The American Board of Internal Medicine is an organization tasked with protecting the public from dangerous internists. That is a noble goal, however, their methods are of dubious value.
James J. Marino, MDThe American Board of Internal Medicine (ABIM) is an organization tasked with protecting the public from dangerous internists. That is a noble goal, however, their methods are of dubious value.
After spending countless hours completing most of the medical knowledge self-assessment program (MKSAP 16) and taking a two-day comprehensive board review course (from the ACP). I passed my recertification exam in May 2014…by a margin of one question. But 35% of the doctors taking that test did not pass-an important fact that should not be overlooked.
In October and November 2015 I corresponded directly with Richard Baron, MD, the president and CEO of the ABIM. In his response to me he focused on the first-time test taker pass rate and the ultimate pass rate as the most relevant data. In fact, those are the only statistics available on the ABIM’s website regarding the MOC recertification exam.
I strongly disagree with his opinion. The bar for passing the secure exam is set so high that many “non-dangerous” internists will fail and become second- and third-time test takers, and these people are not counted in the statistics on their website. It is inconceivable that any more than 5% of internists practicing for 10 or 20 (or soon 30) years are “dangerous.” Some of us don’t go to hospitals anymore, and some of us focus our practice more in certain areas of medicine than in others, thus tailoring our practices to suit our interests. We may need to look up information for unusual cases more than we did 20 years ago, but that does not make us dangerous or deserving of being put through the rigors of preparing for an examination just because the ABIM has set the bar way too high.
Next: Designed for failure
It is my opinion that in May 2014 when the preliminary pass/fail statistics showed 35% failure rate the ABIM should have realized that their tool was invalid and changed the cutoff before the results were made final.
I believe that at any given time at least 95% of experienced practicing internists are not dangerously incompetent and should not fail that test.
Preparing for the exam is laborious, incredibly time-consuming and ultimately useless. To the best of my knowledge there are no evidence-based trials demonstrating that passing the recertification examination translates to better outcomes.
In a letter from Dr. Baron to me dated November 24, 2015, he stated, “The Assessment 2020 Task Force agreed that it is important and necessary for ABIM to continue to assess physicians through a process that culminates in a high-stakes, pass/fail decision.” However, on the ABIM’s website under “Assessment 2020” key recommendations from the report include “replacing the 10-year MOC exam with more meaningful, less burdensome assessments.” I am very confused by this contradiction. It appears as if Dr. Baron is ignoring his own organization’s recommendation.
There is no doubt I am a much better physician now than I was 20 years ago when I first passed the ABIM certification examination, but I fear that my test-taking skills will fail me 10 years from now and I will be out of work and potentially unemployable at the age of 63 because I can’t pass a ridiculous examination that has no real bearing on my abilities to practice medicine. The secure examination needs to be a thing of the past and I hope that others will continue to protest until our voices have been heard.
Next: Should be gone as of yesterday
Policing ourselves and insuring the safety of the public is a noble goal, but a “high-stakes, pass/fail examination” should not be a part of that process. Abolishing this examination should not need to wait until the year 2020, it should be done now.