When You Play The Game And They Change The Rules
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I think one of the biggest frustrations I personally have as a doctor is being at the mercy of people who either have no medical training or are so detached from medicine that they have lost touch with those on the front line.
One particular instance really irked me and I subsequently vented my displeasure to one of the like-minded closed Facebook Groups that I belong to (American Radiologists).
This particular issue is regarding the American Board of Radiology (ABR).
The ABR essentially governs over radiologists who typically need the important board-certified designation in order to find a place of employment.
I have been a card-carrying board certified member in Diagnostic Radiology since 2002.
I have always played by the rules dictated by the ABR and have toed the line with whatever rules/mandates have come from high above.
However it seems like playing by the rules is indeed not enough as this particular board seems to constantly change its stance on multiple issues.
I am basically a captive participant subject to the rules of the Board and whatever whim they are currently touting.
In fact some of these wide-sweeping rule changes occurred while I was still training as a radiology resident.
When I went into the radiology residency program, graduating radiology residents would be granted a lifetime board certification upon completion of training (including taking 3 separate examinations).
I was in my 2nd year in radiology residency (I was post-graduate year 4 (PGIV) resident in this typical PG-III spot because of the lost year I bore from my decision to switch from general surgery to radiology) when the first major impact hit.
The ABR at that point decided that there will no longer be lifetime board certification and made the change to 10 year time limited board certification.
The class of graduating residents, two years above me, just made the cut and were allowed to obtain certification the old way and were “grandfathered” in.
Rather than allowing any resident currently training to also be grandfathered in (essentially 3 more years of trainees), the ABR said that the year above me would be the first to be subject to the new time limited certification.
I personally thought a justifiable argument could be made in support of those already in training to be also grandfathered in as they chose a specialty/residency fully thinking that it would be a lifetime board certification.
Alas as a group, residents typically have no voice and whatever protests were being made across the country were drowned out by the machine.
[As an aside, I am glad that my delay in starting radiology had no bearing on which type of certificate I would have qualified for as it would have been incredibly painful to have just missed out on the coveted unlimited one because of it.]
The financial ramifications of just missing the cut are not insignificant.
There are yearly fees paid to the ABR as well as other expenses associated with maintaining your board certification, all which are not carried by those that have unlimited certification.
Despite all of this, I did make peace with the lot I was cast in and dutifully followed the outline provided by the ABR to maintain my board certification.
Essentially my year and the year above were the guinea pigs in the system.
We were told that there would be a cognitive exam we would have to take and pass prior to our initial 10 year certification lapsing.
For the longest time there was no study materials available or even an idea of what would be covered in this exam as the exam had not even been created.
There were no review courses or asking colleagues what to expect as no one had ever done this.
On top of that issue, there was also very limited locations where you could take the exam.
My year was allowed to take the exam a year early so that it could be treated as a practice run if we wanted to if we did not initially pass.
This meant I was eligible to take the exam in 2011 which I registered for and made plans in 2010.
Because of the limited examination locations across the country, I ended up having to make arrangements to take it in Chicago.
This required me to take time off work, book a hotel, and incur additional expenses, all under the pretense that this would allow me to have another decade of hassle free practice as the cognitive exam reset the clock on the 10 year time limit certification.
For those who have been following my story from the very beginning (thank you), you may recall that 2010 and 2011 were not the best of years for me.
What was going on in my personal life really put additional strain on preparing for the exam.
Despite these awful circumstances, I fortunately passed the MOC cognitive exam on the first attempt.
Technically my ABR certification was now set to expire in 2022 and this is how things remained until 2018 when once again the ABR in its infinite wisdom chose to change the rules.
You see, in 2018 the ABR started sending multiple email proclamations essentially rejoicing that they are doing the radiologists a huge service and instead of taking a cognitive exam every 10 years, diplomates in radiology would now essentially be subjected to weekly quizzes.
The ABR replacement for the Maintenance of Certification Cognitive exam was given the moniker Online Longitudinal Assessment (OLA).
Essentially each radiologist is subject to a weekly quiz answering one question a week from the two questions provided (essentially 52 questions a year).
When I first got the news I assumed that, because I had already taken and passed the cognitive exam in 2011 and it was good for 10 years after my initial certification expired, I would be exempt from these quizzes.
Just to be sure I contacted the ABR to see if this was indeed the case.
The initial email exchange went something along the lines of this (paraphrased from the actual exchange):
XRV (email 1):
Since I am currently board certified and have passed the cognitive exam, I would not have to take part in the OLA until that 2nd certificate I receive has expired, correct?
ABR (email 2):
Thanks Dr. XRV for contacting us!
I have checked on your records and you have indeed passed your cognitive exam and congratulations, you are indeed eligible to take the OLA starting January 2019!
XRV (email 2):
I believe you misinterpreted my initial email.
I knew going in that I would be eligible to take the OLA.
I was inquiring about the possibility of me being exempt from this until 2022 when my 2nd certificate expires since I passed the 10 year cognitive exam.
I spent a decent amount of money and took time off work to take that exam and feel that anyone who had to undergo a similar situation should be exempt from the OLA based on passing the cognitive exam.
ABR (email 2):
Yeah, we invalidated the results of that exam now.
You will have to take the OLA like the rest of the time limited board certified radiologists starting in January 2019.
Essentially I ended up only using 60% of my 10 year certification before the rules changed yet again and I am now forced to be a player in the latest game.
Rather than do the honorable thing and at least acknowledge the remaining time on the cognitive exam the ABR essentially did not care about the sacrifices (both in time and cost) that those individuals had to undertake.
It was essentially a “My game. My rules” stance.
And as bad as it felt for me, there were some who had it even worse.
I know of one radiologist who took the cognitive exam in 2016 and 2 months later was informed it was no longer going to be valid moving forward.
For my non-physician audience, it may seem that the premise behind ongoing maintenance of certification is a good thing as it forces doctors to take tests, etc to prove their competency.
However there is growing evidence that this is indeed not the case:
- How These Useless Exams Are Raising Doctors Costs
- Change Board Recertification Website
- The Clinical And Future Of MOC
The American Board of Medicine has especially been put under the crosshairs as several diplomates of internal medicine have pursued legal recourse against it.
In essence the board of each medical specialty has enjoyed a tremendous monopoly with an extremely captive target audience.
Several grassroot organizations have started to dot the medical landscape hoping to provide an alternative to the various specialty boards, one gaining early traction is the National Board of Physicians And Surgeons.
It has yet to be seen if hospitals and insurance companies will start recognizing certification from these alternative organizations, but it is my hope that they will.
If physicians start voting with their checkbooks as well as their memberships we may have a fighting chance in a system that has always treated us as an afterthought.
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