A few months ago I took my recertification boards for internal medicine (IM). I remembered cramming and doing MKSAP at the end of third year medical residency which coincided with the beginning of first year infectious disease fellowship for my initial certification which I passed on first try.
Now here I was ten years later. My first recertification. I had to ask myself what the value of it was for me. While currently boarded in internal medicine, I don’t practice internal medicine. I focus solely on my second board speciality of infectious disease. I even require my patients with HIV to have a primary care physician.
Why I Took the ABIM Recertification Exam
I will admit that part of the decision to take this first recertification was ego. Primarily, I wanted to remain double boarded. I felt it was too early in my career to drop certification in internal medicine. What if I finally got fed up with the low reimbursement in infectious disease and decide to become a hospitalist? Anyway, proponents of certification/recertification say it’s a measure of a physician’s competence. It’s a way to make sure that our skills and knowledge are kept up to date. It sets a quality standard so to speak.
How I Prepared for IM Recertification
Three months before I was to take the IM recertification boards, my partner quit. My workload doubled. My weekends vanished. Thoughts of taking a few days off to study dissipated. To top it off, I closed on my condo at the same time. To say that I was busy is an understatement.
I prepared by listening to MedStudy’s Core Audio Pearls on my commute to and from work. As I day-dreamed I like to believe that some of what I heard stuck in my mind. At home I spent countless evenings and early mornings taking MKSAP 17 practice questions and reading the answer rationales. My brain was too tired, after a full day of patient care, to just read study material passively. A lot had changed in 10 years, true. By the time exam day came I had completed about 60% of MKSAP. I was as ready as I was ever going to be. I was as nervous as I was with any high-stakes examination. I was also very over it, you know, comatose.
The exam, 4 two-hour blocks of a gazillion multiple-choice questions, was ridiculous. You couldn’t have access to study materials out in the waiting room. You couldn’t have a coat or scarf on meanwhile the exam rooms were kept at a temperature that felt like 32 ° F. I would have worn mittens if I could. You were required to scan your fingers and have your glasses examined each time you walked in. All miserable and anxiety-provoking even before the first exam question flashed on the screen.
After the first five or so questions where I tried to reason things out I gave up. Too hard! The questions made no sense. After that I went with my first choice on each question with no second-guessing. I was so angry. I felt that I had wasted my time all those months of preparation. Evenings I could have used to socialise, rest, take care of myself. Thus, I blew through each section and was out of the Pearson Vue test center in no time. I’m pretty sure the administrator was expecting to see me back for a repeat test soon.
Final Thoughts on Recertification
I passed this exam but I can’t say I was happy with the process. I failed to see its value. It was a complete waste of time. I realised that some things had changed in ten years, indeed. But the MKSAP 17 practice questions alone, which provide CME and MOC credits with passing scores, felt enough to demonstrate commitment to self-improvement and to keeping knowledge base up to date. Doing that in itself was time-consuming. Doing that in itself is a cost of about $500. The 8-hour recertification exam? About $600. This doesn’t include the nearly $200 annual fee for Maintenance of Certification (MOC), whatever that means, which is another new creation for physicians to prove their competency.
Truthfully, I remembered more from the MKSAP 17 practice questions since I was able to read the explanations for those questions that I wasn’t sure about. I felt I was learning in the moment. In comparison, I couldn’t even remember a single recertification exam question to be able to return home to check if I understood the question or the rationale of the right answer.
One can’t help but ask who is making money off us physicians recertifying? I’m not even referencing all the companies feeding off our anxieties by offering review courses and other study materials that we have to pay for. How am I competent one day and all of a sudden no longer competent on the first day my 10 year initial certification expires? Why is it that the initial certification alone is not sufficient? After all, we are all already participating in continuous medical education (CME) annually to prove that we are up-to-date in order to keep our medical licenses active.
Where is the evidence that subjecting physicians to MOC and recertification exams is of any value to the healthcare system? And if these are of value, then why do we allow the older physicians amongst us to grandfather in? Why when in 1990 some wise guy decided board certification needed to be refreshed every ten years did they exclude those who passed their initial certification exams prior to 1990? You would think that they would be most in need to demonstrate that they are up to speed with current medical knowledge, given that the presumption of recertification is that a physician’s years of experience have no value.
So Why Take The Recertification Exam?
When I was lamenting the misery of studying for recertification, a friend, not in the field of medicine, asked why I had to take it. I was hard pressed to provide a logical answer. Right now it is not mandatory to participate in MOC or to be certified by any board in order to keep a physician license. A license acquired only after taking the also time-consuming, difficult, and expensive United States Medical Licensing Examination (USMLE) Steps 1, 2, and 3.
However, many hospitals and insurance companies require board certification or at the very least board eligibility (recent graduates) for physicians to have hospital privileges or to be a participate physician in network. Which means while you can hang out a shingle and open up a medical practice with a medical license in hand, your medical career is not going to be very meaningful if the major players in the healthcare industry refuse to acknowledge you. For those of us then who expect to work in academic medical centers or any hospital system for that matter, or to take care of patients who have health insurance, being board eligible or certified is pretty much a requirement.
If I hadn’t passed I would have had to reconsider if it was worth it to register to take it again (of course, for another fee), especially since I am not currently practising internal medicine. I would have had to take time off to solely concentrate on honing my rote-memorisation and test-taking skills. Sounds insane right? It is.
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