• linkedin
  • Increase Font
  • Sharebar

    Demanding the end of ABIM recertification exams

    James J. Marino, MDJames J. Marino, MDThe American Board of Internal Medicine (ABIM) is an organization tasked with protecting the public from dangerous internists. That is a noble goal, however, their methods are of dubious value.

     

    ABIM extends practice assessment decision


    After spending countless hours completing most of the medical knowledge self-assessment program (MKSAP 16) and taking a two-day comprehensive board review course (from the ACP). I passed my recertification exam in May 2014…by a margin of one question. But 35% of the doctors taking that test did not pass—an important fact that should not be overlooked.
    In October and November 2015 I corresponded directly with Richard Baron, MD, the president and CEO of the ABIM. In his response to me he focused on the first-time test taker pass rate and the ultimate pass rate as the most relevant data. In fact, those are the only statistics available on the ABIM’s website regarding the MOC recertification exam.

     

    MOC: Doctors strike back


    I strongly disagree with his opinion. The bar for passing the secure exam is set so high that many “non-dangerous” internists will fail and become second- and third-time test takers, and these people are not counted in the statistics on their website. It is inconceivable that any more than 5% of internists practicing for 10 or 20 (or soon 30) years are “dangerous.” Some of us don’t go to hospitals anymore, and some of us focus our practice more in certain areas of medicine than in others, thus tailoring our practices to suit our interests. We may need to look up information for unusual cases more than we did 20 years ago, but that does not make us dangerous or deserving of being put through the rigors of preparing for an examination just because the ABIM has set the bar way too high.

    Next: Designed for failure

    21 Comments

    You must be signed in to leave a comment. Registering is fast and free!

    All comments must follow the ModernMedicine Network community rules and terms of use, and will be moderated. ModernMedicine reserves the right to use the comments we receive, in whole or in part,in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

    • this exam need to stop now and not wait till 2018 as they are proposing,why are the people who are due this and next year being penalised.they need to do the same as the anaesthesia board.we all need relief from this onerous exam which is not shown to be very useful but more a money making and power wielding tool in ABIM hand.we all need to put a united front against this
    • this exam need to stop now and not wait till 2018 as they are proposing,why are the people who are due this and next year being penalised.they need to do the same as the anaesthesia board.we all need relief from this onerous exam which is not shown to be very useful but more a money making and power wielding tool in ABIM hand.we all need to put a united front against this
    • I too agree. It is a total waste of time and money. It should stop immediately
    • Anonymous
      sorry, hit twice
    • Anonymous
      The re-cert is meaningless to our day to day practice. It is the time to end it. Regardless, I decided that I would NOT take any more re-cert.
    • Anonymous
      For my re-certification I had questions about innervation of the face, ( I am a dermatologist) that my colleague, a neurosurgeon, searching for the answer in his books couldn't find the answer. How absurd is that?!
    • Anonymous
      For my re-certification I had questions about innervation of the face, ( I am a dermatologist) that my colleague, a neurosurgeon, searching for the answer in his books couldn't find the answer. How absurd is that?!
    • completely agree that this re certification process doesn't help anybody.the rationale for dangerous internist is full of holes.everyone of us have to maintain at least 25 hours worth of cme to maintain our licences.to keep all of us uptodate a simple solution can be to just have a mandatory yearly internal medicine update to be attended by all internist and it should be low cost or free.the whole process of re certification exam is costly and a way of making money for the board and the board members to feel important and have power.what about all the md who have been grandfathered in?why these things dont apply to them.this all is politics at the worst.we should have a petition for removing this exam immediately similar to the one we had for the MOC.
    • Dr. Wright
      This MOC business promulgated by the ABMS to all of their subordinate boards is part broader regulatory over-reach of these agencies that were set up as honorary specialties societies to serve their doctor constituents and now are trying to impose burdensome and often harmful regulation on the members they are supposed to serve. The only real leverage we / practicing doctors have is to chose to associate with boards or societies that serve us., and are responsive to us . That is what the National Board of Physicians and Surgeons is [nbpas.org] an distinguished board that serves its doctor but doesnt demand onerous re-certification. There is no evidence recertification it makes medicine any better in fact a close look at the studies the ABMS and ABIM put out show no difference in board certification on the quality of care . Which makes the far stretch that multiple certification or serial recertification do anything but wear out doctor financially and emotionally.
    • Dr. Vinni Juneja
      Agree completely with your article and the comments. I think once enough of us have not taken the test and have no consequence of being dropped from insurance panels or hospital staff, this madness can stop. For those of you who haven't taken the recert or failed and haven't retaken it and have professionally been unaffected, spread the word!
    • Anonymous
      I agree, total waste of time and money. It should stop immediately
    • Anonymous
      I agree. I'm done. I passed my initial in 1997. I failed in 2007 on recertification. It was only a few questions but what is the point? Mksap costs. Travel costs. The time away from my patients. What was the benefit? I have avoided now for nine years, knowing that the system was fixed and corrupt. I keep up with over 100 hours annual CME, read journals, and constantly research the salient issues on my patients, and changes clinical practice. This year I certified with NBPAS (Nat Board of Phys and Surgeons). Is anyone going to really argue that one board certification is that much different than the other?
    • I absolutely agree that the ABIM recertification should be stopped. I was fortunate enough to have been grandfathered in but have seen how these repeat exams every 10 years have handicapped my colleagues both financially as well as their ability to work. Given all the prep time that has to go into studying for the boards as well as payment for classes and other products produced by ABIM that are a must if you hope to pass the boards, it forms an intolerable burden on many of these providers who are now in the midst of their professional lives. Plus, during our professional lives, we learn a lot from patient care that could not at all be captured in these tests. By the way, for an average physician, how much does it cost to take the test, go over the approved board certification guides etc... Would it be close to a couple of thousand dollars per person. If you multiply that by the number of people taking recertification tests on a yearly basis, that would be quite a haul. Where does all of this money go to?
    • Anonymous
      The ABIM is in a very bad position right now, but not for the immediately obvious reasons. In a letter to ACP members sent February 7, 2016, ACP Steven Weinberger said: [Quote] -The process for determining the passing standard was modified. As part of our feedback to ABIM, we were concerned that the past process for setting the passing standard (using the Angoff method, an established approach for setting a passing standard) typically used the question writers rather than an independent group of physicians who were not involved with writing the questions. ABIM responded to our concerns by changing its process so that the passing standard was set by both those involved in question writing and a group of practicing clinicians who did not write the questions. -ABIM has reported a notably higher pass rate for the 2015 Internal Medicine MOC examinations, a result we suspect is due in large part to the revised blueprint and the modified process for setting the passing standard on the October 2015 administration of the exam. Although there is no guarantee that this positive trend will continue, we are cautiously optimistic. [end Quote] So we have the ACP telling us that the pass rate is essentially arbitrary. Or at very least subject to bias-- namely those of the group of people who determine what the passing standard is (and by extenstion, the biases of the people who get to choose who to put in the 'passing standard' group. This is an onion with far too many layers). Even though Richard Baron and the ABIM Board don't directly determine how strict the passing standard is, it's not hard to see that they have all influence on it by hand picking people they know who will make it strict. I was apoplectic when I read Weinberger admit "the past process for setting the passing standard (using the Angoff method, an established approach for setting a passing standard) typically used the question writers rather than an independent group of physicians who were not involved with writing the questions". I didn't think that even the ABIM would be this incompetent or evil in determining the passing standard for such a high-stakes exam. Yes incompetent or evil, it's one or the other (or both). There are no other options The can of worms that their poorly designed exam opened potentially leaves them with questions that I am sure they will never address, namely: -Will they go back and revise the passing standard for the exams of years past? It would only be fair to the 4,500 first time MOC exam takers from 2011-2014 that failed. -Will they refund the exam retake fees? Presuming that all 4,500 of those physicians retook the exam at least once, that was an additional $3,400,000+ in exam fees ($750 in retest fees x 4,500) that ABIM reaped by having this improperly strict passing standard. ABIM has been quick to mansplain that they don't fail people in order to make money. But as you can see, they stand to make a heck of a lot of money when they do. Someone explain to me how $800,000 in additional revenue per year isn't an incentive to fail more exam takers. -If they decide that the exam is not an essential part of recertification and drop it, What will become of the lawsuits they have filed against physicians for copyright infringement in 2009? Will they refund the lawyer fees they forced physicians to pay when ABIM SUED EXAM TAKERS WHO USED THE ARORA BOARD REVIEW COURSE? Will they drop the current and ongoing lawsuit vs Jamie Salas Rushford over his 'involvement' with Arora when he prepared to take the initial certficiation exam? Obviously to all of the above questions the answer is 'no', but that doesn't mean these questions shouldn't be asked. Because they WILL need to explain why.
    • Dr. David W. Allison
      The ABIM and other specialty boards are not going to abolish their recertification exams unless doctors start refusing to participate in MOC and the recertification exam. Unfortunately, doctors are too weak and timid to stand up for themselves and no one is going to do it for them. BTW, I am up for recertification this year in plastic surgery and I have REFUSED to participate in MOC and I am NOT going to recertify. Do any of you have the balls to join me? I doubt it!
    • I agree w Dr Allison. I am up for recertification in 2017 and have not participated in MOC. Every communication/survey that ABIM sends me I send back with a note that MOC needs to go away
    • Dr. Macaulay
      I completely agree with this article and comments. Working in a solo practice six days a week and doing paperwork on the seventh leaves absolutely no time to do all the work required to take the recertification exam. It feels like a very heavy burden, but I feel unable to change my working conditions to join another practice or move until the MOC is completed.
    • Anonymous
      all recertification tests should Be "open-book" exams with questions taken from a comprehensive syllabus where the answers are found in the syllabus thereby assuring an updating of knowledge to current standards AND passage of the exam when appropriate time is devoted to the study of the syllabus. It would seem this could also be done at a much lower cost for materials and testing not to mention time out of practice.
    • Anonymous
      ABIM has become nothing more than a panel of extortionists, holding hard-working physicians hostage while paying themselves exorbitant salaries. The entire MOC/recertification process is nothing more than a money making scam. Their behavior must be stopped.
    • Anonymous
      I also strongly support an end to ABIM recertification. It's absurd that I'm being tested on vent settings and ER labs when I haven't set for in a hospital for 17 years! You mention the toll and time it takes, but there is also a huge financial burden for the prep courses, travel, lodging, and then finally the test fees themselves. The whole process is a complete racket and I will never be doing it again.
    • CHRISTOPHERJUNREIN
      ACP applauding the efforts of ABIM does not help! As an advocacy group supported by dues paying internists frustrated and angered by the MOC process, ACP should be advocating for wholesale rejection of this burdensome and unnecessary process.

    Latest Tweets Follow