La Nausee

OK, so I didn’t end up laying around eating bon bons.  A foul odor is creeping out of one of our drains and I’m going to have to sit around and wait for the plumber (and save all the useful advice—already tried it all).  One of the problems is that with the PalGals out of town, it’s left to me to determine the source of the stench.  Unfortunately, my sense of smell isn’t too keen; all I know is that something doesn’t smell right.  I guess the plumber can figure that out.  I wish I could charge the prices he does.

I broke down today and bought a MKSAP.  The MKSAP is basically a set of board review books put out by the American College of Physicians, my professional society.  They’ll deny this, calling it a self-assessment product etc., but everyone knows it’s a board review product.  It’s robust enough that it does make a good review product, and a good way to keep up with the field (although like all print-based products, it’s always a bit behind).  It’s also a good way to keep up with Continuing Medical Education credits.

The first time you take your Boards it’s a pretty straightforward process: you finish residency, you go and take the test.  Re-certification is a bit more complicated.  There is no requirement for an internist to be Board-certified. It’s not required for medical licensing, although many hospitals require it for privileges.  Most internists over about 50 were grandfathered in to permanent board certification.   But many of us still feel, for whatever reason, that being board-certified is “a good thing” so I’m going to recertify.

The ABIM (American Board of Internal Medicine) is in charge of the process, called “Maintenance of Certification” (MOC).  The exam is only one part of it. To complete the process, you have to do what amounts to brief, open book quizzes, and you have to complete a Practice Improvement Module (PIM).  The little quizzes are sort of fun and interesting, although the whole thing is expensive and time-consuming. The PIM is not amusing at all.  The requirements are ridiculously Byzantine and aren’t made clear on the website (and emails are not frequently answered, except sometimes with cut-and-paste info from the website).

For my module I chose diabetes, a disease I treat regularly.  The PIM makes me talk at least 25 of my patients into taking surveys, and then requires me to do the same number of chart reviews, an illogical process that culls info from charts, but in a bizarre way: if, for example, I advise my patient to get an eye exam and she does so, it doesn’t “count” because it was done after their visit with me.  You following so far?  Me neither.

After doing all this and a few more things, I apparently have to come up with an improvement plan and “remeasure”.  But it is nowhere defined what “remeasurement” is until you actually get to the step online.  There is no way to plan.

And planning is important.  I get at the office around 730 every day, and leave by about 5, and spend a great deal of time outside regular hours doing paper work and answering phone calls.  I’m fairly certain the folks who designed these PIMs never had to practice medicine in real life and don’t realize what a burden they are putting on working internists.

I don’t care how hard they make the exam, or how many little quizzes I have to do, but the process of recertification is insanely complicated (and costly).  There’s no good reason for this.  I think internists should recertify, but I can understand why someone would simply tell the ABIM to go to hell.


Update here.

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  1. I am one of the lucky 50 somethings who is a member of the first class of grads who weren’t grandfathered. At the time the whole recert process was floated, ABIM reassured all of us clinician-types, not to worry,…The recert exam would NEVER be as basic science/reasearch oriented as the original exam. Of course, 10 years pass, and there was no ‘practice oriented’ (read real life practicing doctor) version, it was still the original type of exam. This test has very very very little to do with seeing real patients. It and all the review crap leading up to it are simply great money makers for ABIM and time wasters for us. Now, they put even more worthless paper pushing on clinicians with this practice module BS. Give me a break. You and your patients know if you are doing a good job. But, there a marginal docs who will pass these tests with flying colors but still can’t communicate well with patients or families, run an efficient office with a happy staff or provide community outreach. The ABIM hasn’t figured out how to make a buck on that one. I will be 54 in 2014 and will be damned if I am going to sit for another meaningless (at this point in my career) test. I agree with you, I think it IS a good benchmark for fellows coming out of training, but after more than 20 years in practice, what does it really prove?

  2. Dianne

     /  December 19, 2011

    I just took the recert a couple of years ago. I didn’t mind the exam and, since I’m a specialist, rather appreciated the review of the bits of medicine that I don’t think much about on a regular basis. The PIM though, those may make me not recert again in general internal medicine. What a waste of time!

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