“Certification is the universal scam.”

I read that in one of James Altucher’s books. If you don’t know who he is, don’t worry, I didn’t know his name twelve months ago either. As it turns out, the Google search phrase that is most likely to take you to his website is, “I want to die.” When I learned this, I thought he must be a physician counseling those with severe depression. As it turns out, he’s not a physician at all. But, he’s helped a lot of people. In fact, you should go read a post on his webpage after finishing this one.

Regardless, Altucher is right.  Certification is the universal scam, at least in medicine right now.

The irony is that most non-physicians don’t even care. I don’t mean this in a bad way. I’m just telling you that I haven’t had one patient ask me about any certificate that’s ever been on my wall. Despite what one of my medical certifying boards, the American Board of Internal Medicine (ABIM), will try to tell you, real patients don’t have much interest in plaques with gold lettering. The reason I know this is because in contrast to the physician leadership running this Board, I actually see large numbers of real patients everyday.

In all fairness to the ABIM, they aren’t supposed to be in the business of seeing patients. Their job is to certify doctors. They are not a government organization. They are not involved with issuing medical licenses. I don’t actually need them to practice medicine in this country. They are really like a country club, and yes, I’m currently one of their members. But, I’m starting to question if I will be a member there for much longer.

In order to be a doctor, by law, you must obtain a medical license. This involves graduating medical school, successfully passing a number of tests, and applying for licensure in your state. Basically, you learn all the stuff that you need to know to initially become a doctor, and then you get your license. To maintain it, you keep going to medical conferences, reading articles, and spending hours every year staying up-to-date. If you do all these things and stay out of trouble, you get to keep your license. All things considered, everything up to this point makes fairly good sense.

But, here is where the wheels fall off the wagon, and the reason is quite simple to understand. In fact, the American Board of Internal Medicine (ABIM) has $55 million in quarters collapsing the cart. That’s how much revenue the organization brought in last year certifying physicians in this country. The ABIM wants you to think that they are improving patient care, but the entire operation has gotten carried away by some of its leadership–basically, a group of physicians with their stethoscopes in the attic.

For example, the ABIM’s Ivory Tower is spending $20 million per year developing and administering exam questions to physicians. If you do the math (see my book), that comes to a cost of over $4,000 per question. I’m not kidding. In this day of healthcare transparency and focus on cost savings, how is any organization who spends $4,000 in order to write a SINGLE test question providing value to anyone?

I may differ from some of the critics here, but I don’t even have a problem with ABIM’s chair making nearly $1 million per year, as long as he or she is doing a good job enabling its physician members to provide quality healthcare. But, ABIM’s Ivory Tower has completely lost touch with the pulse of medicine. They’ve gotten the concept of what’s valuable to patients all backwards. Search the web for “Maintenance of Certification (MOC) requirements” and click the first link. You will see how complicated ABIM is making it for physicians to keep their board certifications. In fact, I researched the entire process before writing my book, and I still can’t explain all the steps off the top of my head.

Almost laughable, the ABIM also requires physicians to now complete numerous “practice improvement projects,” better described as busywork, to maintain their board certifications. It’s almost as if the ABIM thinks they understand more about running my private practice than I do. They obviously don’t have a clue what I’m doing, and here’s why. Every day that I go to work is a practice improvement project. I run a business. A business does not survive if it can’t demonstrate value. Every day that I wake up, I start out running, and if I can’t outrun my slowest competitor, my patients will go see someone else.

We need some standards in medicine, and I outline what those should be in my book. But, you really just need to know how little these recurring standardized exams and practice improvement projects are helping medicine. Lawyers aren’t retaking their bar exams every decade. It’s because they know there’s no value in that type of thing. Medicine is so far behind the curve.

I realize that you may not be a physician who takes these tests, but I am. Test questions are typically a couple of years old, based on guideline statements that may or may not be applicable in the dynamic environment of modern medicine. New research literally comes out every month, and guidelines aren’t updated that frequently. Frankly, if you’re practicing medicine based on printed guidelines, you are probably out of date. Dr. Paul Teirstein made that comment, not me, but he’s right. Dr. Teirstein is chief of cardiology and director of interventional cardiology at the renowned Scripps Clinic in San Diego, and if you are a physician, you should have already joined the movement he’s spearheading against the ABIM.

I have four board certifications. Three of them are with the ABIM. I’ve got plenty of plaques on the wall, and I’m devoted to lifelong learning in medicine. But, I’ll tell you what my patients care about most. They care about me being there for them when they are sick. They want me to be available late in the day or on the weekend when they need me for an urgent matter. They don’t want me paying thousands of dollars taking some outdated computerized test that requires a biometric palm scan, fingerprint, and digital photograph to get in the testing center. They want me at their bedside. This is what provides more value to them.

Unfortunately, the Ivory Tower with a monopoly on medical certification can’t figure this out. They no longer seem to have the best interests of my patients at heart. The ABIM can still fix their failed system, but they won’t. They move like a tanker ship stuck in the sand. And, if there’s one thing you’ll learn from reading my book, it’s that we need to rid medicine of tanker ships.

Godspeed to the establishment of a new physician certifying board. It’s a vision called the National Board of Physicians and Surgeons. Something formed by clinicians to provide better value to everyone. And, do you know the best thing about it? It’s already here.

So, if you are one of the million practicing physicians interested in regaining control of the leadership in America’s healthcare system–the only thing that just might save it–you should have submitted your application yesterday.

I did.


Apply for continued board certification from the National Board of Physicians and Surgeons at www.NBPAS.org