -- other programs really didn't give the ITE much thought -- they just taught their people good medicine and guess what, their people pass with flying colors with monotonous predictability ---

Board certification is what it is --- I hate standardized exams as there is no demonstration that you can think, just that you can come up with the right answer 70% of the time (either by guess or knowledge) -- I've been told that in France (and in some specialties in the US) they have oral board exams and you have to satisfy the examiner that you know WTF you're doing -- wonder if that's in our future?

Anyway, for now, you need it to be on insurance plans, doesn't make it right or wrong, just makes it a fact of life.....and so the OP, in my opinion, should tough it out and get through residency if possible.

 

[Ericslv]

 

[VA Hopeful Dr]

Good point. Its obviously all of us who are mistaken.

 

[Ericslv]

Good point. Its obviously all of us who are mistaken.

Take a look at the posts. I replied to a post to cabinbuilder about govt. regulation and insurance etc. She replied by saying damn you don't know what your talking about" and something like I should leave or not post anymore. So I told her she was rude. That was rude. I've never met or interacted with her before and the first thing she says to me is that I don't know what I'm talking about. And then goes some with some angry rant against me because she is having a hard day. Why is she taking her hard day out on me?

So she may be a nice person and all but I don't know that. I don't know her. All I know is she took her hard day out on me. Then all her friends in her came to her rescue. Isn't that what's happening?

The next guy just plain old insults me (which I never did to him) by calling me a twit and pompous etc. I've seen people get kicked out of here for less. It seems to me if you don't agree with an old time poster in here you get ganged up on by the others. At least so far that what it seems.

So before you point fingers look at your own behaviors? I wasn't the one that started the attacks. In fact I didn't call anyone names. I just explained my position. You don't have to agree with it but that doesn't give you the right to be rude and insult me.

Someone called me an internet tough guy. It seems that if someone call another names on the internet they are the one with the problem and they are the one being the internet tough guy.

 

[VA Hopeful Dr]

Take a look at the posts. I replied to a post to cabinbuilder about govt. regulation and insurance etc. She replied by saying damn you don't know what your talking about" and something like I should leave or not post anymore. So I told her she was rude. That was rude. I've never met or interacted with her before and the first thing she says to me is that I don't know what I'm talking about. And then goes some with some angry rant against me because she is having a hard day. Why is she taking her hard day out on me?

So she may be a nice person and all but I don't know that. I don't know her. All I know is she took her hard day out on me. Then all her friends in her came to her rescue. Isn't that what's happening?

The next guy just plain old insults me (which I never did to him) by calling me a twit and pompous etc. I've seen people get kicked out of here for less. It seems to me if you don't agree with an old time poster in here you get ganged up on by the others. At least so far that what it seems.

So before you point fingers look at your own behaviors? I wasn't the one that started the attacks. In fact I didn't call anyone names. I just explained my position. You don't have to agree with it but that doesn't give you the right to be rude and insult me.

Someone called me an internet tough guy. It seems that if someone call another names on the internet they are the one with the problem and they are the one being the internet tough guy.

I was ignoring your exchange with CB as that was obviously a case of exhaustion rage versus new poster ignorance (not an insult at all, merely that you don't know CB and so didn't realize that usually they are very level headed in their postings and we can all be forgiven the occasional lapse).

However, JustPlainBill's response was exactly in line with my own thinking. I'm sure you mean well, but your posts come off as surprisingly condescending and pompous. Plus, some of the advice you are giving is particularly bad given the audience. Pre-meds, medical students, and even some residents are quite impressionable, so if you tell them that board certification isn't really necessary, they will believe you to their extreme misfortune. Attendings can easily debate the merits of board certification, others much less so.

 

[Ericslv]

I was ignoring your exchange with CB as that was obviously a case of exhaustion rage versus new poster ignorance (not an insult at all, merely that you don't know CB and so didn't realize that usually they are very level headed in their postings and we can all be forgiven the occasional lapse).

However, JustPlainBill's response was exactly in line with my own thinking. I'm sure you mean well, but your posts come off as surprisingly condescending and pompous. Plus, some of the advice you are giving is particularly bad given the audience. Pre-meds, medical students, and even some residents are quite impressionable, so if you tell them that board certification isn't really necessary, they will believe you to their extreme misfortune. Attendings can easily debate the merits of board certification, others much less so.

I see you point but it was not my intention.
He still doesn't need to call me a twit and other things. We can all take it easy in here and just have a conversation. Don't you think?

Anyway, regarding Board certification, I never said they should not be certified. As I've said above they should get it after residency but most will figure out a few years into being an attending that it means very little.

So, I'm done with this. I don't have anything further to add.

 

[cabinbuilder]

I was ignoring your exchange with CB as that was obviously a case of exhaustion rage versus new poster ignorance (not an insult at all, merely that you don't know CB and so didn't realize that usually they are very level headed in their postings and we can all be forgiven the occasional lapse).

However, JustPlainBill's response was exactly in line with my own thinking. I'm sure you mean well, but your posts come off as surprisingly condescending and pompous. Plus, some of the advice you are giving is particularly bad given the audience. Pre-meds, medical students, and even some residents are quite impressionable, so if you tell them that board certification isn't really necessary, they will believe you to their extreme misfortune. Attendings can easily debate the merits of board certification, others much less so.

Thank you, wise as always, and yes things are not well with me professionally or personally at this time.

 

[VA Hopeful Dr]

Thank you, wise as always, and yes things are not well with me professionally or personally at this time.

If there is anything a group of anonymous but caring strangers can do, just say the word...

 

[cabinbuilder]

If there is anything a group of anonymous but caring strangers can do, just say the word...

Thanks, it will all turn out ok eventually. I speak with JustPlainBill quite often.

 

[primadonna22274]

Take it easy on yourself CB. Life is hard but we try to make it easier on each other here.

Sent from my SAMSUNG-SM-N910A using Tapatalk

 

[deleted87716]

regarding Board certification, I never said they should not be certified. As I've said above they should get it after residency but most will figure out a few years into being an attending that it means very little.

The data doesn't bear that out.

"Eighty-five percent of active family physicians in this study (n = 70,323) have current board certification. Ninety-one percent of all active board-certified family physicians eligible for MOC are participating in MOC."

http://www.ncbi.nlm.nih.gov/pubmed/21706905

 

[owlegrad]

Users are reminded to follow the TOS when posting on SDN and keep in mind that the purpose of the forum is to help each other out; rude/inappropriate posts do not fit the spirit of the forum.

Thanks.

 

[VA Hopeful Dr]

The data doesn't bear that out.

"Eighty-five percent of active family physicians in this study (n = 70,323) have current board certification. Ninety-one percent of all active board-certified family physicians eligible for MOC are participating in MOC."

http://www.ncbi.nlm.nih.gov/pubmed/21706905

I think the argument is more that MOC doesn't actually make one a better family physician.

I don't agree, but then I'm the big nerd who really enjoys doing SAMs.

 

[deleted87716]

I think the argument is more that MOC doesn't actually make one a better family physician.

I don't agree, but then I'm the big nerd who really enjoys doing SAMs.

I always learn something when I do a SAM.

Personally, I think it's tough to argue that somebody who isn't motivated enough to maintain board certification is somehow going to be motivated to keep up on their own. Actions speak louder than words.

 

[Ericslv]

The data doesn't bear that out.

"Eighty-five percent of active family physicians in this study (n = 70,323) have current board certification. Ninety-one percent of all active board-certified family physicians eligible for MOC are participating in MOC."

http://www.ncbi.nlm.nih.gov/pubmed/21706905

That's only because they need it to get paid by insurance. By the way many of these studies were done by the same people who administer the exams. ABMS, ABIM, ABFM etc.

Can we say conflict of interest???

 

[Ericslv]

I always learn something when I do a SAM.

Personally, I think it's tough to argue that somebody who isn't motivated enough to maintain board certification is somehow going to be motivated to keep up on their own. Actions speak louder than words.

SAM to me is always a worthless. I get my learning from CME. The quality of my patient care speaks for me. The fact that they come back and are healthy speaks for me.

Your argument is the same argument that the academics have used for years without any evidence.

But let me be clear. I'm not saying you shouldn't take it or get board re-certified. If you feel it help you then go for it.

The point is ABMS and its board take in millions of dollars, and with that money they lobby hospitals and insurance companies to keep them from not requiring board certification. They lobby and spread the falsehood that board certification is the gold standard of quality and its not. They can't prove it.

Then they tell the doctors that it's voluntary. But it's not voluntary if on the other end they are being told you have to have it to work in a hospital or get paid by insurance. It's not voluntary.

We should have the freedom to get our education where we want and not be forced to get it from ABMS.

If ABMS is so great then they should do just fine competing with all the other CME and Boards out there. In fact if they are truly who they say they are then the cream should go to the top.

 

[VA Hopeful Dr]

SAM to me is always a worthless. I get my learning from CME. The quality of my patient care speaks for me. The fact that they come back and are healthy speaks for me.

Your argument is the same argument that the academics have used for years without any evidence.

But let me be clear. I'm not saying you shouldn't take it or get board re-certified. If you feel it help you then go for it.

The point is ABMS and its board take in millions of dollars, and with that money they lobby hospitals and insurance companies to keep them from not requiring board certification. They lobby and spread the falsehood that board certification is the gold standard of quality and its not. They can't prove it.

Then they tell the doctors that it's voluntary. But it's not voluntary if on the other end they are being told you have to have it to work in a hospital or get paid by insurance. It's not voluntary.

We should have the freedom to get our education where we want and not be forced to get it from ABMS.

If ABMS is so great then they should do just fine competing with all the other CME and Boards out there. In fact if they are truly who they say they are then the cream should go to the top.

If you have never learned anything from a SAM, then I think you're just doing it wrong. Patients coming back only means that they like you, its not evidence of good clinical practice (pain mills in Florida had good patient retention as well). Healthy patients can easily be just luck. My mother is completely healthy, has the cholesterol panel of someone who will live to be 107 (LDL=HDL=85). Does that mean her PCP is better than everyone else? Of course not.

I think board certification has a good goal, but like everything else in life its not perfect. We need some type of requirement, otherwise history has certainly shown us that many doctors simply won't keep up. Likewise, just doing CME on your own is often not sufficient. In my urgent care moonlighting, I see many patients just horribly mismanaged - usually in a manner that makes it obvious the doctor isn't up to date. Alpha blocker for isolated HTN without trying other drugs first, plain amoxicillin for adult UTIs, metformin with a creatinine of 2.0. Stuff that just plain shouldn't happen. Obviously self-study isn't good enough for these people. What then do we do?

Besides all of that, I just don't find board certification that onerous. Its got a hefty CME requirement, but no one should really complain about that part. The SAMs are generally pertinent and informative - though I could do without the clinical sim part, that's not the end of the world. I really don't care for Part IV, but the last time I did that it took less than 3 hours of my total time to do using the AAFP free Metric stuff. We're talking $200/year for that stuff. Not worth getting hysterical about (not saying that you are, but some do). The exam is I think a good idea, especially now that you can choose your area of concentration for 2 sections. I'm warming to the idea I've seen floated about making the test open book - more likely to learn that way, but even if not its only once every 10 years. Something you only have to endure 3 times in an average career isn't the end of the world. It is pricey, but again only once per decade.

 

[Ericslv]

If you have never learned anything from a SAM, then I think you're just doing it wrong. Patients coming back only means that they like you, its not evidence of good clinical practice (pain mills in Florida had good patient retention as well). Healthy patients can easily be just luck. My mother is completely healthy, has the cholesterol panel of someone who will live to be 107 (LDL=HDL=85). Does that mean her PCP is better than everyone else? Of course not.

I think board certification has a good goal, but like everything else in life its not perfect. We need some type of requirement, otherwise history has certainly shown us that many doctors simply won't keep up. Likewise, just doing CME on your own is often not sufficient. In my urgent care moonlighting, I see many patients just horribly mismanaged - usually in a manner that makes it obvious the doctor isn't up to date. Alpha blocker for isolated HTN without trying other drugs first, plain amoxicillin for adult UTIs, metformin with a creatinine of 2.0. Stuff that just plain shouldn't happen. Obviously self-study isn't good enough for these people. What then do we do?

Besides all of that, I just don't find board certification that onerous. Its got a hefty CME requirement, but no one should really complain about that part. The SAMs are generally pertinent and informative - though I could do without the clinical sim part, that's not the end of the world. I really don't care for Part IV, but the last time I did that it took less than 3 hours of my total time to do using the AAFP free Metric stuff. We're talking $200/year for that stuff. Not worth getting hysterical about (not saying that you are, but some do). The exam is I think a good idea, especially now that you can choose your area of concentration for 2 sections. I'm warming to the idea I've seen floated about making the test open book - more likely to learn that way, but even if not its only once every 10 years. Something you only have to endure 3 times in an average career isn't the end of the world. It is pricey, but again only once per decade.

I don't necessarily disagree with you. If you like to get your education through SAM and Exams etc. That's great. But there is no evidence that shows it is more effective than other forms of getting your education.

I say let the market decide what works.

Your examples of poor management are good but that poor management happens all the time with board certified doctors. In fact one can argue that most medical mistakes happen by board certified doctors since most doctors are board certified.

In general, if we want board certification to have true meaning and move towards true improvement of quality we have to change the way it's done. We don't have to eliminate it.

Taking an exam once every ten years on topics that a doctor may not even practice any longer is not good quality care. They just take a board review course and pass and then forget all the garbage they had to learn because they don't do it in their practice.

Things have to get customized for re-certification. CME can be changed to get more interactive etc. These are just examples. But the current state of passing a test and taking a sam etc. does not improve quality and has never been shown to do that. Majority of the studies done on this are done by ABMS and its board. There is a major conflict of interest.

So I and thousand like me currently fighting this are not getting hysterical. We are just not willing to let someone control us for money. Why should we give them our time and hard earned money so they can get rich on our back for an exam that has no proof of value. Remember these are a small group of academic doctors that run the show and pay themselves over 500000K per year to do this. Some over 1 million.

They keep talking about evidence based medicine but don't have any evidence for their own exams.

 

[Ericslv]

Please review

www.changeboardcert.com