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This is a mildly edited version of an email I sent a few months ago to my only child, a partner in our practice of primary care internal medicine.
Below is a mildly edited version of an email I sent a few months ago to my only child, a partner in our practice of primary care internal medicine.
My Dear Alberto,
I originally got certified by the American Board of Internal Medicine (ABIM) in 1990. I recertified in 2000 and told myself and a few others it would be my last recertification because by 2010, I would be 58 years old, my son would be through with his training and any patient who insisted on a “board certified” doctor could see him.
I was sure that by 2000 I could retire any time I wanted, since the practice of medicine has been so good to us and we’ve been very frugal all these years. Then and now I work principally for the love of medicine and my patients. If “the system” wants to give me a hard time, I can go concierge or retire completely. The “fat cats” can go to hell. But will they take care of my patients? Of course not. They’re too busy being ivory tower administrators, far away from the trenches in the front lines of medicine, not actually taking care of patients.
Next: "Very cumbersone, expensive" process
In 30 years of private practice, only one telephone caller inquired about my board certification status. I was certified at the time but told the secretary to tell the patient we were not accepting any new patients for several months.
My real objections to the whole certification and recertification process go back a long way. The general practitioner who saved my life in 1975 when I had pneumonia and also inspired me to change career paths was not board certified by the ABIM either.
I only bothered with the whole certification process the first time because in the 1980s the hospitals and insurers were threatening to disaffiliate doctors who were not certified and the literature was saying there was a doctor surplus. Little did they know then and now about the topic of doctor shortage.
The second time I re-certified, I just had to pass the all-day exam, so I reviewed the then-current MKSAP and took the exam. After that, the ABIM changed the whole process to a very cumbersome, expensive, Rube Goldberg-esque experience I had no interest or time to deal with.
Reality then intervened: supply and demand; not enough primary care doctors. The insurers and hospitals backed off their threats in the ensuing years and I breathed a sigh of relief.
Next: "The system knows where I’ll tell them to go if they harass me about board certification"
Now we have nurse practitioners and physician assistants practicing “primary care.” Nice people I’m sure, but not doctors of medicine. They’re certainly not board certified. So the insurers are going to pay the doctors’ helpers and the not the real doctors? I don’t think so!
I’m 63 years old now. The system knows where I’ll tell them to go if they harass me about board certification. Age, saving and investing in very low-cost indexed mutual funds and municipal bonds has its rewards!
What’s all this got to do with you, my son? You hopefully have another 40 years or more in medicine and it certainly doesn’t hurt to be board certified. If they do change the process to what [the ABIM has suggested in reforms] I’ll probably do it too. Continuous quality improvement is more than a slogan or motto. I try to live by it every day.