For those of you navigating the American Board of Internal Medicine’s (ABIM) Maintenance of Certification, I thought this anecdote might shed some additional light on the problems with the process.
On June 26, I had a two-level spinal fusion. On May 9, I called the board to see if it was possible to “stop the clock” on the questions, since I anticipated, correctly in retrospect, that I would not be in optimal form to answer questions after surgery. I was told that no, the only option would be to remove those questions from my total pool. I felt this was punishing me for a temporary disability, so I wrote a letter to the CEO of the ABIM, whose total compensation is publicly reported by ProPublica at $769,945. I wrote a letter because I could not find an email address or a telephone number for him. I heard nothing. On July 1, I received an email telling me, “This is a reminder that this quarter’s questions are available now, and will expire Wednesday, September 30, 2026 11:59:59 p.m. (Eastern Time). Any unopened questions will count against the 100 you can choose not to open over 5 years. This is tracked on your LKA dashboard under the ‘life happens’ section.” Emphasis in the original. The same day, I wrote another letter to the CEO. On July 16, having heard nothing, and still not feeling like I could answer questions at my best, I called the ABIM, whereupon I entered the realm of Kafka. What follows is my recollection of that call.
Customer service representative: May I have your ABIM ID. Perhaps the fact that to the ABIM we are numbers rather than people is informative. Sadly, I actually know my ABIM ID.
Me: Can you please connect me with the CEO’s office?
Representative: I don’t have a number for him.
Me: Really, you don’t have a number for your CEO? I don’t find that credible.
Representative: Would you like to speak to a supervisor?
Me: Yes, I would.
Brief hold, then a supervisor came on the line.
Me: The representative told me he didn’t have a number for the CEO.
Supervisor: That’s correct.
Me: I sent two letters to the CEO and I’ve heard nothing. I sent letters because he doesn’t publish his email, and now you’re telling me you don’t have a phone number for your CEO. I don’t find that credible.
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Supervisor: I don’t have a number for him, but my boss told me they are working on a response.
Me: Who is your boss?
Supervisor: The director of customer experience.
Me: What is her last name?
Supervisor: I can give you her first name and last initial only.
Me: So I am a customer and you won’t give me the last name of the director of customer experience.
Supervisor: That’s correct.
Prior to my surgery, I had an issue with a prior authorization. I sent an email to the CEO of one of the largest health insurers. That same afternoon, I received a call from someone on the company’s executive escalation team, and the issue was resolved the next day. It says something that the ABIM, which by its own publicly reported figures took in roughly $108 million against about $79.4 million in expenses, leaving some $28.6 million, even though it is a not-for-profit, can make a major health insurer look customer-friendly.
On July 30, I formally requested an accommodation of prolonging the timeline for my Longitudinal Knowledge Assessment (LKA). On August 13, I received an eight-paragraph email denying my request. They also “acknowledged my feedback regarding leadership contact information” and added, “Please know your feedback has been noted.”
Seeing no option other than to start the questions, I dove in. The ABIM says it is there to ensure that clinicians have “the clinical knowledge, skills and attitudes essential for the delivery of excellent patient care.” My own experience so far has not matched that. Without going into the content of any individual item, which I am not at liberty to describe, I encountered more than one question whose keyed answer did not appear to reflect approvals and guidelines that had changed years earlier. When I raised this with a senior person at the ABIM, I was told that questions are reviewed at least annually. If that is the case, then the review process seems inadequate to me. If the ABIM expects us to be up to date, isn’t it a reasonable expectation that they too are asking us about the most current therapies and science? Their website says their accountability is “both to the profession of medicine and to the public.” In practice, it seems to me that accountability runs mainly to the institution they have built.
Victor S. Sloan is a physician executive.
