	As a 64 year old primary care physician taking the MOC exam for the third time in 10 year sequences, I read your recent 

	From my point of view, aside from its essential coercive and punitive rather than educational focus, there is a more central fallacy to the internal medicine exam.

	It is essentially a sub-specialist created test that quizzes generalists by repeatedly asking them to make decisions after reviewing cardiac catheter data or viewing renal biopsies. These are responsibilities and decisions that simply do not exist in the real medical world of the primary care physician.

	It not only makes the entire experience useless but in reality for an office-based generalist invalidates any conclusions regarding physician competence or quality of care.

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A reader says the certification exam for internal medicine has little relevance to his practice.