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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 1):
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):
Oh yeah.
About that.
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.
Note:
If you are in search of financial help, please consider enlisting the service of any of the sponsors of this blog who I feel are part of the “good guys and gals of finance.”
Even a steadfast DIY’er can sometimes gain benefit from the occasional professional input.
-Xrayvsn
NOTE: The website XRAYVSN contains affiliate links and thus receives compensation whenever a purchase through these links is made (at no further cost to you). As an Amazon Associate I earn from qualifying purchases. Although these proceeds help keep this site going they do not have any bearing on the reviews of any products I endorse which are from my own honest experiences. Thank you- XRAYVSN
That’s brutal, man. I really really hate stuff like that. Gets me fired up pretty quickly.
Thanks TPP. Yeah these specialty boards are really getting out of hand and on power trips. It really has been a monopoly and they have a forced targeted audience that has to abide or suffer the consequences of losing your board certification which can mean loss of a job, etc. Thanks for stopping by.
I don’t mean to pile on the ABR (or maybe I do) but I have had nothing but bad experiences, starting with their complete botching of the 2017 Core exam which resulted in the candidates sitting in their test seats unable to take the test for upwards of 2 hours and then mandating that those who were affected have to make up the section that was missed at a later date several months later. It was extremely frustrating as most trainees essentially plan their lives around that test date in the summer. All we were offered was a simple shrug… Read more »
Wow. Sorry to hear about your experience Sean. That is absolutely ridiculous. I knew how stressful it was when I had to take my initial board certification exams (I got the pleasure of doing the oral board examination which I believe is no longer a requirement) and can’t imagine being placed in limbo and essentially have to do another section and take time out of your life to prepare for it.
I do hope something changes with the system. Honestly feels like a huge money making scheme with annual dues, MOC costs, etc.
Thanks for the response! Keep up the good work on the blog, its nice to have found a blog like this with a radiology tilt.
Thank you so much. Really appreciate the support 🙂
I went through the exact same scenario as you. Oral boards in Louisville, 10 yr recertifications, and now the OLA. I was quite annoyed but probably not to the same level as you. I do feel like a guinea pig undergoing their ever changing experiments. I wish they would just stick to one thing. I predict there will be another major change in 5-10 years and with more fees. I’ll have to look into the other national board. The thing with bureaucracies is they eventually become similar to the things they are trying to replace. I actually don’t mind the… Read more »
I so agree MD. It has become ridiculous what is expected of any physician, much less radiologists, who seem to have to jump through smaller and smaller hoops all the while getting hit with reimbursement cuts, etc. I don’t know where they want us to find time to see patients. I fear that you may be right that in 5-10 years there will be something else that the board will conjure up to drive revenue and compliance. Well physicians are starting to voice their displeasure with the MOC format. I do hope that leads to some change. Thanks for stopping… Read more »
The hoops are the hoops. I decided to re-up my license one last time before letting it lapse forever. As I went through the CME I realized it’s a means to control our practice by controlling the guidelines. One lesson was a review of OB anesthesia. The questions used very specific guidelines to weed out choices for example HTN of pre-ecclampsia would be treated at 160/100 but not at 158/98. There is no difference except to a lawyer, and these are the guidelines as set by committee. The bottom line of boards is this: “There are yearly fees paid to… Read more »
Well said Gasem. In the end it really is a money issue with little thought to the doctors on the front line. Just another reason why it will be good to hang up the stethoscope/MRI for me.
After reading this, I couldn’t help but be reminded of PoF similar experience: https://www.physicianonfire.com/moca/
Different board, but a money grab nevertheless. Collectively they function like a cartel. In a sign of hope, several state legislatures have passed laws prohibiting MOC as a requirement for medical licensure, hospital privileges, or insurance participation. If you practice in one of these states, great. If not, a good reason to attain FI ASAP, then YOU get to decide whether or not to be subject to these arbitrary requirements.
I think a cartel is a wonderful descriptor for what is going on with the American board system. It is a sad state when boards have to cannibalize their own
I am on my way over, we will taker care of this the old fashioned way
LOL. I am afraid it may have to come down to just that to make them see the light 🙂 Appreciate the support. Maybe we need to get some real henchmen instead of the money henchmen you mentioned in you previous post. 🙂
Thanks for sharing. You have a great blog. Most of your blog and posts commentary are always so positive. So this is really bugging you. I am glad to be retired. I am afraid your story is going to continue to be repeated for a long time. The constant testing and review of performance were intended for a good reason but have gotten way out of line. We are like no other profession. We get it from all sides. Just thinking about it helps refresh my PTSD or burnout or whatever you want to call it. I used to feel… Read more »
Thank you Badger for the kind words. Yeah not too much gets under my skin but when I feel like I am getting taken advantage of it bugs me to no avail. I concur with your opinion that this will continue to repeat as those in power have no incentive to make any changes. As a group physicians are a perfect target. You appeal to our altruistic sides and thus you will never see doctors here for a union and strike because we still put our patients health above our own. These weekly quizzes in particular make me feel like… Read more »
Pediatrics is going through the same transformation. I am in my first 5year MOC cycle and can either take the written test at one of those testing facilities after the second cycle or do the at home questions. I haven’t decided what I’ll do. But don’t worry, it costs thousands either way!! My favorite part of the newest iteration of all of this is that the peds boards people asked for physician volunteers to beta test the new OLA style assessment. They got tens of thousands of pediatricians to volunteer their time and then are going to turn around and… Read more »
I am afraid that when one board specialty sees another board specialty implement something like this, raise more revenue, and get away with it, they will soon follow suit.
Reading about some of the things the American Board of Internal Medicine is accused of and the amount of money in question is eye-opening (evidence money was used to buy a 2.3 million dollar condo with chauffeur driven Mercedes as well as a $1.7 million dollar salary to the outgoing president) make things quite interesting. Here is a post on it if interested: https://www.massdevice.com/abim-its-finances-and-great-collusion/
This is infuriating. Sorry you are having to deal with this. Hopefully the tide is starting to turn as physicians start to push back against the this kind of malarky. It would be funny except what you just described is incredibly costly (in time and money) and has NOTHING to do with patient care. Unfortunately lawsuits may be (part of) the answer as common sense seems to have nothing to do with it. Good luck with all this.
I appreciate the support. Infuriating is a perfect way to describe what I call the “MOC fiasco.”
Being under the auspices of “improving patient care” seems to give these governing bodies a lot of leeway on how they implement things.
OLA is the Spanish word for wave. Fitting, as it keeps pulling you under and pouring salt in the wounds it creates. I am hopeful that as a backlash develops, merit-badge medicine will be something we look back on like we now do leeches (I’ll resist yet another metaphor).
Hang tough, Xrayvsn.
CD
I hope so too. This kind of thing would not fly with pretty much any other profession. Would have union uproars etc
My professional and critical response is: That is some bullshit.
I guess I’m lucky I don’t have to deal any of that kind of regulatory crap, and I’m sorry you do. Woof. What a headache.
(P.S. I had this blog post open in a tab for severallllll days because I wanted to make sure I’d have time to actually read it. So congrats to you, because I close all my tabs at the end of the night, typically! ?
Lol. Is that why my Google analytics says the average time a reader spends on my site each is now 27 hours? Was a big improvement from my 3 min duration. Lol. Just kidding. Honored my tab stayed open that long ?
Happy to help pad the stats ?
Ugh – this completely sucks. At ABEM they’ve also recently revised the certification process because the troops were getting riled up, but the perpetual fees and tests (even in reduced form) remain quite painful. At least with ABEM if they made you take a test that turned out to be useless they credited you the cost toward their new test.
Sorry for the latest aggravation, Xray.
-CD
Thanks CD. Yeah I think the specialty boards have lost their way and now driven by money