An upstart in the certification of doctors

Sep 7, 2015

Board certification of physicians has grown into a big business. What was once a one-time exam has slowly expanded to an ongoing and time-consuming process that includes recertification exams every decade and a near continuous stream of online learning modules.

It’s also gradually become a multi-million dollar industry that includes fees, study materials and prep courses. Many doctors claim it’s an expensive waste of time, and now some of them are challenging the business of board certification.

Paul Teirstein, chief of cardiology at Scripps Clinic in San Diego, he sat down at his computer a little over a year ago and attempted to complete the online modules required to maintain his certification with the American Board of Internal Medicine, or ABIM. He figured it’d be no big deal.

“And I was shocked at how complicated it was and how much time it took, and how unrelated to important patient care it was,” Teirstein says.

These modules, which became a requirement in 2014, must be completed every two years as part of something the boards call MOC, or Maintenance of Certification. The whole process costs Teirstein thousands of dollars for something he calls “busywork.”

“You have to click on little answers and spend a lot of time logging in and logging out and figuring what module they want us to do,” Teirstein says. “It’s also very expensive, and it doesn’t seem to help us.”

Teirstein found the process so aggravating that he vented his frustrations to his colleagues on an online message board, asking if any of them had had similar experiences. He expected a few sympathetic responses, but instead he found himself flooded with emails from doctors who shared his frustrations.

“My colleagues were very upset about it, and after about a week of emailing back and forth, they began to ask me what I was going to do about it,” he says.

Around the same time, a handful of doctors began speaking out — they wrote papers in medical journals, and editorials in The New York Times  — and Teirstein gathered more than 20,000 signatures on a petition asking the ABIM, the largest of the 24 medical specialty boards, to remove the online modules.  But when nothing happened, they decided they had had enough.

“This is what ultimately led to the formation of the National Board of Physicians and Surgeons,” explains Paul Matthew, a neurologist and the director of continuing medical education at Brigham and Women’s hospital in Boston.

In January, he and 15 other physicians from institutions such as Harvard, The Mayo Clinic, Columbia and Dartmouth joined Teirstein in forming the National Board of Physicians and Surgeons or NBPAS, an alternative to the American Board of Medical Specialties.

Matthew says the American Board of Medical Specialties is an organization that has gone off course.

“Now the tail is wagging the dog,” says Matthew, "and these boards that were created for very virtuous reasons are now shaking the system and saying, ‘You’re going to do what we tell you and if you don’t you will not be able to practice. So pay these fees, do these modules, and just do what you’re told.’”

Not long after the NBPAS announced its formation, the ABIM issued a public apology to its members, and has since temporarily suspended a number of the MOC requirements.

“We made a mistake with part of our program,” says Robert Baron, CEO of the ABIM. “We’re committed now to listening to the community and learning other ways to do the work that we’re doing.  But we’re committed to the idea that doctors need to keep up, that patients want us to keep up, (the doctors want to keep up), and that’s really hard work.”

But Teirstein says this isn’t about avoiding hard work, it’s about making sure the work they do helps them take better care of their patients.