Thinking about quitting after 1st year residency

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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.
The market mostly does decide about this. Until very very recently, no one forced hospital/insurance credentialing people to only accept board certified doctors. Now, you can argue the ABMS tricked them into this but that's how the free market works.

We also don't have any evidence that SAMs are inferior to just CME.

In fact, we have very little evidence for much of what we do. If it seems like a good idea and isn't proven harmful, I don't see the issue.
 
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The market mostly does decide about this. Until very very recently, no one forced hospital/insurance credentialing people to only accept board certified doctors. Now, you can argue the ABMS tricked them into this but that's how the free market works.

We also don't have any evidence that SAMs are inferior to just CME.

In fact, we have very little evidence for much of what we do. If it seems like a good idea and isn't proven harmful, I don't see the issue.


The point is there is no evidence. So why be forced to do it?


The ground swell of physicians continues . . .
and FINALLY an up-rise against yet another burdensome change to the ever-changing ABIM MOC requirements is coming to a boil.

Keeping abreast of the advances in medicine is something every physician agreed to do. We know that being well-read in the current medical arena is not only recommended, it is essential. That’s one thing, but the burden saddled on physicians by the American Board of Medical Specialists has gotten out of hand. Dr. Ron Benbassat is leading the charge of action among physicians. Go to his website and read more!

Here is his letter in response to the introduction of the new head of the ABIM who is spear-heading even more requirements.

Dr.Richard Baron has inherited the Maintenance of Certification (MOC) mantle from Dr. Christine Cassel and her predecessor Dr. Harry Kimball. Like them and fellow propagandists Drs. Robert Wachter, Eric Holmboe, Wendy Levinson and Rebecca Lipner PhD, he perpetuates the ABIM’s mantra of MOC all the way to the bank.

We at Change Board Recertification (www.changeboardrecert.com) find this shameful and appalling.

If this new President wants to be a game-changing advocate for the practicing physician, he should be challenged to dismantle MOC and defuse all attempts to tie it to Maintenance of State Licensure (MOL). Neither has any place in the life of practicing physicians.

We’ve had an effective system in place for decades, one that is the equivalent of MOC and MOL: keeping up to date through our CME and remaining in good standing to maintain state licensing. There is absolutely no need or justification for MOC/MOL and its imposed burdens.

Let’s be clear on what MOC means to the AMBS and its Boards and why they are so insistent on the value of MOC. The twenty-four Boards’ 990 IRS documents disclose over $400 million in total reported assets—an amount compounded by the yearly certification and recertification of thousands of diplomates.

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Here’s just one example: $39,457,253 in revenue reported in the ABIM’s 2009 tax return for “examination fees and MOC.”

So it’s no mystery as to why MOC was developed and continues to be promoted, despite its having evolved into a discriminatory and costly burden to physicians, patients and healthcare. The Boards’ MOC program has become a profiteering juggernaut without any reasonable proof of benefit, efficacy or patient protection, and MOC compliance is slowly being tied to the privilege of practicing medicine.

During these changing times of health-care reform, our Boards sit on nearly a half-billion dollars in assets while hard-working physicians get diminishing reimbursements and many Americans remain without health-care coverage. This to me seems far more newsworthy a story, don’t you?

No one is disputing that staying up to date is essential to practicing medicine, but the existing MOC process neither qualifies physicians nor protects patients effectively. MOC requirements have not been shown to be fair, accurate or predictive indicators of a physician’s skills or competency nor have they been shown to improve patient care or safety. All licensed professions have continuing education requirements, but imposing MOC on physicians is simply egregious.

The financial agendas of all Board members are transparent; they show no commitment to improving patient care or cultivating better physicians. And the ABIM’s plans of changing MOC in 2014 to an every-2-year cycle of Continuous Maintenance of Certification (CMOC)—thereby aligning their product with state licensure renewal—only reduces “sticker shock” and masks the cumulative costs of MOC. Such a proposition actually increases related costs covertly: Though the resulting fees would be collected in smaller amounts over time, the completion of more frequent MOC requirements would require physicians to spend even more time away from the practice of medicine.

While almost every practicing physician wants MOC abolished, we feel that the system’s self-evaluation of medical knowledge modules can be worthwhile. We take issue with the bulk of the MOC process: The Practice Improvement Modules and Patient and Peer Reviews amount to little more than busy work, and the costly, time-consuming Secure Examination—which requires time off from work and an enormous amount of preparation—is clinically irrelevant and has no place in the life of a practicing physician.

Our goals remain clear:

1. MOC should involve only the self-evaluation modules and be a voluntary alternative to obtaining CME.
2. MOC should not require time away from patient care and the office. MOC should represent how physicians actually practice medicine: i.e., open-book and open-colleague, thereby eliminating the secure exam and practice-improvement modules.
3. MOC should not be associated with hospital privileges.
4. MOC should not be associated with insurance reimbursements or network participation.
5. MOC should not be required for Maintenance of Licensure.
6. MOC should not be mandatory.

MOC is deemed “voluntary” by our Boards’ Ivory Tower physician/politicians and PhD’s, who generally do not practice medicine or even see patients on a daily basis—yet they create the rules for those on the front lines. Our collective outcry against MOC continues to fall on the deaf ears of the ABMS and its Boards while their bureaucrats are working behind the scenes on a state-by-state basis with the Federation of State Medical Boards (FSMB) to tie their MOC product to Maintenance of Licensure, thereby making it mandatory for maintaining licensure. We absolutely cannot allow this to happen.

As our Boards don’t represent the collective interests of its constituency, perhaps mass noncompliance and lawsuits are the only rational and logical means to reclaiming control of our practices.

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We appeal to our new President to do the right thing.

Respectfully,

Ron Benbassat MD
Founder
Change Board Recertification

If you want to read more about this topic, see this article by Dr. Paul Kempen which explains the issues at hand with MOC, or this article which discusses what happened in Ohio when the State Board tried to add board certification to license requirements.

 
OK first, we are not under the ABIM so just stop it. Their MOC program is much different than ours and even I can see it sucked.

Second, you're not forced to do any of this. You don't want to be board certified, then don't be. However, that free market you're preaching about has decided its important.

Third, the process is fairly benign for us so the lack of evidence doesn't really bother me.

Fourth, I got into an argument with Paul Kempen about this on Sermo a year or so back. He compared MOC to the Holocaust and said that being stuck in MOC was analogous to being in a concentration camp, so his words are less than worthless to me.
 
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1. It does not matter if we are not abim. We are doctors. this is going to happen to all of us. One step at a time they move forward.

2. We are forced to do this. If we don't get certified we don't get paid or hired by hospitals and insurance. The free market did not do this. It was ABMS with millions of money extorted from doctors and strong lobby efforts that did this. The free market had very little to do with this.

3. It's not benign. And even if it was just because something does not hurt doesn't mean it's good for you.

4. It's not just Paul Kempen. It's thousands of other doctors. We are fed up with being controlled by academic doctors who don't even see patients but feel they know what is best for us.

5. Now they are trying to link board certification of MOL. maintenance of license. Are you kidding? Without an inch of evidence they want to tell doctors you have to be certified to practice medicine.
 
1. It does not matter if we are not abim. We are doctors. this is going to happen to all of us. One step at a time they move forward.

2. We are forced to do this. If we don't get certified we don't get paid or hired by hospitals and insurance. The free market did not do this. It was ABMS with millions of money extorted from doctors and strong lobby efforts that did this. The free market had very little to do with this.

3. It's not benign. And even if it was just because something does not hurt doesn't mean it's good for you.

4. It's not just Paul Kempen. It's thousands of other doctors. We are fed up with being controlled by academic doctors who don't even see patients but feel they know what is best for us.
Prove it. I see no evidence the ABFM is the most egregious of what the ABIM was doing.

Funny, I'm pretty sure strong lobbying efforts are free market. If it wasn't, then the lobbying efforts of these thousands of doctors wouldn't be allowed. Plus, aren't you the same guy who was crowing about a non-BC doc with a super successful DPC practice? Seems an easy way out that ignores hospitals and insurance requirements.

What do you have as a better idea then? And don't say just more CME, that's not a good solution. We had that once, and that's why we now have board cert and MOC.

I see 2 private practice doctors right here that don't seem to mind it.
 
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Prove it. I see no evidence the ABFM is the most egregious of what the ABIM was doing.

Funny, I'm pretty sure strong lobbying efforts are free market. If it wasn't, then the lobbying efforts of these thousands of doctors wouldn't be allowed. Plus, aren't you the same guy who was crowing about a non-BC doc with a super successful DPC practice? Seems an easy way out that ignores hospitals and insurance requirements.

What do you have as a better idea then? And don't say just more CME, that's not a good solution. We had that once, and that's why we now have board cert and MOC.

I see 2 private practice doctors right here that don't seem to mind it.


Yes, two of your buddies in here.

Yes, I would do DPC and cash when the time is right. So what? I don't believe we need any of these tests to be a good doctor. DPC easily ignore hospital and insurance so perfect it works. Take their power away all at once. Then they come asking us for help not the other way around. The reality is they need us more than we need them. But with BC garbage they have managed to change the rules and control us. Lobbying is free market but the part thats not is the extortion from the boards and the money from that that goes into it.

I never said abfm was the most egregious. I said ABMS and all it's boards have created a situation that forces doctors to comply like puppets. A bunch of useless academic doctors who don't practice medicine and think they can dictate how physicians should run their practice. Some of them aren't board certified themselves or are and were grandfathered in. How pathetic.

But if you want to do it go right ahead. I never said you shouldn't. I said I'm going to do it differently because I don't believe in it.

Someone in here was upset at me for talking about board cert. because of the young mds and the residents being impressionable. But at the same time someone in here said they are in the top 2% of intelligence. So if they are that smart they will be able to figure it out. We don't need to baby them. That would be pompous and arrogant making us look like twits.
 
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Yes, two of your buddies in here.

Yes, I would do DPC and cash when the time is right. So what? I don't believe we need any of these tests to be a good doctor. DPC easily ignore hospital and insurance so perfect it works. Take their power away all at once. Then they come asking us for help not the other way around. The reality is they need us more than we need them. But with BC garbage they have managed to change the rules and control us. Lobbying is free market but the part thats not is the extortion from the boards and the money from that that goes into it.

I never said abfm was the most egregious. I said ABMS and all it's boards have created a situation that forces doctors to comply like puppets. A bunch of useless academic doctors who don't practice medicine and think they can dictate how physicians should run their practice. Some of them aren't board certified themselves or are and were grandfathered in. How pathetic.

But if you want to do it go right ahead. I never said you shouldn't. I said I'm going to do it differently because I don't believe in it.

Someone in here was upset at me for talking about board cert. because of the young mds and the residents being impressionable. But at the same time someone in here said they are in the top 2% of intelligence. So if they are that smart they will be able to figure it out. We don't need to baby them. That would be pompous and arrogant making us look like twits.
For what its worth, I am doing DPC and still plan to maintain board certification. Blue Dog is one of the fewer and fewer docs who isn't owned by the hospitals. Seems to me we are the ones most likely to buck authority that we think is harmful.

As I said, the ABFM isn't perfect but no one has yet given a better solution. Purely relying on CME doesn't seem to work that well.

I was the one making the comment about students and residents. Just because students and residents are smart doesn't mean they have the experience to judge things that will affect their careers from the get-go. Let them get out into practice, being board certified, then see if its worth it to them. Its better to be as completely certified/trained/whatever at the beginning and then to decide later on that you can get away with less than the other way around once you're out in practice.
 
Yes, two of your buddies in here.

There are only a couple of people on SDN that I've met IRL, and they aren't on this thread.

That being said, if I met cabinbuilder, JustPlainBill, or VA Hopeful Dr at a party, I'd buy them a drink. I have a feeling that if I met you at a party, I'd have to do a fake page to escape. ;)
 
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There are only a couple of people on SDN that I've met IRL, and they aren't on this thread.

That being said, if I met cabinbuilder, JustPlainBill, or VA Hopeful Dr at a party, I'd buy them a drink. I have a feeling that if I met you at a party, I'd have to do a fake page to escape. ;)


Don't worry the feeling is mutual.
 
For what its worth, I am doing DPC and still plan to maintain board certification. Blue Dog is one of the fewer and fewer docs who isn't owned by the hospitals. Seems to me we are the ones most likely to buck authority that we think is harmful.

As I said, the ABFM isn't perfect but no one has yet given a better solution. Purely relying on CME doesn't seem to work that well.

I was the one making the comment about students and residents. Just because students and residents are smart doesn't mean they have the experience to judge things that will affect their careers from the get-go. Let them get out into practice, being board certified, then see if its worth it to them. Its better to be as completely certified/trained/whatever at the beginning and then to decide later on that you can get away with less than the other way around once you're out in practice.

Like I said before initial board certification is good. They can choose after that. But right now everyone is forced into it unless they don't take insurance or need hospitals.
 
There are only a couple of people on SDN that I've met IRL, and they aren't on this thread.

That being said, if I met cabinbuilder, JustPlainBill, or VA Hopeful Dr at a party, I'd buy them a drink. I have a feeling that if I met you at a party, I'd have to do a fake page to escape. ;)
Yeah, I only actually know who like 2-3 people here are in real life and have met only one of them - and Josh doesn't exactly hide anything about his identity so I'm not sure that counts.
 
There are only a couple of people on SDN that I've met IRL, and they aren't on this thread.

That being said, if I met cabinbuilder, JustPlainBill, or VA Hopeful Dr at a party, I'd buy them a drink. I have a feeling that if I met you at a party, I'd have to do a fake page to escape. ;)

I knew I liked you for a reason ;->.....I'd return the favor and then see if I could get you to dance on a table with me and 2 young nurses -- just kidding (well, maybe sorta not so much).....

Seriously, I've had the unfortunate experience of coming into an inpatient situation in a small hospital that was still running things a la 1990s (and this was in the 2010s) -- it was shotgun medicine run by docs who had been in this town for better than 20 years -- I come in as the new guy and do my complete admission physical (including full body skin inspection in a patient with fever and leukcocytosis), actually order labs before just starting therapy and then do workups for common problems such as hyponatremia and the population repeatedly tells me I'm "the best doctor we've ever had" and "the most thorough" -- is that the "new kid straight out of residency" or lack of laziness? I can't say but when you have to tell the administration that, Yes, you need a bougee in every crash cart, it makes me wonder.

I have skimmed the articles about the board certifications (mainly IM) being $$$ mills for the board organizations -- at $200/year + the cost of a SAM I really don't see that as odious, more like administrative costs.

SAMS -- Yes, I can do without the pseudo-interactive patient part -- when we were required to do SAMS as residents, most of us figured out the way to pass the thing and move on -- we thought we didn't have the time then to actually read the articles/research from the list that were supposedly helpful -- and we learned the ways around the pseudo-interactive patient part also -- that was a mistake. At our local TAFP conferences, they typically have SAM workshops where you can do it together and learn from each other.

On the whole -- I will say this -- I appreciate the self-policing our profession has done and I can tell you that I'm young enough in my career that there are physicians that I know of (and some I haven't met IRL) who inspire me to be better at my profession every day --- as it should be--- some are goofy as all get out but very knowledgeable and humble -- like the guy with horn rimmed tortoise shell glasses who wears bow-ties, white short sleeved shirts, khakis and black sneakers with his lab coat embroidered and the arms cut down to mid-forearm while working in the ER -- started his career before board certification as a GP and just loved the ER so much that now he's actually an FM doc who's BC in ER and one of the hitters in the local ER scene -- taught me a lot on my ER rotation including style points like" don't say the patient is morbidly obese in your note -- quote the BMI" -- things like that.

Or the FM doc who's a former military officer who jumps out of perfectly functioning aircraft in flight for "jump pay" and is one of the best teachers I've ever met -- he's mastered the socratic method and can get anyone to plumb the depth of their knowledge and inspire them to dig deeper without making them feel like fools.
 
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Hi guys, hope you all doing good.
I was successfully working as a PGY-2 IM resident. I competed PGY-1 and 9 months of PGY-2. I have been recently dismissed/ let go from the program because of Crossing the line of professional behaviour. Right now, I am going through the process of getting the medical board license. In the mean time, I am looking for open spots for PGY-2 and PGY-3 Internal and Family medicine. I read pretty much all the discussion above but Being at my position, I am very nervous about my career.
Is there any one who has been through my position?
Has anyone started working after getting the medical license? If yes? How easy it is to get any job and how much do one get pay?
 
Hi guys, hope you all doing good.
I was successfully working as a PGY-2 IM resident. I competed PGY-1 and 9 months of PGY-2. I have been recently dismissed/ let go from the program because of Crossing the line of professional behaviour. Right now, I am going through the process of getting the medical board license. In the mean time, I am looking for open spots for PGY-2 and PGY-3 Internal and Family medicine. I read pretty much all the discussion above but Being at my position, I am very nervous about my career.
Is there any one who has been through my position?
Has anyone started working after getting the medical license? If yes? How easy it is to get any job and how much do one get pay?


Not going to lie - I'm most concerned about the "crossing the line of professional behaviour." I worry for your future patients and depending on what it was, I would have serious reservations about taking you as a resident in another program.

There are a few posts around here about alternative careers including wound care.
 
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Not going to lie - I'm most concerned about the "crossing the line of professional behaviour." I worry for your future patients and depending on what it was, I would have serious reservations about taking you as a resident in another program.

There are a few posts around here about alternative careers including wound care.
I appreciate your opinion. I am just being honest.
I am in the process of getting medical license right now and applying for opening positions.
What position can you think of I can work after getting medical license?
 
My usual approach as well, and the vast majority are usually fine since we all make mistakes or BS consults every now and then. I'm still just pissed at the one asshat who called me back after seeing the patient I sent over to berate me.

Old thread, but I find a “you and I aren’t gonna talk about this” followed by an “I’m gonna hang up now” to work wonders with idiots like that.
 
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Hi guys, hope you all doing good.
I was successfully working as a PGY-2 IM resident. I competed PGY-1 and 9 months of PGY-2. I have been recently dismissed/ let go from the program because of Crossing the line of professional behaviour. Right now, I am going through the process of getting the medical board license. In the mean time, I am looking for open spots for PGY-2 and PGY-3 Internal and Family medicine. I read pretty much all the discussion above but Being at my position, I am very nervous about my career.
Is there any one who has been through my position?
Has anyone started working after getting the medical license? If yes? How easy it is to get any job and how much do one get pay?

In terms of getting back into a residency more information would help.
1) AMG or IMG?
2) Board scores?
3) Any failed rotations or years in medical school?
4) Impaired physician program?
5) What was the concern about your professionalism?
6) Any legal action taken against you?
7) Do you have any letters to recommend you for FM rather than IM?

In terms of getting a job without completing residency some of your options are:
1) Open your own primary care clinic. Public insurance will usually credential you. Private insurance may not credential you and I have no idea how much malpractice would cost.
2) Many prisons will take non-boarded physicians, though the volume of lawsuits will usually preclude you from ever going back to training
3) Some underserved urgent cares will take you
4) You can pick up a non ACGME specialty such as wound care, hair restoration, or obesity medicine
5) You can join the military and serve time as a general medical officer. They aren't very likely to take you they legally can.

I'm sure there is more.
 
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Old thread, but I find a “you and I aren’t gonna talk about this” followed by an “I’m gonna hang up now” to work wonders with idiots like that.
I was fresh out of residency and still somewhat unsure of myself. Your approach is exactly what I started doing with that guy after that.
 
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