Full disclosure. I have 4 board certifications and dutifully do all of the required reading, continuing medical education (CME) and recertification exams to maintain my status (I am board certified in OB/GYN in both the US and Canada as well as board certified in pain medicine by both the American Board of Pain Medicine, ABPM, and the American Board of Physical Medicine and Rehabilitation).

I would never go to a non-board certified physician. Ever. When I hear about OB/GYNs doing plastic surgery, I cringe. I want the doctor who not only did a residency or fellowship in the kind of care I need, but also had to pass some kind of standard testing, not the rogue one who, you know, “knows better.”

Now many doctors have been practicing since before some of the specialities even existed. I am one of those dinosaurs. When I found myself practicing more pain medicine than OB/GYN I decided I needed to legitimize myself somehow. There was no fellowship to do, so I contacted the pain medicine boards and filled out a lot of paperwork to prove I’d been practicing as a pain medicine doctor, did A LOT of continuing education, and then proved my knowledge by passing their exams. I learned A LOT studying for those exams (and doing the CME). I also learned A LOT when I recently did my ABPM recertification exam. And when I do the annual recertification for OB/GYN I learn A LOT. I believe learning things helps to make me a better doctor.

Maintaining certification (or MOC), which is doing a minimum amount of continuing medical education and exams, is required for pretty much every medical specialty (someone correct me if I’m wrong). Studies tell us that MOC tends to improve knowledge of clinical guidelines, because the practice of medicine changes over time. A LOT. There are medications and imaging techniques today that did not exist when I finished residency in 1995.

But the American Medical Association doesn’t think doctors without board certification or those who haven’t maintained their certification over time with the required reading/course work/exams should be prevented from practicing medicine. In fact they are working to find ways to keep the 22% of allopathic and 60% of osteopathic doctors who are not board certified in practice.

I disagree.

Let me tell you, the OB/GYN board exams in the US are a joke. The exam in Canada that I took to complete my residency (because you can’t call yourself an OB/GYN in Canada or actually finish your residency until you pass the exam) was infinitely harder than what I had to do to be a board certified OB/GYN in the US. After both the written and then the oral 2 years later I was left thinking, that’s it????

Keep in mind that board certifications are not a super high benchmark, to quote my recent congratulations letter from the ABPM, they are the “minimal requirements.”

So, I’m sorry. If you have completed your residency and you can’t pass the exam, meaning you can’t meet the minimal requirements, there’s a problem. And if the claim is exam anxiety, I submit managing a shoulder dystocia or heart attack or gunshot wound to the chest is way more stressful than any exam. There are also ways to manage acute situational anxiety. Biofeedback or a beta blocker come to mind.

But there are probably reasons besides failing to pass the exams that keep doctors from being board certified. Some refuse to take the test as a “statement” of some kind (lost on me, sorry), others choose not to recertify when the time comes (I’m not sure why, perhaps the medicine they practice doesn’t change with new research or maybe they are pissed off they have to do it?), and I suppose some cite cost. It’s about $200 a year to maintain my OB/GYN boards and the ABPM exam was a pricy $1700 (but that’s every 10 years). My Canadian recertification cost is covered by the $600 or so I pay a year for the privilege of being a Member of the Royal College of Surgeons of Canada. No sarcasm there, I am proud I completed a challenging 5 year residency and passed that exam.

I’ll be the first to admit that board certification in no way guarantees you are seeing a good doctor, just like a drivers license doesn’t guarantee you are a good driver. However, because certification in many cases is actually a pretty low benchmark, if a doctor has been unable or unwilling to pass the requirements I think that’s an issue.

If you trained before your specialty existed, get grandfathered in. That’s what I did. And I learned a lot in the process. The AMA should be encouraging board certification and perhaps even working on improving the standards for certification, not trying to find ways for doctors to continue to practice without meeting the “minimal requirements.”

Jennifer Gunter is an obstetrician-gynecologist and author of The Preemie Primer. She blogs at her self-titled site, Dr. Jen Gunter.