A prominent medical journal embarrrasses itself by publishing a flawed study from the American Board of Internal Medicine. Critical appraisal lessons are obvious.
ABIM exists for only one purpose, to make profits and pay its employees!!
They are monopolistic and using scaring tactics to force doctors to pay their dues and fees. This organization need to be abolished.
I never understood their point of testing every 10 years. What are they trying to test?? Medical school knowledge?? That’s what the questions are like!! Or maybe residency knowledge?? Real world practice of medicine is way more than that !! They know that very well, but they want to keep promoting their narrative just to make profit. If they wanted to teach physicians updated knowledge for last 10 years, they would come up with CME for landmark practice changing trials in the last 10 years. And let all the physicians review those trials. BUT no that’s not the point of these tests, the point is to intimidate by asking medical school or residency based trick questions which are far far away from real world, with choices to trick the test takers, for what?? For your information ABIM , in case you didn’t know, in real world sometimes there are more than one best next step. Or steps in different directions or steps that patients may not agree with, or steps that may not be in the best interest of the patient given the situation. ABIM wants to create their relevance when they have none for real world practice of medicine. They have no unbiased good evidence , double bling RCT data to prove that the recertifications matter at all. They have become profit driven corporation ! With only one motive, to make more profit and to make it seem like it matters to be ABIM certified. It is beyond ridiculous.
NBPAS is the only answer! Let’s all support NBPAS!! Most hospitals and insurance companies and now even CMS has started accepting NBPAS certifications!!
I have said this many times: while I have had disagreements with Mandrola, he is actually a living saint. He would, however, profit further in his analysesif he ran them by John Ioannidis
Yes, Jim, there are many possible explanations of why some Hospitalists who took the 30-questions pre-test scored high or low.
But those potential explanations are not logically connected to 1) ABIM's recertification revenues, 2) JAMA's editorial choices, nor 3) hospital in-patient outcomes.
So, the study contains no objective evidence related to the causes of hospital inpatient outcomes, nor the effectiveness and economic profitability of ABIM's recertification process.
I think we're under the mistaken illusion that the testing modality, frequency, or content has any impact on patient outcomes. The main outcome is that the ABIM contines to shake us down for blood money. They could charge a big fee every 5 years or so, or proportionally smaller fees more frequently. What matters is ONLY that they get paid. What you know, and how you practice are of no importance. You just need to pay on time.
I never thought much about the expense of the recert process when I was a hospital based physician. I had employer provided funds to pay for MOC exams, CME… But in my 60’s when I wanted to work part time that budget dried up. I wasn’t about to pay out of pocket just for the privilege of working a day or two a week. I retired. That wasn’t the only reason, obviously, but it was a consideration. This system is disincentivizing folks like me from
Another factor is the fact that multiple hospitalists are involved with the care of any one patient. Are all the involved physicians involved in the program, or just some? And are patients who have a NP or PA provide some care excluded? How about whether doctors participating in the program are not grandfathered in and being compared to those certified in the 1970s.
Excellent. Joining NBPAS is the answer. Once the majority of current ABIM certified docs sign on, ABIM ceases to have power. Take charge of your career and pursuit of excellence and knowledge by using CME that actually helps you to obtain information pertinent to your practice and patient's needs. NBPAS is a respectful and organized entity that accentuates achieving excellence. Instead of feeling like a monkey doing tricks for the master while answering questions in under 4 minutes after consulting Open Evidence, join NBPAS. Just do it.
Yes! Join NBPAS. ABIM and JAMA are as much about science as COVID vaccines. Complete nonsense. They want our money and will do and publish anything to get it.
I agree with you that this study is flawed nonsense. But your reasoning that we need controlled trials to determine if continuing education and certification makes better doctors is also flawed. Are there any studies to show whether medical school or residency create better doctors? Or what kind of training makes a better doctor? In the making of a physician, we're never going to have randomized controlled trials that answer our questions. We have to use our best judgement. Based on my own best judgement I do believe ABIM is flawed and in many ways abusive. We practice in a system where a nurse practitioner with 500 hours of formal medical education can wear a subspecialty hat and manage patients whereas a physician with 30,000 hours of formal training and ABIM certification every 10 years cannot. Does it not stand to reason that a physician with vast experience in independent management of patients and many thousands of hours of formal education is better qualified to manage patients? My judgement and common sense says yes, but there will never be a valid study to prove it. Our system is completely upside down.
I don't know anything about this topic but this author and this source disgraced themselves around COVID and they help foist the current NIH/FDA/CDC leadership on all of us. Platforming these people is a mistake.
It is statistically difficult to prove a "racket". I believe that ABIM and ABEM (and many other clinical monopolies who require their brand of exclusive certification) add dubious value and definitely approach "racket territory." Full disclosure, I have had no problems maintaining board certification since 1999, but I find retesting a recurrent and expensive nuisance which adds little to no value to my clinical competence.
The statistical difficulty relates to "proving a negative." Now that ABIM or other certifying boards have propagated the originally plausible notion for decades that more training / testing leads to better outcome, this is hard to disprove. Essentially, to prove the valuelessness of ABIM CME requires proof of equivalence between participating and non-participating physicians.
While traditional hypothesis testing (like a t-test) aims to find evidence of a difference or effect, it requires specialized statistical methods to demonstrate equivalence or the absence of a meaningful effect, and this would require ABIM to design or support a study demonstrating that ABIM certified physician outcomes are equivalent to patient outcomes among non ABIM doctors within a pre-defined range of practical or clinical indifference (the "equivalence margin" or delta, denoted as Δ).
This parameter such as defining a clinically meaningful readmission or mortality rate is difficult to derive. To reject the so-called null hypothesis, the patient outcome endpoint difference must be inside a pre agreed upon equivalence interval of a sufficiently large sample. This evidence could be gathered from a properly designed study, but ABIM is unlikely to sponsor or support such self-defeating introspection. That is a pity and highlights an unfortunate decline in professionalism in our industry. We can reverse this trend. Society is our client, we do possess specialized skills, and the vast majority of physicians are smart, caring and selfless.
Observational studies are generally weak and vulnerable to bias. You are correct regarding the fact that alternate ways of analyzing the data could have led to alternate results. The ABIM along with other specialty boards are more interested in continuing their existence than enhancing medical outcomes.
“Evidence based practice” for thee, but not for me.
ABIM exists for only one purpose, to make profits and pay its employees!!
They are monopolistic and using scaring tactics to force doctors to pay their dues and fees. This organization need to be abolished.
I never understood their point of testing every 10 years. What are they trying to test?? Medical school knowledge?? That’s what the questions are like!! Or maybe residency knowledge?? Real world practice of medicine is way more than that !! They know that very well, but they want to keep promoting their narrative just to make profit. If they wanted to teach physicians updated knowledge for last 10 years, they would come up with CME for landmark practice changing trials in the last 10 years. And let all the physicians review those trials. BUT no that’s not the point of these tests, the point is to intimidate by asking medical school or residency based trick questions which are far far away from real world, with choices to trick the test takers, for what?? For your information ABIM , in case you didn’t know, in real world sometimes there are more than one best next step. Or steps in different directions or steps that patients may not agree with, or steps that may not be in the best interest of the patient given the situation. ABIM wants to create their relevance when they have none for real world practice of medicine. They have no unbiased good evidence , double bling RCT data to prove that the recertifications matter at all. They have become profit driven corporation ! With only one motive, to make more profit and to make it seem like it matters to be ABIM certified. It is beyond ridiculous.
NBPAS is the only answer! Let’s all support NBPAS!! Most hospitals and insurance companies and now even CMS has started accepting NBPAS certifications!!
I have said this many times: while I have had disagreements with Mandrola, he is actually a living saint. He would, however, profit further in his analysesif he ran them by John Ioannidis
Yes, Jim, there are many possible explanations of why some Hospitalists who took the 30-questions pre-test scored high or low.
But those potential explanations are not logically connected to 1) ABIM's recertification revenues, 2) JAMA's editorial choices, nor 3) hospital in-patient outcomes.
So, the study contains no objective evidence related to the causes of hospital inpatient outcomes, nor the effectiveness and economic profitability of ABIM's recertification process.
it's all about $.
I think we're under the mistaken illusion that the testing modality, frequency, or content has any impact on patient outcomes. The main outcome is that the ABIM contines to shake us down for blood money. They could charge a big fee every 5 years or so, or proportionally smaller fees more frequently. What matters is ONLY that they get paid. What you know, and how you practice are of no importance. You just need to pay on time.
I never thought much about the expense of the recert process when I was a hospital based physician. I had employer provided funds to pay for MOC exams, CME… But in my 60’s when I wanted to work part time that budget dried up. I wasn’t about to pay out of pocket just for the privilege of working a day or two a week. I retired. That wasn’t the only reason, obviously, but it was a consideration. This system is disincentivizing folks like me from
staying in the workforce part time.
Another factor is the fact that multiple hospitalists are involved with the care of any one patient. Are all the involved physicians involved in the program, or just some? And are patients who have a NP or PA provide some care excluded? How about whether doctors participating in the program are not grandfathered in and being compared to those certified in the 1970s.
Physician Extenders = Hamburger Helper
Excellent. Joining NBPAS is the answer. Once the majority of current ABIM certified docs sign on, ABIM ceases to have power. Take charge of your career and pursuit of excellence and knowledge by using CME that actually helps you to obtain information pertinent to your practice and patient's needs. NBPAS is a respectful and organized entity that accentuates achieving excellence. Instead of feeling like a monkey doing tricks for the master while answering questions in under 4 minutes after consulting Open Evidence, join NBPAS. Just do it.
Yes! Join NBPAS. ABIM and JAMA are as much about science as COVID vaccines. Complete nonsense. They want our money and will do and publish anything to get it.
I agree with you that this study is flawed nonsense. But your reasoning that we need controlled trials to determine if continuing education and certification makes better doctors is also flawed. Are there any studies to show whether medical school or residency create better doctors? Or what kind of training makes a better doctor? In the making of a physician, we're never going to have randomized controlled trials that answer our questions. We have to use our best judgement. Based on my own best judgement I do believe ABIM is flawed and in many ways abusive. We practice in a system where a nurse practitioner with 500 hours of formal medical education can wear a subspecialty hat and manage patients whereas a physician with 30,000 hours of formal training and ABIM certification every 10 years cannot. Does it not stand to reason that a physician with vast experience in independent management of patients and many thousands of hours of formal education is better qualified to manage patients? My judgement and common sense says yes, but there will never be a valid study to prove it. Our system is completely upside down.
I feel that the ABIM has lost its way, and certification is now expected and another box to tick off. It does not measure quality any longer.
This is the least important problem we have in medicine or society right now.
I don't know anything about this topic but this author and this source disgraced themselves around COVID and they help foist the current NIH/FDA/CDC leadership on all of us. Platforming these people is a mistake.
It is statistically difficult to prove a "racket". I believe that ABIM and ABEM (and many other clinical monopolies who require their brand of exclusive certification) add dubious value and definitely approach "racket territory." Full disclosure, I have had no problems maintaining board certification since 1999, but I find retesting a recurrent and expensive nuisance which adds little to no value to my clinical competence.
The statistical difficulty relates to "proving a negative." Now that ABIM or other certifying boards have propagated the originally plausible notion for decades that more training / testing leads to better outcome, this is hard to disprove. Essentially, to prove the valuelessness of ABIM CME requires proof of equivalence between participating and non-participating physicians.
While traditional hypothesis testing (like a t-test) aims to find evidence of a difference or effect, it requires specialized statistical methods to demonstrate equivalence or the absence of a meaningful effect, and this would require ABIM to design or support a study demonstrating that ABIM certified physician outcomes are equivalent to patient outcomes among non ABIM doctors within a pre-defined range of practical or clinical indifference (the "equivalence margin" or delta, denoted as Δ).
This parameter such as defining a clinically meaningful readmission or mortality rate is difficult to derive. To reject the so-called null hypothesis, the patient outcome endpoint difference must be inside a pre agreed upon equivalence interval of a sufficiently large sample. This evidence could be gathered from a properly designed study, but ABIM is unlikely to sponsor or support such self-defeating introspection. That is a pity and highlights an unfortunate decline in professionalism in our industry. We can reverse this trend. Society is our client, we do possess specialized skills, and the vast majority of physicians are smart, caring and selfless.
Observational studies are generally weak and vulnerable to bias. You are correct regarding the fact that alternate ways of analyzing the data could have led to alternate results. The ABIM along with other specialty boards are more interested in continuing their existence than enhancing medical outcomes.
https://nbpas.org/
the competition and the answer