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I Am Simply a Pawn in the Board Certification Game

Op-Med is a collection of original articles contributed by Doximity members.

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 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. 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 three separate examinations).

I was in my second year in Radiology residency 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 a 10-year-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 three 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.

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. 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. Because of the limited examination locations across the country, I ended up having to make arrangements to take it in Chicago, which 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.

Despite all this hardship, I passed on my first attempt. This meant that 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 were 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. But when I contacted the ABR to confirm, they told me I would 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 percent 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 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. It would be a good idea, if it were done rationally. 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.

For those physicians practicing in specialties that are outside of the American Boards mentioned above and feel that this therefore does not pertain to you, I leave you with an all-time classic quote:

First they came for the socialists, and I did not speak out—

    Because I was not a socialist.

Then they came for the trade unionists, and I did not speak out—

    Because I was not a trade unionist.

Then they came for the Jews, and I did not speak out—

    Because I was not a Jew.

Then they came for me—and there was no one left to speak for me.

— Martin Neimoller

Image: Hermin / shutterstock

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