* * Anonymous Doc

Sunday, December 18, 2011

I'm not really sure how the American Board of Internal Medicine can be a non-profit organization when they charge so much for their tests. My internal medicine boards registration just cost me almost as much as one of my paychecks. This is what I end up doing on a "slow night" as medical consult-- almost remarkably slow, practically no admissions, no consults, but instead of trying to take a nap (which, realistically, I guess I know won't happen because the pagers are still going off every twenty minutes), I end up sitting front of the computer spending hours falling down a rabbit hole of reading about study guides and review materials. MKSAP vs. MedStudy, how much do they update each version or can I get by with an older edition, and if so, how old, and is anyone selling this stuff on Craigslist, do I really need to spend hundreds of dollars on study materials after spending hundreds and hundreds and hundreds of dollars just to sign up for the test...

And then I come across a 5-year-old thread on KevinMD filled with comments about doctors who fail recertification and get kicked out of their practice. As if 4 years of medical school and 3 years of residency isn't enough.

I actually don't mind taking tests. This isn't a post complaining about the existence of the tests. They shouldn't make us pay for the tests. And the tests should actually measure something useful. I have no idea if the boards up to this point have measured anything useful. Step 1, Step 2, Step 3, you study, you take the test, you have no idea when you finish the test if you passed or not. I think there's something wrong with the test if you can't tell whether you've passed or not after you take it. Step 2 CS-- the clinical skills test, with fake patients-- almost made sense. At least it was trying to test us on stuff we actually need to have in our heads, we actually do need to remember what questions to ask patients and how to do a physical exam. We actually do need to develop hypotheses and some working ideas of what's going on with our patients. But what dose you give of what drug in what context, we look that stuff up anyway. I shouldn't need to memorize the eight steps of whatever, because when I'm faced with needing to know it, I pull out the card and I use it. I check drug interactions on an iPhone app. And, yes, over time you memorize some of them, and it's a good thing to know as much as possible without having to check, but you check anyway, to make sure, and there are too many possible interactions to memorize every single one.

In principle, I think it's good that we have to take tests to get certified and then re-certified every x number of years, because doctors who aren't up to speed on the latest knowledge are almost certainly hurting their patients at least to some extent. But they make it such a burden, not just the cost but the time you end up spending reviewing things for a test instead of reviewing things for the patients you're actually treating. And who knows if there's any correlation between test score and doctor quality. I'm guessing there is a small and barely-significant correlation. Which is also the correct answer to any epidemiology question on the boards. There is a small and barely-significant correlation. Answer choice C, usually. So, MedStudy 12? 13? 14? Is there a difference? MKSAP? Mayo?


  1. There's an association between % board certified anesthesiologists on staff at a hospital and your likelihood of dying as a patient. It's been shown for other types of drs as well, but it is a real effect.


    Silber JH et al. Anesthesiologist board certification and patient outcomes. Anesthesiology. 2002 May;96(5):1044-52.

    Good luck!

  2. "Non-profit" doesn't mean people aren't making money, Doc, I promise you.