The Certification Racket by Stella Fitzgibbons MD

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I dutifully went through the American Board of Internal Medicine’s Maintenance of Certification process, but on the day I was supposed to take the exam I had fever, nausea & vomiting. Since I failed to reschedule at least 48 hours ahead, I am now informed that it will cost me $775 to take a 7-hour multiple choice test to get a new certificate.

Okay, I’m fortunate that my board cert doesn’t expire. But look at the MOC process:

  1. Accumulate CME credits, preferably via the Am. College of Physicians’ excellent every-3-years program…which I already do and would if the ABIM vanished tomorrow.
  2. Complete a MOC “module”. The only one for hospitalists involved getting doctors, nurses, supervisors etc. to fill out surveys about me and analyze the results. My son had harder assignments on his Scout badges, and IMO they were more relevant to his life.
  3. Take the aforementioned multiple-choice test. Are you serious, ABIM? Do you really think even my least educated patient believes that is an adequate measure of my clinical expertise?
  4. Get a couple of people to write letters saying that I know how to do my job. Neither of my references reports any contact from the ABIM to make sure they are who they say they are.

I hear equally snarky comments from doctors in other specialties about their certifying boards. Do these boards have any reason to exist other than charging exorbitant fees for something of such dubious value?

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  10 comments for “The Certification Racket by Stella Fitzgibbons MD

  1. leibe
    July 1, 2014 at 8:41 pm

    Just curious but has anyone, physician or PA-C, ever felt as if they actually practiced BETTER medicine because they spent a great deal of money and time becoming recertified? Personally I would prefer to take that money and time and get some much needed rest, quiet and peace as I finally was able to make time to read through journals.

    • Pat
      July 2, 2014 at 6:27 pm

      No. Part of my required MOC was “cultural competence”. In preparation, I bought a bottle classic Bombay gin, picture of Queen Victoria on the label, and had several fortifying gin & tonics in celebration of the dying strains of imperialism and western civilization as I wasted an entire evening stomping through the most anti-American propaganda I’ve ever been forced to read. It was utter crap, and insulting to boot. All I ended up with at the end of my 9 CME hours was a further hatred for organized family practice and a resolve to never, ever incorporate any cultural competence into my practice.

      • leibe
        July 2, 2014 at 7:07 pm

        They may hate us but they sure do love that free medical care, free food stamps, free housing and free money!

        • Pat
          July 3, 2014 at 12:22 pm

          While it lasts … Other peoples’ money always runs out, eventually.

  2. June 28, 2014 at 8:15 pm

    Agh. I have to get a BLS card again from the American Health Association. Nevermind that it says on the front that it doesn’t “expire.” It’s got to be renewed every year or so. It’s a good example of the death of medicine by the lukewarm blandness of the bureaucracy. You have to have a current BLS card. That means you have sat through a course. I often ask if anyone else in the course has PERFORMED CPR, or BLS. Yes, I have. Sometimes it worked. The human airway anatomy and cardiovascular system has evolved incrementally since I did ICU rotations. I’m sure I can pick it up and riff on it given the situation. Ca-chingg!!

  3. June 28, 2014 at 11:20 am

    It is just the indignity of it, too. You’d think that they’d even make a little pretense that they believed in their own solemn pronouncement of raising the standards. But they come off like politicians making speeches about integrity.
    You may see an example of some scolding from the ABIM directed at Rand Paul here: http://community.the-hospitalist.org/2010/06/24/dr-rand-paul-not-all-board-certifications-are-created-equal/
    There is little attention being paid to the question itself, never asked in the American educational community, how multiple-choice-tests can be seen as representative of a person’s ability.

    • Pat
      June 29, 2014 at 12:05 am

      The Rand Paul example is instructive. Board certification is important, and useful. Re-certification is pointless, and only a larger way among many for non-physicians to control us, and for masochistic doctors to assist them.

      I dream of the day when I know I have taken my last stupid, insulting exam. Until then – I wish I could scream this personally to the greater public, and to every drone doctor who parrots the industry line – I only do this wasteful recertification/MOC because it is required for my job. It is a cost of doing business that I suffer for a greater net profit. I do not approach this forced “lifelong learning” garbage with any passion or interest. I do it for the cash. There is no pride, no sense of accomplishment in being a bitch for these faceless, omnipotent overlords. We should all have disdain for a public that wants to force their doctors to meet arbitrary goals to provide them meaningless assurances.

      ” I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything — except the desires of the doctors. Men considered only the ‘welfare’ of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter was regarded as irrelevant selfishness; his is not to choose, they said, only ‘to serve.’ … I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind — yet what is it that they expect to depend on, when they lie on an operating table under my hands?” Dr Hendricks, “Atlas Shrugged”

      • June 29, 2014 at 8:58 am

        Yes, good Dr. Hendricks; and I was surprised to find that Ayn Rand’s book would turn out to be, not a lengthy farrago on an impossible future, but rather a handbook, a “Fascism for Dummies” that would be stunningly accurate.
        I like Ayn Rand – not as the cartoonish, dyspeptic shrew she seems to have become later in life, or her oafish followers, the “Objectivists” – they alone can put one off her writing for twenty years, as happened to me.
        Rather, I like her as Alice Rosenbaum, her early self, from whom one can see all her early thoughts arising. “If we do all this only because we love life,” one of her characters offered, “why do THEY do what they DO, to oppose us?” That is a profound moral question. The roots of her thought began in the basis that human life is an awesome thing, and to be respected and cared for. Sounds a lot like the original days of medicine.
        It grieves me when I pick up a learning objective in medicine, and do it because I am forced to, that it is a chore. I used to love the profession! I would read even what other branches would do and discover, not because it was practical to me, but because it was part of the great tree of Medicine.
        I had an ethical twinge yesterday – merely the transit of some moral gas, it turns out. I had to Obtain an Active BLS Card. I have resuscitated quite a number of folks, and perhaps it’s immodest, but I’ve only lost the ones who were bound and determined to wind up dead. It’s really the patient who makes that decision, combined with whatever lies Beyond.
        But back to the BLS Card. There are now firms that offer it online, and it merely is a cash transaction, viewing the movie and reading the script, taking the test, and all that jazz. The American Heart Association has the audacity to update its recommendations, such as – “The rate of compression is no longer 100 compressions per minute, but AT LEAST 100 compressions per minute.” Anyone who says this has never been at a code. I tell the ancillary resuscitators to check for peripheral pulses when resuscitation – useless compressions are useless. I guess I made that up myself, or heard it from someone during a discussion. It’s not authorized, I can tell you that much.
        Was it less than moral to take a canned test solely for the BLS card? No, I was not told to be good at resuscitation, as I am by experience. I was told to purchase a $50 card from the American Heart Association and their financial distributors, which I did.
        The certification is legitimate – I am quite good at Basic Life Support. And I have a card that the bureaucrats Require.
        BLS is a fiction, for a doctor. A doctor needs to do “nisi quamquam” (mandaturus est patiens ad salutem, per totam suam facultatem). Nisi quamquam, a useful and arcane phrase, means in Latin, “specifically that which is necessary” (for the survival of a patient, by means of all one’s ability).
        BLS, ACLS, all that says is to do whatever you know to make a patient not-die. It is a sad little fiction that it can be described and a circle drawn around it. I’ve seen a patient or two come back Through The Door, where they were getting fitted for the Heavenly Robes. Never seen one ungrateful to be back, but boy are they surprised! I was clearly interrupting them from something.
        “Maintenance of Certification” is a sad mockery of Medicine, I fear. Apres moi…..

  4. DrBonz
    June 28, 2014 at 9:13 am

    I was board certified in Orthopedic surgery back in 1995 shortly after my residency. I have to recertify every 10 years. Had to pay for a trip to DC (flight, hotel, meals, test) back in 2005 and now again in 2015. Just the fee for the “honor” of taking the test is $1750 not including the other things involved. At least now I can take the test (multiple choice test) on a computer somewhere a little closer to home and not have to fly somewhere but still, it is unnecessarily expensive. My partner who is 10 years older than me, “grandfathered” in so after his original certification back in 85, he has never had to do anything to maintain his. Nope, doesn’t make any sense to me either.

  5. Randy
    June 28, 2014 at 7:35 am

    I feel your pain. I missed lifetime certification in Psychiatry by six months. In addition to the test (which has about a 98 percent pass rate), there are a number of useless activities you must do. I had planned to get my re-certification done to cover me for the next ten years, then retire before my next date. However, the ABPN has come up with a scheme which mandates that you enroll in their ongoing maintenance program involving a yearly payment. If you don’t pay your protection money, you are not listed as board certified, even if you passed the test just last year. THEY WILL MAKE SURE THEY GET THEIR MONEY.

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