Why I would never go to a non-board certified physician

Full disclosure. I have 4 board certifications and dutifully do all of the required reading, continuing medical education (CME) and recertification exams to maintain my status (I am board certified in OB/GYN in both the US and Canada as well as board certified in pain medicine by both the American Board of Pain Medicine, ABPM, and the American Board of Physical Medicine and Rehabilitation).

I would never go to a non-board certified physician. Ever. When I hear about OB/GYNs doing plastic surgery, I cringe. I want the doctor who not only did a residency or fellowship in the kind of care I need, but also had to pass some kind of standard testing, not the rogue one who, you know, “knows better.”

Now many doctors have been practicing since before some of the specialities even existed. I am one of those dinosaurs. When I found myself practicing more pain medicine than OB/GYN I decided I needed to legitimize myself somehow. There was no fellowship to do, so I contacted the pain medicine boards and filled out a lot of paperwork to prove I’d been practicing as a pain medicine doctor, did A LOT of continuing education, and then proved my knowledge by passing their exams. I learned A LOT studying for those exams (and doing the CME). I also learned A LOT when I recently did my ABPM recertification exam. And when I do the annual recertification for OB/GYN I learn A LOT. I believe learning things helps to make me a better doctor.

Maintaining certification (or MOC), which is doing a minimum amount of continuing medical education and exams, is required for pretty much every medical specialty (someone correct me if I’m wrong). Studies tell us that MOC tends to improve knowledge of clinical guidelines, because the practice of medicine changes over time. A LOT. There are medications and imaging techniques today that did not exist when I finished residency in 1995.

But the American Medical Association doesn’t think doctors without board certification or those who haven’t maintained their certification over time with the required reading/course work/exams should be prevented from practicing medicine. In fact they are working to find ways to keep the 22% of allopathic and 60% of osteopathic doctors who are not board certified in practice.

I disagree.

Let me tell you, the OB/GYN board exams in the US are a joke. The exam in Canada that I took to complete my residency (because you can’t call yourself an OB/GYN in Canada or actually finish your residency until you pass the exam) was infinitely harder than what I had to do to be a board certified OB/GYN in the US. After both the written and then the oral 2 years later I was left thinking, that’s it????

Keep in mind that board certifications are not a super high benchmark, to quote my recent congratulations letter from the ABPM, they are the “minimal requirements.”

So, I’m sorry. If you have completed your residency and you can’t pass the exam, meaning you can’t meet the minimal requirements, there’s a problem. And if the claim is exam anxiety, I submit managing a shoulder dystocia or heart attack or gunshot wound to the chest is way more stressful than any exam. There are also ways to manage acute situational anxiety. Biofeedback or a beta blocker come to mind.

But there are probably reasons besides failing to pass the exams that keep doctors from being board certified. Some refuse to take the test as a “statement” of some kind (lost on me, sorry), others choose not to recertify when the time comes (I’m not sure why, perhaps the medicine they practice doesn’t change with new research or maybe they are pissed off they have to do it?), and I suppose some cite cost. It’s about $200 a year to maintain my OB/GYN boards and the ABPM exam was a pricy $1700 (but that’s every 10 years). My Canadian recertification cost is covered by the $600 or so I pay a year for the privilege of being a Member of the Royal College of Surgeons of Canada. No sarcasm there, I am proud I completed a challenging 5 year residency and passed that exam.

I’ll be the first to admit that board certification in no way guarantees you are seeing a good doctor, just like a drivers license doesn’t guarantee you are a good driver. However, because certification in many cases is actually a pretty low benchmark, if a doctor has been unable or unwilling to pass the requirements I think that’s an issue.

If you trained before your specialty existed, get grandfathered in. That’s what I did. And I learned a lot in the process. The AMA should be encouraging board certification and perhaps even working on improving the standards for certification, not trying to find ways for doctors to continue to practice without meeting the “minimal requirements.”

Jennifer Gunter is an obstetrician-gynecologist and author of The Preemie Primer. She blogs at her self-titled site, Dr. Jen Gunter.

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  • John C. Key MD

    I believe there is much wisdom in what you say, as well as much fallacy. I do agree that your primary board certification and residency training are of critical importance, as is you committment to recertification and MOC in your primary specialty.

    I am a bit more sanguine about your additional trainings, certifications, “grandfatherings”, etc. I do not believe these are equal to full “in-residence” residency training. They are very akin to what the American College of Emergency Physicians once derisively referred to as “merit-badge medicine” meaning that attending courses or purchasing some certificates for the wall did not equal a residency. It doesn’t. But does it really need to?

    When I entered practice as a newly minted Board-Certified General Surgeon over 30 years ago, it drove me crazy that so many people seemingly didn’t know what “Board Certified” meant, nor did they seem to care. In those days it took little more than a state license to do anything from podiatry to brain surgery if your degree of personal anti-social behavior was that high. Fortunately that has changed. But at age 62, I find myself in agreement with others whom you cite that MOC and the obtaining of other merit badges shouldn’t be necessary. I took and passed my boards twice. I didn’t sit for the boards a third time because I was no longer practicing operative surgery and thus didn’t qualify. Did this mean I should no longer practice any medicine? I think not.

    As you rightly point out, a practicing physician can learn a lot outside of a residency program through reading, courses online and otherwise, and you also assimilate a lot of medical knowledge along the way and you get a lot better as time goes on. We don’t call it “practicing” medicine for nothing–practice gets you closer to perfect. I’m not sure that non-residency requiring boards and certificates are really worth much more than the paper on which they are printed. Unfortunately a lot of it devolves, I think, to personal integrity and rigorous personal assessment of one’s ability to practice in a given area.

    There’s still a lot to be said for personal initiative and responsibility.

  • http://twitter.com/pacificpsych pacificpsych

    Board certification is a scam intended to keep these private organizations rich. It says less than nothing about who you are as a doctor – whether you’re knowledgable, compassionate, conscientious, ethical, kind, wise, etc. Sounds to me like you’ve bought the management – bean counter spiel, hook, line and sinker.

    I guess it might be appropriate for certain types of specialties where these qualities don’t matter.

    • kjindal

      I agree wholeheartedly. not to mention the infinite “board certifications” in bogus made-up crap like wound care etc., which are not ABMS boards, but what patient (or even insurance company the MD is credentialing with) knows the difference?
      the pediatrics example above is quite telling. And the ABIM fees, including MKSAP materials (which either the ABIM or ACP owns – not sure which, but can anyone say “conflict of interest”?) are upwards of $3000. And their execs are making big money off the perpetuation of the “board-certified” myth. Meanwhile 70-yr-old docs are practicing medicine and grandfathered in, just getting by on 2 antibiotics, digoxin, and about 6 other drugs. Ridiculous. And meanwhile NPs can “board-certify” with a weekend course and exam in subjects like cardiology, thus trumping an INTERNIST in “cardiology” and running a clinic as such. How deceptive, as patients (particularly the elderly) feel they’re seeing a “specialist”, in a field that the board-certified internist is incapable of managing. The ABMS and ABIM have definitely sold us down the river on that one, and meanwhile we’re paying the freight…

  • MarcGarfield_DPM

    If board certification is a low but competent benchmark (And it is!!),then, why not incorporate those standards into the licensing requirements and keep the whole process centralized under one authority. Nomenclatural suffix hyperalphabetosis (okay I made that one up) serves only to falsely assert superiority over equally trained and experienced colleagues. As we speak, health care cost are skyrocketing, while reimbursements are dropping and the cost of staffing, education and certification continue rising. If we want to control this issue than we should make some effort as a group to consolidate these redundant expenses. While we are at it, does anyone really feel that a medical education requires every bit of 4 years undergraduate and 4 years medical school? Is it really unrealistic to stream line the process to 6 years, cutting the cost by 25% and adding 2 years of 6 figure income to a doctors working career? Let’s start cutting the costs to operate as a physician somewhere!! In stead of insisting that everything we do is necessary and someone needs to pay us accordingly.

  • http://www.facebook.com/people/Jason-Simpson/100001631757606 Jason Simpson

    The American Board of Pediatrics pass rate is only 70%. Does that mean that 30% of the docs are incompetent? No. In fact, the ABP sets an automatic threshold where at least 30% of all test takers FAIL, even if they answer 99% of the questions correctly.

    Think about that for a minute. You have to pay $3500 to take a test in which A PRIORI, 30% of all test takers are guaranteed to fail before they even sit down to take the test. Thats absurd.

    In order to make sure that at least 30% of test takers fail, the ABP has to make the exam harder and harder every year as people become more savy and study more and more for it. As a result, upwards of 50% of the questions are on obscure, rare genetic diseases that you could spend 20 years in pediatrics and never see a single case!

  • Gordon Terry

    Wow, I had never heard that statistic before that 60% of DO’s were not board-certified. Apologies for my (possibly) dumb question, but do osteopathic physicians have to take different exams from a different certifying authority than allopathic ones? If so, can they take the allopathic board exam and get certified in both?

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