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Letters

From the January 2001 ACP-ASIM Observer, copyright 2001 by the American College of Physicians-American Society of Internal Medicine.

Recertification

Recertification costs too much time and money, especially for diplomates who have student loans and young children. ("As recertification deadline nears, concerns keep growing," November ACP-ASIM Observer, page 1.) Today's medical climate is harsh enough.

MKSAP should be an integral part of the recert process. I passed my boards the first time by studying with MKSAP, and I try to complete MKSAP every three years. The ABIM's process is so time-consuming that I will not be able to complete MKSAP next time around. That is a sad thought! Perhaps ACP-ASIM could start a rival recertification program centered around MKSAP.

My goal is to one day be a College Fellow. If ABIM has its way, I may eventually have to drop my ACP-ASIM membership. I won't be able to enjoy the scholarship and camaraderie the College offers because I won't have the time.

Finally, I most resent being a perpetual student instead of a scholar, as Faith Fitzgerald, MACP, aptly said. Let the ABIM give me an exam every 10 years that is reasonably priced, then let me enjoy my personal and professional growth.

Cary M. Dash, ACP-ASIM Member
South Hadley, Mass.


I recently sat for the final board recertification exam for pulmonary disease and critical care medicine. As I began the recertification process last year, I was wary, despite the Board's assurances that the tests would focus on everyday practice issues. Each of the self-evaluation modules demanded significantly more than the 18 hours of CME credit awarded, but as open reference tests, they did help me review material to keep up in my field.

I was disappointed, however, by the final exam. While the self-evaluation modules were advertised as covering recent developments in medicine, the final exam was supposed to cover the more "bread and butter" aspects of practice. I felt that the test did not accurately reflect my knowledge or the quality of my practice. I have been in my current practice for more than five years and I see a wide variety of common lung diseases including COPD, asthma, lung cancer, pneumonia, septic shock and respiratory failure. But to expect me to know off the top of my head how to treat conditions I rarely see—like Rocky Mountain spotted fever and tularemia—is ludicrous.

Now that the first large group of recertification candidates has been tested, the Board needs to review the entire process and what it is trying to accomplish with it.

The ABIM's Web site contains a list, "Who's Who on the ABIM Critical Care Medicine Committee," showing that each of the prominent physicians has a strong academic and tertiary care affiliation. (The list is available on the Web at www.abim.org/pubs/pdfnews/2000pulm.pdf.) Because most of the physicians taking the test are in private practice, primary care should be better represented on the specialty testing boards.

Alan Ginzburg, ACP-ASIM Member
Bloomington, Ill.


I am delighted that ACP-ASIM is addressing recertification. Data from the ABIM's Web site (www.abim.org/subspec/examdata.htm) show that for the spring 2000 critical care recertification exam, only 15 of 25 physicians who had previously failed the exam passed on their next attempt. The Web site also shows that the pass rate on the pulmonary recertification exam was 83% for the total group and 84% for first-time takers. I am convinced that the ABIM has very unrealistic expectations and doesn't understand the ramifications of what it has proposed.

Stuart Padove, ACP-ASIM Member
Birmingham, Ala.


The new multiple re-examination required by the ABIM for mandatory recertification is nothing more than a new and onerous harassment of doctors. This continuing degradation of the practice of medicine increasingly makes doctors opt for early retirement and decreases interest in medicine as a career. If medical organizations don't protect their members, I see no value in them.

I would like to point out that I have no personal concern in the matter. I was first certified in 1952 and have recertified twice.

Saul B. Gilson, FACP
New York


We physicians ought to help each other, not force colleagues to spend their time learning esoterica that only fulfills the egos of academic physicians and compounds the difficult requirements that bureaucrats, insurance companies and lawyers impose on our practices. The time spent in CME should be used to gauge physicians' desire to improve their skills and knowledge rather than taking an onerous and highly esoteric exam.

Arthur W. Hammer, FACP
Roslyn, N.Y.


As chair of the ABIM task force that designed the new recertification process and as a former Chair of the Board, I would like to try to put the process into perspective.

The ABIM developed recertification in response to the growing recognition that a once-in-a-lifetime examination does not sufficiently measure physician knowledge and expertise. The Board made recertification mandatory only when the profession failed to embrace a voluntary process.

The ABIM recently redesigned its recertification process to be continuous and relevant to internists' practices, to examine and improve the quality of care, and to solicit patient and peer feedback to aid quality improvement.

The new ABIM recertification process, Continuous Professional Development (CPD), ensures that we stay abreast of the most recent advances in our field and credibly demonstrate our knowledge. The CPD program helps internists assess and improve their practice performance, test daily practice skills and listen to peers and patients.

Using tracer diseases, internists review current practice guidelines and evidence, then evaluate a group of their patients to see how well they are meeting specific guidelines. They then design practice improvement protocols.

Through this nonfailable process, internists will be able to provide regular, direct evidence of quality improvement. Modules in preventive services, the physical examination and interviewing skills will also help internists assess what they truly do every day.

CPD will also allow internists to demonstrate professionalism by obtaining peer and patient assessments of their interpersonal and clinical skills. These new tools will require substantially less time than the self-evaluation models that are required in the current recertification process.

I would like to address several specific criticisms of the CPD program. The new process does not change the ABIM's role from that of evaluator to educator. The CPD process is designed to have the ABIM partner with professional organizations to provide the essential educational materials. The ABIM has reached out to ACP-ASIM and other specialty professional societies to begin implementing this evaluative-educational partnership.

It is essential that physicians recognize that the era of unexamined practice and self-asserted excellence is over. The very real threats to our profession and our professionalism, and our anger and dismay at them, must not blind us to the need to respond to the public demand for quality improvement and accountability.

Stephen I. Wasserman, FACP
La Jolla, Calif.


Editor's note: George Dermksian, FACP, asked for the following clarification regarding his letter on recertification, which appeared on page 2 of the November ACP-ASIM Observer:

The concept of recertification would be best accomplished on the simple recommendation of the chairperson and the executive committee of the department of medicine instead of the administration of a formal exam. It is not my view that they should recommend that a physician take the recertifying exam unless that person does not meet the standards I outlined in my original letter.

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