The man behind MOC defends the program against critics
So for example a disease that you don’t see very often, that is very rare, but if you missed it the consequences for the patients are dire. That is something we want to keep on our exam, because missing that is really a problem even if it’s not something you see every day. So getting a crowd-sourced opinion on that of people helping us think through well how important is this really? And OK, I mean I (don't) carry around in my brain what antibiotics to treat meningitis, but I better understand meningitis when it happens, and I better understand the test I need to do when a patient shows up with a fever and a headache.
So that kind of thing, it was just a bunch of calibration across a very large exam.
ME: Another complaint we often hear from readers is the requirement to have to board in each subspecialty in which the physician practices as well as in IM, and that the ABIM doesn’t advocate strongly enough on behalf of its members with hospitals that require this for admitting privileges. They want to feel that the ABIM is going to bat for them. Any response to that?
RB: Well, I think how people use ABIM credentials is very geographic and market-specific. When I finished my training in New York the first practice I did was in the NHS Corps in rural Tennessee. It was a community hospital with an ICU and CCU and no medical subspecialists. There were nine internists in the community. So when I had a patient with a heart attack I admitted them and took care of them in the CCU.
Three years later, when I moved to Philadelphia, I got admitting privileges in an academic health center. I admitted my first heart attack on a Thursday night, I was in the CCU writing orders and the nurse asked what cardiologist are you going to consult? I said will they come in tonight? The nurse said no, why would they need to? And I said well why would I need to consult a cardiologist? And the answer was you don’t have admitting privileges in our CCU because you’re not a board-certified cardiologist.
So it’s very market-dependent. Institutions are looking to maximize the quality opportunities they can get, and they want the best-trained doctors in their communities providing care in their institutions. We don’t tell anybody how to use the credential. We explain what the credential is. That’s our responsibility is for the credential to mean something and say what it means. But how it gets used is not something we decide.
ME: But why not try to advocate more strongly and say, ‘this is a real burden for our members to get certification in an area they clearly already have competence in.’ Wouldn’t that help them?
RB: When you say they clearly already have competence in, that’s where things get sticky. Over time knowledge decays, over time people don’t know what they don’t know, treatment expectations change, treatment options change. I’d love to say that every licensed doctor in America always keeps up with that stuff, but that’s not how the world works. And putting out a credential that speaks to whether people are staying current in knowledge and practice, I think overwhelming numbers of doctors want to know that they’re doing that, want to have a way to reassure themselves that they’re doing that, and want a way to communicate to their patients and colleagues and institutions that they’re doing that. That’s what we do.