ABIM recertification for specialists necessary?

[chromaticscale]

What is the general consensus on recertification for the internal medicine ABIM for specialists (e.g. cardiology) or even sub-specialists? I couldn't find much information on this from the ABIM website nor from other forums. People were saying that it is not necessary but couldn't confirm this.
Obviously I would re-certify for cardiology but for IM, I would not go through the MOC or LKA if I didn't need to.

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[NewYorkDoctors]

I cannot speak on a general rule or anything, but many older physicians (not so old to be grandfathered into a board) who are IM subspecialized end up not taking the IM boards after a while. I know plenty of PCCM physicians who stopped IM and just maintain pulmonary and CCM. the same goes for plenty of other subspecialists. Many of the hospital based general cardiologists at one large tertiary center I go to (part of the faculty and all that) are also just boarded in cardiology

Personally, I plan on keeping my IM boards because I do a little primary care on the side. While it is true you do not need an IM board to practice primary care as a specialist (after all knowledge is knowledge), one would need an IM board if one wanted to be listed as potential PCP for insurances. This is only relevant for if you plan to open your own PP. If you are an employed PP physician, then your employer will lay out the terms of what you need or do not need.

I know a few PP general cardiologists who also advertise as PCP (he/she owns the practice). They would need the insurance companies to list them as PCP and specialist. That would require the IM board certification. While hospitalists can work as board eligible, the IPAs that negotiate with the insurance companies for the insurance coverage usually requires IM board certification. While they cannot "double dip" a patient, this does allow these physicians to expand their patient base without the need for relying on referrals. After all I'm sure most older metabolic syndrome patients have some reason to get an echo, stress test, holter, carotid, and nuke... plus patient seem to like it when they brag "my PCP is also my cardiologist!" (but the same does not hold when the PCP is another subspecialist... cardiologists get all the glory and renown)

If you plan on becoming super specialized as Interventional Cards, EP, structural, CHF, etc... there may not be any real reason to keep your IM boards. I suppose if you planned to cover a lot of CCU and want to be the "best internist" you can, consider the IM boards. But you just consult whatever subspecialist you need anyway. If you plan on being general cardiology, consider keeping IM boards for the future when you decide "i've had enough of these employers taking half of my productivity and feeding me RVUs, I am going to open my own practice!"

 

[gutonc]

What is the general consensus on recertification for the internal medicine ABIM for specialists (e.g. cardiology) or even sub-specialists? I couldn't find much information on this from the ABIM website nor from other forums. People were saying that it is not necessary but couldn't confirm this.
Obviously I would re-certify for cardiology but for IM, I would not go through the MOC or LKA if I didn't need to.

You are not required to keep up your IM board to maintain your sub-specialty board. You are welcome to do so if you choose. You can also re-take your IM board but not do MOC for it, but that seems silly to me.

I stopped doing MOC on my IM boards as soon as I got my oncology boards done and let them expire without fanfare.

 

[NewYorkDoctors]

side note, the easiest way to get MOC is just to get those UpToDate credits

i fill them up and my ABIM.org profile is all done. easy as pie.

I do not pay for uptodate thankfully. my hospital gives me access through the hospita library and my own account. good times

 

[chromaticscale]

I cannot speak on a general rule or anything, but many older physicians (not so old to be grandfathered into a board) who are IM subspecialized end up not taking the IM boards after a while. I know plenty of PCCM physicians who stopped IM and just maintain pulmonary and CCM. the same goes for plenty of other subspecialists. Many of the hospital based general cardiologists at one large tertiary center I go to (part of the faculty and all that) are also just boarded in cardiology

Personally, I plan on keeping my IM boards because I do a little primary care on the side. While it is true you do not need an IM board to practice primary care as a specialist (after all knowledge is knowledge), one would need an IM board if one wanted to be listed as potential PCP for insurances. This is only relevant for if you plan to open your own PP. If you are an employed PP physician, then your employer will lay out the terms of what you need or do not need.

I know a few PP general cardiologists who also advertise as PCP (he/she owns the practice). They would need the insurance companies to list them as PCP and specialist. That would require the IM board certification. While hospitalists can work as board eligible, the IPAs that negotiate with the insurance companies for the insurance coverage usually requires IM board certification. While they cannot "double dip" a patient, this does allow these physicians to expand their patient base without the need for relying on referrals. After all I'm sure most older metabolic syndrome patients have some reason to get an echo, stress test, holter, carotid, and nuke... plus patient seem to like it when they brag "my PCP is also my cardiologist!" (but the same does not hold when the PCP is another subspecialist... cardiologists get all the glory and renown)

If you plan on becoming super specialized as Interventional Cards, EP, structural, CHF, etc... there may not be any real reason to keep your IM boards. I suppose if you planned to cover a lot of CCU and want to be the "best internist" you can, consider the IM boards. But you just consult whatever subspecialist you need anyway. If you plan on being general cardiology, consider keeping IM boards for the future when you decide "i've had enough of these employers taking half of my productivity and feeding me RVUs, I am going to open my own practice!"

Thanks so much, this was very helpful!

 

[DrMetal]

If you plan on becoming super specialized as Interventional Cards, EP, structural, CHF, etc...

How outrageous. So if you're IC, you have to maintain your IC, Echo, and General Cards boards? That's 3 boards. Add ABIM, and that makes 4?

It still baffles me that we put up with this racket.

 

[dozitgetchahi]

How outrageous. So if you're IC, you have to maintain your IC, Echo, and General Cards boards? That's 3 boards. Add ABIM, and that makes 4?

It still baffles me that we put up with this racket.

At my residency program, there was a cards attending who handled congenital heart defects etc. He was boarded in:

- IM
- Peds
- Adult Cards
- Peds Cards
- HF
- Echo

I asked him if all he did in his spare time was study for board exams. He just chuckled.

 

[NewYorkDoctors]

At my residency program, there was a cards attending who handled congenital heart defects etc. He was boarded in:

- IM
- Peds
- Adult Cards
- Peds Cards
- HF
- Echo

I asked him if all he did in his spare time was study for board exams. He just chuckled.

he probably writes the board exam questions and the guidelines

 

[chromaticscale]

How outrageous. So if you're IC, you have to maintain your IC, Echo, and General Cards boards? That's 3 boards. Add ABIM, and that makes 4?

It still baffles me that we put up with this racket.

Not sure if this is the most up to date information, but based on this article it seems certain subspecialists such as interventional cardiologists don't need to re-certify in cardiovascular diseases: ABIM Will Discontinue Requirement for Maintaining Underlying Board Certification for Interventional Cardiology and 14 Other Subspecialties - Cardiac Interventions Today

Regarding echo boards, it is probably institutional dependent. Some of the general cardiologists (who have been practicing for a long time) and interventional cardiologists don't have echo board certification when I looked their names up on the National Board of Echocardiography website.

 

[timpview]

Oh and you can’t read nucs at some places if you’re not nuc boarded… even if a 14 year old can read those..

It’s such a racket.

 

[DrMetal]

At my residency program, there was a cards attending who handled congenital heart defects etc. He was boarded in:

- IM
- Peds
- Adult Cards
- Peds Cards
- HF
- Echo

I asked him if all he did in his spare time was study for board exams. He just chuckled.

I'll bet, probably a nervous chuckle. It's no wonder why we're such dolts and have the personality of a doorknob.

The garden variety, loose rules, the confusion amongst us demonstrates how unnecessary this all is.


I hope some of you will consider joining NBPAS (which is becoming more recognized). I know it hypocritical to advertise for another Board Certification [quite frankly, if up to me, I would get rid of all BC, it's an unnecessary credential to begin with] . . . but at least NBPAS is trying to present a reasonable alternative.

 

[CatFactorial]

What is the general consensus on recertification for the internal medicine ABIM for specialists (e.g. cardiology) or even sub-specialists? I couldn't find much information on this from the ABIM website nor from other forums. People were saying that it is not necessary but couldn't confirm this.
Obviously I would re-certify for cardiology but for IM, I would not go through the MOC or LKA if I didn't need to.

Not Cardiology, but BMT is a lot of IM, so I’ll probably at least plan to do IM LKA and whatever streamlined heme/onc LKA

Had an attending in fellowship who maintained all boards and also did gen med attending a few weeks a year.

 

[NewYorkDoctors]

Orlando Cardiologist | Heart Specialist Orlando | Dr. Sharma

In the bio page this doctors website likes to advertise that he has eight board certifications . Hence BC status remains a marketing tool for PP I suppose

 

[DrMetal]

Orlando Cardiologist | Heart Specialist Orlando | Dr. Sharma

In the bio page this doctors website likes to advertise that he has eight board certifications . Hence BC status remains a marketing tool for PP I suppose

Chee I wonder if he can convince my methamphetamine-induced cardiomyopathy patients to comply with medications and stop smoking meth? I haven't been able to do so, and it's probably b/c I don't have 8 BCs.

We physicians are so stupid and fickle. We've made up these credentials, we boast over them, and we beat each other up over them.

The real world doesn't care. The real world just wants results, as evidenced now by the army of NPs that run many Cards services.

 

[VA Hopeful Dr]

Chee I wonder if he can convince my methamphetamine-induced cardiomyopathy patients to comply with medications and stop smoking meth? I haven't been able to do so, and it's probably b/c I don't have 8 BCs.

We physicians are so stupid and fickle. We've made up these credentials, we boast over them, and we beat each other up over them.

The real world doesn't care. The real world just wants results, as evidenced now by the army of NPs that run many Cards services.

I know you and I won't see eye to eye on BC, but even I will say that non-ABMS boards are pointless. Of that guy's 8 "certifications", only 3 are ABMS specialties and those are all legit - IM, cardiology, and interventional cardiology.

 

[NewYorkDoctors]

I know you and I won't see eye to eye on BC, but even I will say that non-ABMS boards are pointless. Of that guy's 8 "certifications", only 3 are ABMS specialties and those are all legit - IM, cardiology, and interventional cardiology.

shh... cash paying patients don't know that

 

[DrMetal]

I know you and I won't see eye to eye on BC, but even I will say that non-ABMS boards are pointless. Of that guy's 8 "certifications", only 3 are ABMS specialties and those are all legit - IM, cardiology, and interventional cardiology.

Well, how bout just 1-2 BCs being enough? Like, IM and Cards. (Why do we have a board for IC? Incorporate it into Cards, for those who do it).

And how bout just taking those tests once, and being BC'd for life, not having to do MOC? Don't trust me to continue being a good/competent doctor for some reason? Then take away my credentials and privileging.

Ahh whatever, we're doomed. I just got off the phone with the Heart Failure Nurse Practitioner, we're bumping up the Bumex. [the Cardiologist is no where to be found, he's busy studying for his 8 MOCs]

 

[VA Hopeful Dr]

Well, how bout just 1-2 BCs being enough? Like, IM and Cards. (Why do we have a board for IC? Incorporate it into Cards, for those who do it).

And how bout just taking those tests once, and being BC'd for life, not having to do MOC? Don't trust me to continue being a good/competent doctor for some reason? Then take away my credentials and privileging.

Ahh whatever, we're doomed. I just got off the phone with the Heart Failure Nurse Practitioner, we're bumping up the Bumex. [the Cardiologist is no where to be found, he's busy studying for his 8 MOCs]

Our hospital runs a heart failure clinic designed to prevent CHF readmissions within 30 days. It is run by a nurse practitioner who spends way more time and is way more thorough dealing with these patients than either I or the cardiologists. She'll spend 30 minutes talking about diet, daily waves, how much diuretic to take based on daily weight gain and so on.

That's the kind of time consuming drudgery that mid levels are perfect for.

 

[DrMetal]

That's the kind of time consuming drudgery that mid levels are perfect for.

Yeah. Too perfect. Ya know a doctor used to do all this stuff. We physicians are successfully boxing ourselves out of medicine.

 

[dozitgetchahi]

Chee I wonder if he can convince my methamphetamine-induced cardiomyopathy patients to comply with medications and stop smoking meth? I haven't been able to do so, and it's probably b/c I don't have 8 BCs.

We physicians are so stupid and fickle. We've made up these credentials, we boast over them, and we beat each other up over them.

The real world doesn't care. The real world just wants results, as evidenced now by the army of NPs that run many Cards services.

Half of his certs sound like bull**** anyway. Wtf is a cert in “vascular interpretation”.

 

[dozitgetchahi]

Yeah. Too perfect. Ya know a doctor used to do all this stuff. We physicians are successfully boxing ourselves out of medicine.

Exactly, right?

Where did this idea come from that nurses are “so much better at educating the patient” than doctors? Gee if you give me adequate time at the appointment, I promise I can do better than the nurse anyway, and it really should be us doing these things anyway. I mean wtf.

 

[DrMetal]

Exactly, right?

Where did this idea come from that nurses are “so much better at educating the patient” than doctors? Gee if you give me adequate time at the appointment, I promise I can do better than the nurse anyway, and it really should be us doing these things anyway. I mean wtf.

It's been the perfect formula for disaster:

[Hyper-specialized, over-BC'd physicians that are too costly] + [physicians in formal training way too long, >PGY8+] + [medical industrial complex that doesn't care about you, nor will wait for you to complete your third fellowship] + [mid-levels who are willing to do essentially the same job, and cheaper] = Death of the Physician.

Don't matter to me much any more. Did you know the Andromeda Galaxy is blue-shifted? Which means it's barreling right at us. It'll collide with our own galaxy, the Milky Way, and we'll all perish into oblivion. So what's the point?!

Good night.

 

[VA Hopeful Dr]

Yeah. Too perfect. Ya know a doctor used to do all this stuff. We physicians are successfully boxing ourselves out of medicine.

Then go do it. There's nothing stopping you.

It's like me with diabetic education. Sure I could book 45 minute appointments and do all the education myself, but that sounds just awful for a multitude of reasons.

 

[VA Hopeful Dr]

Exactly, right?

Where did this idea come from that nurses are “so much better at educating the patient” than doctors? Gee if you give me adequate time at the appointment, I promise I can do better than the nurse anyway, and it really should be us doing these things anyway. I mean wtf.

Then do it. Most of y'all here are IM trained, so go set up a CHF clinic and take care of these patients.

 

[Drrrrrr. Celty]

Then go do it. There's nothing stopping you.

It's like me with diabetic education. Sure I could book 45 minute appointments and do all the education myself, but that sounds just awful for a multitude of reasons.

Yeah. Too perfect. Ya know a doctor used to do all this stuff. We physicians are successfully boxing ourselves out of medicine.

I think there is an important need for post-hospital or post-icu or I guess in this case post heart failure ae clinic.

But we are lying to ourselves if we think it's extremely interesting or intellectually stimulating. It's usually extremely unsatisfying and cumbersome.

For uncontrolled DM, I think if I had to do a full DM ed visit after a medical management visit. I'd lose my mind and my patient would likely be off put.

 

[dozitgetchahi]

Then do it. Most of y'all here are IM trained, so go set up a CHF clinic and take care of these patients.

I’m a rheumatologist so I could care less about managing random CHF patients. You go do it.

(However, in the world of rheumatology I DO handle all of the relevant education myself, show patients how to use pen injectors, etc etc.)

 

[NewYorkDoctors]

I think there is an important need for post-hospital or post-icu or I guess in this case post heart failure ae clinic.

But we are lying to ourselves if we think it's extremely interesting or intellectually stimulating. It's usually extremely unsatisfying and cumbersome.

For uncontrolled DM, I think if I had to do a full DM ed visit after a medical management visit. I'd lose my mind and my patient would likely be off put.

the way I see it, if the endocrinologist physician is doing the DM education himself/herself, then that means less time that the Endocrinologist is spending on someone else with say... thyroid cancer, Cushing's, acromegaly, addison's... like real issues that a midlevel cannot handle.

for PCP/internists, I see how there may not be a real need to hire a nurse or midlevel to do that stuff unless the internist is very very busy and has high volumes to run through.

plus some patients have lower education levels (which is not a criticism it is what it is) and just need more time explaining and the 6th grade level. that's part of the game. but this can be quite the time sink and someone else should help out. Think Homer THompson

 

[VA Hopeful Dr]

I’m a rheumatologist so I could care less about managing random CHF patients. You go do it.

(However, in the world of rheumatology I DO handle all of the relevant education myself, show patients how to use pen injectors, etc etc.)

I'm perfectly happy to let the mid levels do it, you're the one that was complaining about them doing it.

 

[QuizzicalApe]

Short of severe head injury, I can't see a reason for me to maintain 3 board certifications instead of 2. Dropping IM like a hot potato

 

[rokshana]

the way I see it, if the endocrinologist physician is doing the DM education himself/herself, then that means less time that the Endocrinologist is spending on someone else with say... thyroid cancer, Cushing's, acromegaly, addison's... like real issues that a midlevel cannot handle.

for PCP/internists, I see how there may not be a real need to hire a nurse or midlevel to do that stuff unless the internist is very very busy and has high volumes to run through.

plus some patients have lower education levels (which is not a criticism it is what it is) and just need more time explaining and the 6th grade level. that's part of the game. but this can be quite the time sink and someone else should help out. Think Homer THompson

We use diabetes educators for that… it is after all what they are trained to do.

 

[NewYorkDoctors]

We use diabetes educators for that… it is after all what they are trained to do.

yes that's the point i am trying to make... *deadpan*

linking to what Dr Metal was saying about how physicians need to do it all and not let other non-physicians do some like DM education

 

[Drrrrrr. Celty]

We use diabetes educators for that… it is after all what they are trained to do.

yes that's the point i am trying to make... *deadpan*

linking to what Dr Metal was saying about how physicians need to do it all and not let other non-physicians do some like DM education

Honestly I use DM education half the time as basic survival skills for DM...

I don't have the patience for that. Nor do I think even I with my generally down to earth disposition can make up for.

 

[sloh]

I think there is an important need for post-hospital or post-icu or I guess in this case post heart failure ae clinic.

But we are lying to ourselves if we think it's extremely interesting or intellectually stimulating. It's usually extremely unsatisfying and cumbersome.

For uncontrolled DM, I think if I had to do a full DM ed visit after a medical management visit. I'd lose my mind and my patient would likely be off put.

This is how I feel about my specialty (PM&R) and sitting in a room educating chronic pain patients hahaha. Soul crushingly boring. Rather just give them a flyer.

 

[MD46]

There is a move to completely do away with MOC, hope it happens. There are pod casts on Spotify etc with more details, not sure if they can be shared on this forum.

 

[DrMetal]

There is a move to completely do away with MOC, hope it happens. There are pod casts on Spotify etc with more details, not sure if they can be shared on this forum.

Of course they can be shared here. If I can discuss such egregious things like my whiskey habit and a+25 golf handicap, you can share such details, share away. Are you talking about NBPAS?

 

[MD46]

Of course they can be shared here. If I can discuss such egregious things like my whiskey habit and a+25 golf handicap, you can share such details, share away. Are you talking about NBPAS?

This is what I was referring to, there is a followup to this with an Interview with CEO of ABIM as well, will try to look for that too.

 

[DrMetal]

This is what I was referring to, there is a followup to this with an Interview with CEO of ABIM as well, will try to look for that too.

We've seen many podcasts and stories like this. I think the vast majority of physicians agree that MOC is BS, and that BC should be a one time certification.

The only organization that seems to be doing something about is NBPAS, which seems to be gaining some acceptance NBPAS Acceptance - Nationally Accepted, Recognized and Growing