I received a lifetime certification from the American Board of Internal Medicine (ABIM) in 1983. Since then, I have not participated in any of the Board’s “Maintenance of Certification” (MOC) programs.
I have taken the continuation of my medical education seriously, and have performed more than the number of hours required for my state licensure, professional liability insurability, and AMA continuing education recognition awards. Additionally, I have taught medical students and residents at two medical colleges, lectured to dozens of physician groups across the United States, published three medical books, contributed more than 200 articles to the medical literature, and penned my own feature column in “Internal Medicine World Report.” All this required my staying current with the latest developments in medicine.
The redundancy of MOC
Considering the redundancy in studying for the ABIM MOCs and all I have done to be able to continue practicing internal medicine at the same location for the past 45 years, I do not feel the MOCs could have, in any way, improved my fund of knowledge or competence as a physician. What the MOCs could have done is forced me to pay exorbitant prices for courses I could have easily duplicated by simply reading current medical journals and textbooks, attending relevant medical lectures that were geared toward the medicine I actually practice, and performing the ongoing research I require every day to be able to provide the highest level of medical care to my patients.
A “pay to play” scheme?
The argument that the ABIM has attempted to lock physicians it has previously certified into a “pay to play” scheme is a valid one. Another argument that the ABIM has extorted money from physicians by forcing them to test and retest to stay in the Board’s good graces, as well as those of its related institutions, also bears legal and legislative consideration.
A final argument that the ABIM designation of a physician who was certified before 1990 and has chosen not to participate in the MOC as “Certified; Not Participating in MOC” is misleading and potentially harmful to the reputations of physicians so designated. Such a designation could be mistaken by patients or colleagues to identify a physician who did not support or was indifferent to continuing medical education.
A change in practice
I recently turned 77 years of age and started limiting my professional activities to patient care in my office and house calls performed in the homes of my patients. I no longer provide inpatient or skilled nursing care. I made this change, not because of any changes in my physical or mental health, but because of how disillusioned I have become by the way institutions are taking decision-making responsibilities away from competent, dedicated, and highly trained physicians and transferring them to committees, physician extenders, and artificial intelligence.
At a stage of the game when most of my contemporaries have already retired from the practice of medicine, I am able to view the medical profession and its workings from a unique perspective. I am also able to speak confidently and authoritatively about my profession because, in 1983, the ABIM determined that I was competent to practice internal medicine and awarded me lifetime certification. The names, faces, and policies may have changed at the ABIM over the years, but a lifetime certification is a lifetime certification, regardless of who grants it or who receives it.
No intention of retiring
Being of sound body and mind, I have no intention of retiring from the practice of medicine as long as there are patients who require my services. Accordingly, I will continue to practice medicine knowing I have done so for many years as a board-certified, for life, physician.
This essay is cited in the KevinMD record on board certification.
Bernard Leo Remakus is an internal medicine physician.
