Maintaining certification
In "Recertification made easier" [June 15], I was surprised that no mention was made of the absurdity of having a recertification exam based on a pass/fail
approach. Recertification exams should not fail doctors, but instead make suggestions to them in areas where they could improve.
As educational tools, the boards' methods are clearly outmoded and out-of-sync with the real-world of medicine.
Most doctors, especially those in primary care, customize their practice based on the type of community they are in and the
availability of specialists. Yet the family practice board, for instance, bases its exams on their idea of an ideal family
physician. In my state of Connecticut, I don't know of any that exist.
In addition, the boards are costly and time consuming. They have spawned a whole industry of CME that feeds on doctors' fears
of not being up-to-date. I get a constant stream of advertisements for board reviews and courses throughout the year which
makes me believe that the boards have become a profitable business. The boards cannot measure a physician's competence and were not intended to. Neither can they measure the personal qualities
that make a good physician. They were intended as voluntary exams and never meant to discriminate against doctors or infringe
on their ability to make a living.
If the administrators of the boards would come down from their ivory towers they would get rid of the pass/fail mindset, and
make it known to healthcare organizations that boards should not be used to threaten a doctor's livelihood.
Edward J. Volpintesta, MD
Bethel, CT
I would like to point out the certification by the American Board of Internal Medicine is, at least in part, bogus. As you
point out, internists certified before 1989 do not need to recertify. If the aim of certification is to help assure the excellent and up-to-date quality of all those physicians
who are certified, recertifying should be mandatory for all internists that wish to be ABIM certified.
So in effect, old Dr. Whoever, certified in 1960 and who hasn't read an article or book or attended any courses since that
time, is still a certified diplomate of ABIM. Yet he may still be treating all diabetics with tolbutamide. If you really want
to be legitimate, all diplomates must keep current with certification and no one should be grandfathered in. At the very least,
there should be two categories of certification. One that indicates those who are proven up-to-date and one for those who
have no evidence of having read anything new since phenobarbital was used as a treatment for hypertension!
Perhaps those running the ABIM are afraid of having to take the exam themselves!
Norman Bennett, MD
East Setauket, NY
Not quite "free"
The Feb. 16 "Update" technology item, "Free e-prescribing software for all," is misleading. While the prescription application is free, the interface
to pull the necessary demographic data into the application is not. The base charge for most practice management systems is
$295 plus $19.95 per month, every month.
Donald J. Mirate, MD
Valdosta, GA
Editor's note: It's true that users of eRx NOW have to pay Allscripts for an interface to their practice management system
if they want demographic data to flow automatically into the e-prescribing program. The amounts mentioned in Dr. Mirate's
letter are also correct (although owners of certain PM systems might have to pay more). But the fees charged for the eRx NOW
interface are minor compared to what commercial vendors usually charge. Moreover, eRx NOW users don't need an interface to
use the software; they can simply enter each patient's name, gender, date of birth and zip code manually. That's what most
users do, according to Allscripts.
Appreciate the recognition
Practice Tools
