Specialty Board Re-certification: Improving Care or a Money Makeing Racket?

April 5, 2010 in Health Policy, Medical Ethics by RangelMD

Physicians are among the most frequently tested group or profession in the history of the planet. Through four years of undergraduate education, the medical school entrance examination (MCAT), four years of medical school, three or more years of graduate training, three licensing examinations (USMLE), and board specialty exams, physicians are more akin to “professional test takers” these days than healers and practitioners. Even though physicians (especially the ones in academia) like to say that the training and learning should never end, now neither does the testing. Except for those lucky (i.e. old) enough to be grandfathered out, all specialty boarded physicians must re-take their board exams every 10 years.

On the surface, this re-testing sounds like a good idea for a profession where new treatments, new discoveries, and new medications are constantly emerging. And yet, there is no evidence that board certification or repeat testing of any frequency leads to better qualified doctors or better health care quality. What is the upside to re-certification? Theoretically, it compels physicians to study and keep current with all the latest research and treatments. But this is what a good physician should do regardless and with a testing frequency of every 10 years, those facing re-certification are likely to wait 9 years until right before the test to crack a book or worse, to study for the test and enroll in a  board “refresher” course rather then to enhance their own medical knowledge. Educators with experience with standardized tests know what I’m talking about here.

What are the downsides? Stress and anxiety for one. Board certifications are not just something that physicians do to have another decoration to hang on their office wall in order to give their patients a false sense of security. Current board certification is often a requirement for hospital staff privileges, professional society memberships, and enrollment in most insurance plans. The loss of board certification could have a profound impact on their financial security and ability to continue to practice in their specialty.

Cost is another. The cost of the test itself in addition to a “quickie refresher course” plus time off from work to study for and to take the test can cost several thousand dollars. Though this is certainly not prohibitive considering the average income of most practicing physicians, I have to wonder about the intent and ethics behind an entire industry of specialty boards and study aids and courses that has sprung up to siphon off money from a profession based on a standardized testing scheme that has not been shown to improve or strengthen the delivery of patient care.

Back in medical school we were taught that an organism that benefits in some way from another organism without giving anything back is called a parasite. Thus, specialty board certification remains a parasitic activity until proven otherwise.

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