1. Before anything, advertise yourself as a protector of the public against incompetent physicians.

2. Design the examinations for each specialty with a “one size fits all” approach. You can achieve this by disregarding the fact that many physicians prune their practices over time to accommodate to the demographics of their communities and their availability of specialty care. This has particular significance for internal medicine and family medicine.

Also, by including a large number of questions that do not pertain to the individual physician’s needs, you will increase their doubts about their competency and reinforce their need to take board preparation exams. This will broaden your network of friends in the continuing education industry as they see their profits increase.

3. Make the costs of the tests high: a thousand dollars or more. This will impress upon physicians their value. Additionally your profits will increase.

4. Be sure to squash any other organizations’ attempts to create their own certifying tests. This will ensure your monopoly status and maintain your control. Needless to say, there is a danger that newcomers may design exams that will eliminate some of the worse defects of yours.

5. Once you legitimize yourself as a protector of patients’ safety, your prestige and respectability will be assured. The path will be open for you to extend your area of influence to create additional certifying exams. Start with hypertension, diabetes, and heart disease. The possibilities are endless. Soon doctors won’t be qualified to treat a sore throat without being certified. The public will feel more secure knowing that you are watching out for them. This too will increase your profits.

6. Give physicians a “failing” grade if they don’t pass the numerical threshold that you feel is proper. Do this even if they have been in practice for decades providing good care and have been recognized by their patients, colleagues and hospitals as good and caring physicians. The potential to harm their reputations and livelihoods will make them redouble their efforts to retake the exam again. The stigma of not being recertified will soon make them forget all about the extra cost and wasted time.

If you adhere to these simple rules, financial success and a position of prominence in the world of medicine will be yours. You will be courted by national advisory committees on patient safety and even Federal agencies. Your word will carry weight.

And you will not suffer any serious repercussions from the doctors that you have harmed because the great majority of them has been indoctrinated to never question the methods or validity of recertification.

Edward J. Volpintesta is an internal medicine physician.