If you want to understand the world of professional board certification, it is important to understand the business and politics of testing professionals. Such testing is big business. So big in fact, that huge international media and education companies that trade on the New York Stock Exchange have been created to service this need. According to one article on Reuters from 2012, "the entire education sector, including college and mid-career training, represents nearly ...

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I have been a way from blogging for a a bit and tried to clear my head a bit with a vacation skiing.  I left the computer at home, disconnected (as best I could), and had the luxury of feeling the knees working less fluidly than they had before, but still had some fun for a brief 3 day stint.  It was nice to notice that there's a whole world ...

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I truly enjoy the practice of medicine.  The challenge, the complexity, and the constant evolution, combined with the opportunity to continually, positively, and substantially affect people's lives should lead to an exciting career. However, the economics of medicine as a business have sapped much of this enjoyment for everyone involved. As the government strives to save health care dollars, the hospitals and insurance companies gear up their high priced lobbyists to guide ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 43-year-old man is evaluated in the hospital for severe abdominal pain of 2 days' duration. He is otherwise healthy except for the recent finding of pancytopenia. Family history is noncontributory. His only medication is a daily multivitamin. Following a physical exam and lab results, what test is most likely to establish ...

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Remembering why we got into medicine in the first place can often soften the edges of long, difficult days. My story unfolded on a circuitous route to medical school. I started with a master’s degree in sociology, and my first job after I graduated was working for the Virginia Center on Aging. I administered hour-long assessment surveys to the elderly population of the state. I would drive my old Volkswagen to ...

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As an internist (yes, I am a specialist, just not a subspecialist), I do no procedures.  Patients pay me (albeit mostly indirectly) for my cognitive skills.  But we live in a culture that seemingly rewards procedures more that pure cognition.  Now I understand that procedures are not mindless.  Physicians doing procedures must think prior to the procedure, during the procedure and after the procedure.  But cognition without procedures seems undervalued. The ...

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It saddens me to proclaim that the American Medical Association (AMA), the once-venerable organization that has advocated for the interests of physicians and patients alike since its founding in 1847, is on the precipice of irrelevancy.  Membership has dwindled such that only 1/4 of physicians now belong to its ranks. The attendant decrease in social and political influence that accompanies this decrease in membership arguably compromises the ability of the AMA ...

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Most of us would agree that health care costs are too high in America.  They must be controlled or else we won’t have a sustainable health care system here.  And we should acknowledge that, on average, all doctors in America are paid higher than their overseas counterparts.  But we should also agree that expenses for doctors to earn a degree, maintain that degree and licensure, and pay their malpractice premiums ...

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I first read Dr. Matthew Moeller’s piece from this past March for the first time this week after a classmate of mine passed it on to me. I’m a first-year medical student -- bright-eyed but sleep-deprived, trailing the smell of the cadaver lab everywhere. I entered medicine fully aware of the long, arduous road ahead, almost exactly as Dr. Moeller described it; with many of my classmates in my ...

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There’s an elephant in the room, one that’s preventing patients from getting the most out of their visits to the doctor -- and the name of that elephant is embarrassment. It’s not unusual to feel uncomfortable about some of the more intimate aspects of your health, but too often this discomfort turns into outright embarrassment.  This embarrassment can lead to omissions, which in turn make it impossible for your doctor to ...

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