Wednesday, November 26, 2003


DB had a post a few days ago providing commentary on this story in American Medical News about the "clinical skills exam" that is to become part of the USMLE step 2 in 2004. I agree with Dr. Plested and DB on this subject. Burdening medical students with additional fees is a severe hardship, especially when they are also faced with the expenses of residency interviews. While DB exerpted a large portion of the article on his site this is the strongest argument against it IMHO:

Finally, and most importantly, there is no evidence that this exam will produce the results that are desired, i.e., fewer state license actions for misconduct, negligence and incompetence. These are legitimate interests of the state, but overwhelmingly take place after many years of practice. Ironically, in this day of evidence-based medicine, those who would tell us how to practice the profession, for which we have trained extensively and exhaustively, have yet to consider any evidence for the requirements they so pompously heap upon us.

Also would you want to see Kramer as your "patient"?

In a similar vein, the latest issue of Medical Economics carries a story on the increasing requirements of board recertification. As Dr. Alice has posted it has taken her a good deal of time (and money) taking the "modules" required for recertification. The use of chart reviews and patient surveys (what say you, HIPPA?) would become key portions of the recertification.
Such things as chart reviews and patient surveys would have little use for a surgical practice, based on the limited interaction that we have with most of our patients (preop visit, operation and postop visit). A surgeon in my city has a brother who is on a committee trying to come up with additional recertification requirements for surgeons. The ideas have ranged from videotapes of surgery, "educational modules", and (gulp!) repeating the orals.
One reason that the "powers that be" perhaps are eager to impose new tests and requirements is that they can become a steady source of income for the NBME, ABS, or the ABIM. The "Step 2 clinical skills" exam will set back the MS4' s of the world $975. The ABS requires you to pay $1675 to become certified and $675 for recertification. The ABIM ticket costs you $950 for certification. The website would not allow me to find fees for the modules or recertification. The American Board of Pediatrics charges $1260 for the first time. I'll stop here, since as you can see that taking boards is an expensive endeavor. Just to do the math, given the 13,300 seniors that matched (assuming the number of graduates remain constant) last year, at $975 a head, comes out to $12,967,500, and this doesn't include the fees from the written portion of step 2. A tidy sum to say the least.
There is little enthusiasm about increasing recertification requirements amongst the physicians I know. There is a "town and gown" division in surgery about this (and other things, such as per diem payment for trauma services) the community surgeons see this as the academics imposing their will from the ivory tower on the peasant masses.
Well I have to go help Mrs. Parker get some things ready for Thanksgiving dinner tomorrow, as her father and stepmother are coming tomorrow. As always, your comments are welcome.
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