Tuesday, July 1, 2014


Not written about life of the physician in a while.  As I reach the closing chapters, it seems not so much a downward spiral as a series of impositions.  Maybe what attracted people of my era to medical school, when our generally ample college grades would have enabled other pursuits, was the expectation of independence which has clearly eroded piece by piece.  In rough sequence, first came the lawyers, then the DRG's, then managed care and now we are increasingly gutted not so much externally but by our own people, be they management setting performance quotas while pulling out the means to fulfill them or more recently by our own eunuchoid specialty organizations capitalizing on changes in the Board Certification process as it becomes increasingly onerous, when they should be serving as their constituencies' advocates.

When I took my first American Board of Internal Medicine exam, Jimmy Carter was still President, though about to be voted out.  His tenure was transient but the Board Certification was permanent.  Not that I would ignore my need to keep current on medical knowledge but at least not have a 12% failure rate hanging over me.  As I moved to Fellowship, the rules changed making the certification only good for ten years, then having to be renewed, which I did in 2001 and 2011.  Expect to be retired by 2021.  However,  the ABIM unilaterally changed the rules again, putting time restrictions on the intermediate steps, which I would typically lie dormant for five years while I did other things, to two year cycles.  I could probably find 20 hours every couple of years since I can use that credit for license renewal. What seems to have changed, though, is the pass rate on the exam from 87% to 60% in some of the exams along with the fees to enter the program at all and take the exam a second time.  Moreover, this has moved from a self-assessment, or even a promotional credential to attract patients, to an economic necessity where insurers who pay you require the certification to stay current, as well as hospitals such as mine that require certification to see patients there.  Jeopardizing that threatens livelihood and probably threatens patient care, as those 40% see a lot of patients and mostly do their medical assessments with great levels of skill.

Needless to say, many of our professional organizations find themselves caught in the middle.  Most have sent inquiries or petitions to the ABIM to protest or show concern.  None thus far have tried to pull the plug by setting up a committee to assemble a competing certification process or passing a resolution requiring their officers and committee members to avoid complicity with this by not agreeing to develop questions of modules for the ABIM.  Moreover, out professional societies are at the forefront of providing ongoing medical education to their members, as they should.  More requirements means more courses to give and more organizational income from it.  So we receive a mixed message, our organizations which our dues support have an incentive not to take action against what the membership finds onerous.

My best guess is that by about two years, reality will set in.  The American College of Physicians whose executives have moved on to become Presidents of the ABIM can expect a membership decline as they fail in the role of member advocate.  My membership lapsed without renewal last summer.  But for the most part, you can't fight City Hall, or at least the risk of protest is too high, so most physicians will comply.  And for me a module or two this summer, as I need the Continuing Ed credits anyway.

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