Wednesday, September 27, 2006
Internal medicine recertification is getting more difficult
Only 74 percent are passing recertification their first try.
Posted by Kevin |
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Comments:
Wrong attitude from Claire.
If docs are to have meaninful reassessment of their knowlege base and judgement (such as can be tested by a fill in the bubble type test) then the pass rate needs to be decreased. The pass rates for most specialites is jokingly high, often 99%+. This is true for the two boards I have personal experience with, pediatrics and anesthesia; further, subspecialty board recert rates are similarly high for both specialties. The process of recertifying should involve some period of focused study; honestly I did nothing but bring a #2 pencil because there was no possibility of failure on these recert exams. If boarded physicians, who are voting members of Board organizations, are to be meaninfully tested as a means of feedback, then they cannot be subject to too harsh of economic penalty or negative public image.
Do I think that I an my colleagues should have exams that actually have some meaningful rate of non-passing, yes. The key here is non-passing versus failure. Not passing is merely the means by which a group for additional study is identified, not penalized. Only on repeat non-passing and confirmation of non-pass status by an alternative means of testing by oral exam, would the status change to failure and withdrawal of board certification.
The recert process should be one that not only weeds out a few poor performers, but seeks to move the whole group toward better performance. Basically it is the opposite of 'no child left behind'.
If docs are to have meaninful reassessment of their knowlege base and judgement (such as can be tested by a fill in the bubble type test) then the pass rate needs to be decreased. The pass rates for most specialites is jokingly high, often 99%+. This is true for the two boards I have personal experience with, pediatrics and anesthesia; further, subspecialty board recert rates are similarly high for both specialties. The process of recertifying should involve some period of focused study; honestly I did nothing but bring a #2 pencil because there was no possibility of failure on these recert exams. If boarded physicians, who are voting members of Board organizations, are to be meaninfully tested as a means of feedback, then they cannot be subject to too harsh of economic penalty or negative public image.
Do I think that I an my colleagues should have exams that actually have some meaningful rate of non-passing, yes. The key here is non-passing versus failure. Not passing is merely the means by which a group for additional study is identified, not penalized. Only on repeat non-passing and confirmation of non-pass status by an alternative means of testing by oral exam, would the status change to failure and withdrawal of board certification.
The recert process should be one that not only weeds out a few poor performers, but seeks to move the whole group toward better performance. Basically it is the opposite of 'no child left behind'.
"I hope my physician is in that 74%"
You need to understand that recertification is largely a matter of being a doctor who finished residency within the past 10-15 years. Most specialities "grandfathered" the physicians who could use recertification the most, namely older physicians. In general, they never need to recertify; this is mostly a matter for young physicians. This has engendered a major intergenerational conflict within specialities, as recertification costs money, takes time, and is another stressor to pile on the camel's back. It has bred resentment about those older physicians who can claim to be board-certified without having to recertify, versus younger docs with "time-limited" board certification that must be renewed every 10 years. So when you see that your physician is "board-certified" be aware that this may refer to a test taken decades in the past and may have very little relevence as pertains to modern medical practice.
You need to understand that recertification is largely a matter of being a doctor who finished residency within the past 10-15 years. Most specialities "grandfathered" the physicians who could use recertification the most, namely older physicians. In general, they never need to recertify; this is mostly a matter for young physicians. This has engendered a major intergenerational conflict within specialities, as recertification costs money, takes time, and is another stressor to pile on the camel's back. It has bred resentment about those older physicians who can claim to be board-certified without having to recertify, versus younger docs with "time-limited" board certification that must be renewed every 10 years. So when you see that your physician is "board-certified" be aware that this may refer to a test taken decades in the past and may have very little relevence as pertains to modern medical practice.
What is the pass rate for the initial certification test?
Does not the ABIM require their diplomates to take "modules" prior to recertification?
If so, not too effective are they?
Does not the ABIM require their diplomates to take "modules" prior to recertification?
If so, not too effective are they?
Having taken the ABIM General Internal Medicine recertification test yesterday (and not knowing yet how I did), I am amazed at how large a percentage of the questions had absolutely NOTHING to do with my day-to-day practice, or whether a GENERAL internist is certifiable to practice.
We have all gone through the weeding-out processes of medical school, residency, and (for many of us) board certification. The idea that 26% of those taking this test are, by "ABIM standards", INCOMPETENT to be recertified is ludicrous. They are a POLITICAL organization ('we have pressures from public ABMS members and others to make the test set standards'--read, 'fail a bunch of people for the sake of doing it so we can self-justify and keep making money and stay politicaly relevant').
Apparently the academics and "pseudo-primary care" test question decision-makers at ABIM need desperately to RESET what they consider PROPER test questions for certification in general internal medicine.
The idea that 26% of us are UNRECERTIFIABLE even after the volume of test prep that most of us do is RIDICULOUS. The VAST majority of us ARE competent, our decade plus of work history can prove this. One wonders why 25% do NOT try to recertify, and would the failure percentage be much higher YET if ALL Internists were FORCED to recertify...INCLUDING those "grandfathered in" who never have to recertify. You KNOW the answer (the failure percentage would likely be 35-50%+), and that answer is UNACCEPTABLE. The TEST is thus unaccetptable.
In my area, if one isn't Board Certified, one can be dropped from hospital staffs, and lose one's job--as "Board Certification" is required in our contracts.
A 99% pass rate WOULD be wrong if this were an INITIAL weeding-out process. It is NOT...we are ALREADY judged competent via long and arduous medical training AND testing, and as evidenced by long work histories, so in my opinion a 95%+ pass rate would be APPROPRIATE.
Of course, speaking this way gets one branded negatively so, like most, I will remain publicly rather silent. What a sad state of affairs.
We have all gone through the weeding-out processes of medical school, residency, and (for many of us) board certification. The idea that 26% of those taking this test are, by "ABIM standards", INCOMPETENT to be recertified is ludicrous. They are a POLITICAL organization ('we have pressures from public ABMS members and others to make the test set standards'--read, 'fail a bunch of people for the sake of doing it so we can self-justify and keep making money and stay politicaly relevant').
Apparently the academics and "pseudo-primary care" test question decision-makers at ABIM need desperately to RESET what they consider PROPER test questions for certification in general internal medicine.
The idea that 26% of us are UNRECERTIFIABLE even after the volume of test prep that most of us do is RIDICULOUS. The VAST majority of us ARE competent, our decade plus of work history can prove this. One wonders why 25% do NOT try to recertify, and would the failure percentage be much higher YET if ALL Internists were FORCED to recertify...INCLUDING those "grandfathered in" who never have to recertify. You KNOW the answer (the failure percentage would likely be 35-50%+), and that answer is UNACCEPTABLE. The TEST is thus unaccetptable.
In my area, if one isn't Board Certified, one can be dropped from hospital staffs, and lose one's job--as "Board Certification" is required in our contracts.
A 99% pass rate WOULD be wrong if this were an INITIAL weeding-out process. It is NOT...we are ALREADY judged competent via long and arduous medical training AND testing, and as evidenced by long work histories, so in my opinion a 95%+ pass rate would be APPROPRIATE.
Of course, speaking this way gets one branded negatively so, like most, I will remain publicly rather silent. What a sad state of affairs.
Claire is a little misguided and possibly works for the ABIM. Past good scores meant that doctors had jumped through yet another hoop because in fair examinations, they knew the material.
LovesMedicine has hit the nail on the head.
I took the re-certifying test, after taking 4 months off from work and studying 8-`12 hours a day. I completed MKSAP, MedStudy and perused another review course. I listened to the MKSAP audio companion and watched the DVD board review by MedStudy. In my opinion, the ABIM seemed to have combed review courses and eliminated any and all clues, from their questions, required to accurately diagnose illnesses. The data was way too scanty to draw any conclusions. How does this simulate medical practice?Many of the questions had more than one real world answer. A specialist said a few of the questions, in his field, were impossible to answer for no such disease entities existed, as described by the questions. The fact that we must remain anonymous, and quell any objections to the abuse, reminds me of victims of the Stockholm Syndrome.
The ABIM has that much power; they can fail you and you'd never know why. As this political organization is granted more and more power, by insurance companies and the government, the abuse will only grow. That doctors are willing to accept this abuse by a non licensing private company is unconscionable in itself. There is no real way to study for this exam when they don't seem to play fairly. The propaganda about the exams importance is widespread as evidenced by no dissenting opinions about the fiasco in the Google search engine and all of the articles about its merit. If this company continues to snowball and grow, as seems to be the case, we are seeing only the beginning of troubles. Think about it. They get at least $1200 per candidate, answer to no one, (where's the oversight?)and are allowed, to determine your fate. Not medical school, residency, experience, credentials, but one exam by one company. The ABIM exam tests how well you can decipher, under timed pressure, what they are asking and how accurately you can guess what they want. It has little if anything to do with patient care, and more to do with power, control and fiduciary gain, as more and more is the case with all aspects of our hijacked profession.
The rules for writing exam questions for the ABIM can be found here. http://www.acvim.org/uploadedFiles/Candidates/exam/ABIMQuestionWritingGuidelines.pdf.
How well did they stick to their own criteria?
LovesMedicine has hit the nail on the head.
I took the re-certifying test, after taking 4 months off from work and studying 8-`12 hours a day. I completed MKSAP, MedStudy and perused another review course. I listened to the MKSAP audio companion and watched the DVD board review by MedStudy. In my opinion, the ABIM seemed to have combed review courses and eliminated any and all clues, from their questions, required to accurately diagnose illnesses. The data was way too scanty to draw any conclusions. How does this simulate medical practice?Many of the questions had more than one real world answer. A specialist said a few of the questions, in his field, were impossible to answer for no such disease entities existed, as described by the questions. The fact that we must remain anonymous, and quell any objections to the abuse, reminds me of victims of the Stockholm Syndrome.
The ABIM has that much power; they can fail you and you'd never know why. As this political organization is granted more and more power, by insurance companies and the government, the abuse will only grow. That doctors are willing to accept this abuse by a non licensing private company is unconscionable in itself. There is no real way to study for this exam when they don't seem to play fairly. The propaganda about the exams importance is widespread as evidenced by no dissenting opinions about the fiasco in the Google search engine and all of the articles about its merit. If this company continues to snowball and grow, as seems to be the case, we are seeing only the beginning of troubles. Think about it. They get at least $1200 per candidate, answer to no one, (where's the oversight?)and are allowed, to determine your fate. Not medical school, residency, experience, credentials, but one exam by one company. The ABIM exam tests how well you can decipher, under timed pressure, what they are asking and how accurately you can guess what they want. It has little if anything to do with patient care, and more to do with power, control and fiduciary gain, as more and more is the case with all aspects of our hijacked profession.
The rules for writing exam questions for the ABIM can be found here. http://www.acvim.org/uploadedFiles/Candidates/exam/ABIMQuestionWritingGuidelines.pdf.
How well did they stick to their own criteria?
# posted by 
: 2:58 PM
: 2:58 PM
I am angry after reading the article linked to the title of this page. The condescending tone of the article is sickening. My husband is a great doctor. He worked 12 hour every day and then studied several hours every night to pass the test and keep his job. He failed. He has never been sued, is licensed and attended medical school, residency and did a fellowship. He has practiced for over 15 years and is respected by his colleagues and patients. This CEO acts like the courts, the government and the employers aren't enough and that some test justifies whether my husband can get paid by insurance companies? This is a professional man who contributes to society and they talk about doctors like they are criminals. How dare her say they should study. Maybe the older doctors taking the test have had heart attacks and strokes like some of my husband's friends. Maybe they have too much responsibility saving lives and working and taking care of their families. Our doctor friends feel that the profession is bullied and harassed, especially the general practice ones. It hurts me to watch my husband suffer so much trying to do what he loves. What happened to medicine? It is too bad because patients suffer along with their doctors.
# posted by : 5:42 AM
: 5:42 AM
I totally agree with the comment by Anonymous. The ABIM is wielding too much power over competent physicians with this re-cert exam. Just like Anonymous, my husband has practiced for close to 20 years, is respected among his peers, has never been sued and is loved by his patients. Unfortunately he has now made two attempts at taking the re-cert. I can't begin to describe the number of study aids and courses he has paid for to help him pass the exam. He is not allowed to take time from his group practice to study. Therefore he is relgated to spending nights and weekends working with the study aids. What disturbs me greatly is the fact that the Board doesn't allow any type of post-exam review. The results are random "decile" numbers - and from this you are supposed to ascertain what areas of concentration need additional focus. Give me a break - this is unconscionable at best. The problem is that the questions don't focus on "real world" examples of medical issues. As stated in one of the previous posts "...the ABIM seemed to have combed review courses and eliminated any and all clues, from their questions, required to accurately diagnose illnesses. The data was way too scanty to draw any conclusions. How does this simulate medical practice? ...A specialist said a few of the questions, in his field, were impossible to answer for no such disease entities existed, as described by the questions." What is going on here? Can't anyone take a stand against this biased, political machine?
After being practice for 10 years in Internal Medicine I have one recommendation. Build your retirement as fast as you can and then get the hell out of this profession. For me it is no longer fun to practice. Insurance companies, the ABIM, patient's looking for miracles and when you don't come through are itching to call an attorney. Brother, there has got to be more to life then this!
# posted by : 11:42 PM
: 11:42 PM
I too failed the recert, much to my dismay. since I cultivate arrogance I will try again. my excuse for being a failure besides just guessing wrong once I had the answer narrowed down to one of two....I am a single mother, working full time, with a severely handicapped daughter that takes every second of my free time...my study time if from 10PM to 12MN. my daughter wakes up 3 times a night with seizures so needless to say exhaustion often precludes the desire study. I am an excellent physician, great bedside manner, never been sued, love my job and my patients and spent 15 years studying to get here...when will it end? when will I be able to live a normal life and use the brain god gave me to focus on my patients instead of worrying about some test that proves I can do what I do already? does not my full practice and the excellent health of my patients prove that already?
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# posted by : 12:52 AM
: 12:52 AM
