Does Board Certification Really Matter?

My patients have the confidence of knowing that I am a board certified gastroenterologist (GI). I haven’t disclosed this to them personally, but somehow resourceful and curious patients can now find out facts about me that heretofore would have required a government warrant. (In fact, for my entire medical career, I have never displayed a diploma or any professional certificate in my office, which annoys my mom.) Now, with a few keystrokes, patients can read about my suspension from the fifth grade after making an unwelcome comment about another student. Being from the northeast, my initial reaction to this transgression was, “Will this be on my college record?” Assuming that I successfully recertify in gastroenterology in the coming year, I will enjoy this prestigious designation for another decade. I hope I that I am still practicing then, since the health care reformists have promised us a medical nirvana in in the coming years. It would be a shame if I retired just before the nirvana tsunami struck our shores.

What does a board certified label mean for patients? Patients seem to be reassured when their physicians have received the American Board of Internal Medicine’s ‘Good Housekeeping Seal of Approval’, but do they really know what it means?

Here’s a short quiz for patients to gauge their knowledge of this issue. While each answer may seem reasonable, you are charged to choose the best answer. Don’t agonize over this. After all, this is not the SAT or the ACT, where a single incorrect response can determine one’s ultimate success in life. Indeed, we have taught our 5 kids since kindergarten that failure on important standardized tests is tantamount to failure in life. For this reason, since our kids were small, I placed a different ‘flash card’ under the toilet seat each morning, so that their gastrointestinal function could be combined with educational enhancement. Our kids wondered if this activity needed to be continued during their high school years, but I emphasized that knowledge acquisition is ongoing, and should not be prematurely flushed aside.

Here’s the quiz question.

Board certified gastroenterologists, in comparision to 'board eligible' GI wannabees are able to :

(1) Perform rectal exams with all 10 digits

(2) Complete a colonoscopy speedily before the sedation has taken effect

(3) Impress patients with fancy jargon like dyspepsia, instead of using common verbiage, such as stomach ache

(4) Profess ignorance of the cost of procedures since health has no price

(5) Order enemas routinely assuming that patients will enjoy the experience

(6) Make an involuntary donation every 10 years to the American Board of Internal Medicine (ABIM) so that hospitals and insurance companies won’t kick us off their rosters.

I am now deep in the recertification experience, which is known by the ABIM as MOC, or Maintenance of Certification. I have completed most of the required modules, which are home study sessions that can be retaken, if they are not successfully passed. Afterwards, I can proceed to the culminating experience of the entire recertification process – the all day test. Here's where I will likely have an opportunity to guess at answers that I could look up in a book or computer in real life. Physicians in private practice like me are always delighted to sacrifice a day’s income to serve the greater good. In this digital era (who knows more about digital than gastroenterologists?), would it not be possible to take this exam from my own computer on my own time? However, it is not for me, a simple blogger, to question the infinite wisdom of the ABIM who has commanded from a Philadelphia mountaintop:

 Thou shalt set aside a day of wages on the Altar of Knowledge after the check has cleared.

There’s a reason that so many physicians find the MOC to be an expensive hassle that doesn’t accomplish its mission to improve the quality of our care. While some argue that board certified physicians have superior clinical outcomes, this may be unrelated to the MOC process. These physicians may perform well because they are already skilled and knowledgeable practitioners. This is similar to concluding that high school students who score well on the exalted SAT examination will perform at a higher level in college. It’s the kid that determines the success, not the test score. Personally, I don’t think that the lengthy and expensive recertification process will improve my knowledge and performance. Like most physicians, I have developed my own educational strategies to remain current in my field, and I believe they are working well. It is clear, however, that the MOC delivers great benefit to the ABIM.  Not surprisingly, Christine Cassell, MD, president and CEO of the ABIM expresses on KevinMD that the current recertification process is worthwhile, although admits that reforms are needed

Would we physicians run this gauntlet if we didn’t have to? For many of us, the MOC is a Marriage of Coercion. Don’t look for my certificate on the wall.