Recertification: I’m not impressed

Recertification: I’m not impressed

June 2013

Well, I’m making progress toward recertification through the American Board of Internal Medicine (ABIM). Having done most of the other pre-board exam requirements, I spent quite a while on the ABIM Web site looking for a practice improvement module relevant to a hospitalist’s practice–even though I’m signed up to recertify in focused practice in hospital medicine.

Finally, I e-mailed the board and was told about the teamwork effectiveness assessment module and started it. It was interesting getting input from nonphysicians about how our group communicates, cooperates and so on, and analyzing responses and formulating a plan. But as an influence on my practice, there are many more powerful factors: hospital quality-improvement initiatives, InterQual standards, phone calls from primary care docs … I could go on, but you know them as well as I do.

This will be my third time recertifying for the ABIM and, at my age, probably the last. And I gotta tell you, the recertification process does not impress me.

The continuing education requirement is reasonable, sure. But you’re a fool if you don’t already attend courses or get your CME from online or mail-in courses. The New England Journal alone offers 100 credits a year, and your professional organizations will award even more while teaching you stuff to care for hospital patients. Getting a letter from your department chair is not a big burden because it’s just a quick e-mail or phone call.

But the last board exam I took was, in my opinion, based on 30 years practicing internal medicine, not a reasonable measure of my clinical competence. It was entirely written–understandable given the cost of one-on-one exams and the possibility of conscious or unconscious bias by examiners. It lasted several hours and was clearly the result of a lot of effort on the part of the preparers, who seemed to be aiming to cover all the major areas of medicine.

But those exam writers have an impossible job. There is simply no way for pencil and paper to show whether you take a careful history and perform an adequate physical exam. Or if you can find the meaningful lab values from an entire page with lots of little red flags or figure out how to see 20 patients without finding a nasty surprise on the last patient’s chart. And covering all of internal medicine? The exam would need several days, not just a few hours.

So if I don’t believe that the ABIM recertification process gives an accurate measure of competence, how do I know that my partners are good at their job? Now, that’s easier: I review their charts, talk about patients with them and get feedback from other health care professionals. If there’s a dud in our group, we know it within a few weeks of that doctor’s being hired.

Most boards charge several hundred dollars for recertification, and with hospitals requiring it for credentialing, the boards have a gold mine on their hands. But don’t hospitals and other health care groups have a right to expect certification to reflect the doctor’s ability to take care of sick people?

Change won’t happen unless the the boards’ customers–both doctors and those who rely on certificates–demand it. That means not just individuals, who have little choice but to take what the boards hand out, but organizations like the American College of Physicians, the Society of Hospital Medicine and others.

Write your organization. Tell them what you need. Or your board certification will just be another roadblock in the way of patient care.