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The Dilemma of Retaking my Family Medicine Boards

I have been researching this topic for some time. I am currently board certified in Family Medicine – yes, mother, I am a specialist!! My recertification exam is coming up next year, 2018. As of this writing in 2018, I have decided against retaking my family medicine boards. Which means, I won’t be paying $1,300 for the test. And yet, I will still remain board certified – lemme ‘splain.

Practicing medicine in the USA

To practice medicine in the US you must be licensed. Which means, you must have an acceptable medical school education followed by a residency year. This is often a 1-year internship, at which point you would be considered a general practitioner, a GP.

Internists and family docs aren’t GP’s, even though we refer to them as that.

Each State can set their own minimum number of years of internship/residency before allowing you to be licensed. Connecticut, Kentucky, Michigan, Montana and a few others, for example, requires 2 years of residency before licensing a physician in their territory.

It’s estimated that 20% of US physicians aren’t board certified.

Employment without Renewing Family Medicine Boards

So the biggest concern for doctors is that they won’t get a job if they aren’t board certified. Ironically, these same doctors earned extra income in residency through moonlighting – when they weren’t board certified!

So, if my dumbass as a resident was able to earn a decent income moonlighting then I certainly will have job availabilities as an attending who once was board certified.

Admittedly, it’s a little easier to have at least finished a residency to become board eligible (BE). And having had a status of board certification once in the past will make it much easier to skip future board certification – keep reading and I’ll expand on this.

Why Be Board Certified in Family Medicine?

Well, according to American Board of Medical Specialties (ABMS) – the officially recognized umbrella group in charge of all the other medical specialties – if a patient sees a physician who isn’t board certified then they are putting their health at risk. I’m not making this up.

My buddy Dr. S only completed 1 year of residency and he works beside me in the urgent care as a per diem and I would say he is a better clinician than myself. Not only is he not board certified in family medicine but he will never never have to worry about renewing a family medicine board certification.

My medical group won’t hire him part-time or full-time because he needs to be BE/BC in order to qualify for that position.

Then again, the ABMS also recommends that you interview your physician with the following questions when you meet them for the first time. None of which measure the competency of the clinician.

Insurance Billing

The most obvious issue is that when you don’t have a board certification (BC) then you potentially may not be able to bill in your particular medical group. This is the case with Kaiser Permanente, if I wanted a part-time or full-time gig with them.

Most other insurance groups also prefer or even mandate board certification in order for you to be part of their network of physicians.

In some circumstances, the insurance company can decrease the payout if a provider without a family medicine board certification is doing the billing.

Malpractice insurance

Most carriers will insure GP’s the same as specialists. But there is a good number who will either charge more or not insure such clinicians at all.

This becomes a problem because if you are seeking employment somewhere, they could legally deny you a job because you aren’t accepted by their malpractice carrier.

Litigation

If a case goes to court then you will most likely have to accept expert testimony against you from a board certified clinician. This, of course, is an opportunity for the plaintiff to claim that you don’t have the minimum expertise needed to handle their particular case.

Most States lean towards having expert witnesses be in the same specialty as the defendant physician. However, exceptions are made and if the non-specialized doctor was practicing in an urgent care where most doctors are family medicine or emergency medicine board certified then that expert witness will be the gold standard by which the defendant will be judged by the jury.

If you have issues with malpractice in the past then renewing your family medicine certification makes sense. Maybe.

My Family Medicine Board Certification Process

If I knew that I was going to not give a fuck about recertifying before my next deadline then I wouldn’t have bothered taking those damn SAM’s all these years or go through the headache of dealing with the fuckfest of ABFM.

The ABFM’s incomprehensible website has come a long way. It was a nightmare dealing with them when it came to the various recertification steps because I wasn’t practicing traditional family medicine, I was only doing urgent care.

Someone can chime in below. But the image above states that I only owe $250 to take the recertification exam – the ABFM website states I have to pay $1,400 – so, are they just being shady or am I too stupid to figure this out?

The above screenshot is the enigma which I need to deal with in order to qualify to sit for my 10-year anniversary family medicine board examination.

Ways around ABMS certification

There is a monopoly on the board certification process in the US, the ABMS holds that monopoly. There is oversight over this entity but the ABMS are the ones who mandate maintenance of certifications (MOC) and the need to take and pay for self-assessment modules (SAM’s).

Their legislative arm pushes hard to get MOC’s included in the bylaw wording of various institutions including malpractice insurance, health insurance, and hospital appointment.

MOC’s = $$$’s.

NBPAS vs. ABMS

The National Board of Physicians and Surgeons (NBPAS) came on the scene not too long ago to simplify the specialty certification process. They are a separate group from the ABMS and claim that they will a provide board certification document to qualifying physicians.

Their process is simple, it’s on you to do your 50 CME’s every 2 years and there is a fee of $169 for a 2-year certification process. No SAM’s. No MOC’s. No board examination.

The caveat is that you must have been previously board certified by the ABMS and you can’t be in poor standing and of course, you must meet other basic criteria.

Is NBPAS Recognized?

For the record, the NBPAS is referred to by medical professionals as the “fake” board certification. Sadly, our own colleagues are as brainwashed as our patients.

This won’t stop the NBPAS’s cause. They are petitioning aggressively to get recognized by various organizations.

Insurance companies and most malpractice groups will accept this board certification designation, from my research.

Your employer will be another issue. I recommend reviewing their bylaws. I just flipped through a massive document of Kaiser Permanente’s bylaws to look for the requirement of ABMS designation and couldn’t find anything that specified it.

What specialties are offered?

NBPAS offers all the board certification that ABMS offers.  You can view a complete list on their site here.

And no, if you were never board certified in Orthopedic surgery then you can’t just get a mock certificate saying you are board certified in it. The process for NBPAS is legit and you’ll need to submit all the proper documents.

Do I endorse The NBPAS?

I am not mentioning NBPAS because I think they are a valid organization. I just found them on the first page of Google. Some research showed that they might be a great alternative to renewing my family medicine board certification.

Then again, I don’t think I am a better physician because I am board certified despite what the ABMS claims on their propaganda websites.

The reason I don’t want to continue with ABMS is because I don’t want to pay their high fees nor have to take a 1-day exam for board certification.

Why do I need to report to a brick and mortar facility to take my test, anyway? Why can’t I refer to my peripheral brain resources? Why do I have to pay another entity to certify me? Will they protect me in court? Will they gimme a hug after a patient finishes chewing me out?

The application process

I went on their application website and uploaded my CME’s, entered my medical license number and my NPI number and paid the $169 fee. That’s it.

Hilarious. It reminds me of the way taxis work and the way Uber works.

Taxi: call them, be on hold, get a rude person on the phone, request a cab, wait forever, have a rude person show up, have them get pissed that I didn’t tip well, leave the cab smelling like shit.

Uber: open the app, enter my destination, set my location, get in and get out.

They state that it takes 6 weeks to get the certificate made out to you. I am updating this post because it’s been 2 weeks now and the board certificate has been emailed to me.

In the future, I’ll let the readers know how this certificate holds up to various job applications. I am quite curious myself. The process was incredibly easy and I am very glad I went with this option.

2021 Update on Family Medicine Board Recertification with ABFM

I decided to retake my family medicine boards with the ABFM. There are many reasons why which I’ll share in future articles. Here is a podcast episode I recorded explaining it.

The advantage is that I am now eligible for some telemedicine gigs which I couldn’t even apply for because of how strict the board certification requirement has gotten.

I wouldn’t go as far as to say it’s necessary to be board certified. But renewing my family medicine boards means that I have even more time until my own business ideas take off.

I maintain my NBPAS board certification (the link goes to my active certificate). And here is my ABFM active certification. For the time being, it’s worth it to have both because it’ll give me a lot more options.

15 replies on “The Dilemma of Retaking my Family Medicine Boards”

Good post here. The abfm is a joke. They send me letters weekly asking me to rejoin for 700-800/yr. for what? To get their shitty little journal. No one ever tells you as a premed that besides the 250k in loans you’ll have to payback, that you’ll have to pay 700-800 every other year for a license, 500-600 every 3 years for a DEA, and this MOC bullshit every year!!! (Grab ankles now)

The MOC is actually a joke. I did mine in like 4 weeks when they should been done over 3 years. It’s purely a money grab. What other profession is subject to this? What about Cme conferences. I just paid $750 to go to a shitty primary care conference last week. All for CME credit.

So ridiculous man. What about mcat and usmle costs. There are some very evil greedy sob’s running the show for us dude

I figure this, we’ll jump through hoops all day to make the kind of income we’re making. But eventually, our need for that income will decrease. That’s when we start thinking twice about paying certain fees. All of a sudden, we’re the ones in the driver’s seat, calling the shots. “No, I’m good, not gonna do that, unless you want to pay me for it.” “Nope, not interested in your meaningless designation, you can keep it.”
The more of us decrease our reliance on the income we get from these large medical groups, the less these organizations can exert control on us.
So far my theory has proven correct, the less I need them, the more they need me. Naturally, there will be a breakeven point, but for now, my hourly income has increased, I have more free time and I am less afraid of “them”.

Why certify with the NBPAS if you don’t think they are a valid certifying body? I mean, why get tagged as being “fake-certified “ by your colleagues? And, from what you say, you’re probably better off being labeled a gp (not certified) as it may be easier to get work that way because at least you are not perceived as having fake credentials.

That said, I joined the NBPAS this year as well instead of going through the MOC process. But, I believe it is a valid certifying body and believe myself to be board certified as I have held Board Certification status for nearly twenty years. I am the same physician now as I was prior to December 31, 2016 when my ABFM certification ended. And, these guys (NBPAS) are not clowns.

Indeed, the NBPAS is about MOC reform. It’s about corruption and monopoly (as you mentioned) as well as about time spent investing in this costly and ineffective process. In fact, when / if the ABMS adopts new policies that are reasonable and transparent, the NBPAS promises to disband.

So, it’s not a fake anything, it’s probably the first time Doctor’s have stood together against the crap we have been dealt since the so called “Golden Years of Medicine,” prior to the HMO creation.

Good post, by the way- never knew a gp was by definition someone who finished internship but not residency. Didn’t know you could even work these days without a residency (but, why can’t you)?

I too moonlit all through residency, doubling my income. I never thought about the fact that I was not certified at the time but still made a decent amount being employed as a moonlighting doc. The big slap in the face is how mid levels are not held to the same standards for employment even though we may be competing for the same position (generally speaking).

Thank you for your comments.
I don’t care too much how my colleagues perceive me or tag me in regards to board certification and hopefully it won’t matter too much to other healthcare professionals. We’re playing a game here with the various certifying and regulating bodies. Though it’s possible to have no board certification at all and still practice, it will make life easier to have some sort of board designation when it comes to applying to certain jobs and taking on certain positions.

As for the “fakeness”, what I wrote may have come across wrong but what I was trying to say is that no board certification entity can be any more or less legit than another which is why I am perfectly comfortable having the NBPAS certify me as opposed to it’s wealthier and more corrupt ABMS.

In short, I am not again nor for any particular board certification entity. Nor do I believe that an online test can capture my competency or reveal my incompetency.

Is there anyway to be board certified without completing Residency because your residency director was a mean girl literally and gossiped about you and didn’t renew your contract for your final year in Residency and is blacklisting you from ever getting into any Residency in the future despite having more attendings supporting me than the PD had in evidence to fire me

Unfortunately, getting that medical degree and the board licensure to practice is all about overcoming adversities which include racism, sexism, and other biased attitudes towards individuals. You will encounter the same things at work and later with medical boards and especially when you deal with a lawsuit; it’s the nature of medicine. You can’t pocket $300k/year without a lot of hands reaching into your pockets.
Focus on transferring your residency somewhere else – know that you’ll come across mean people again and figure out ways to overcome them. Get your board certification and start practicing and you’ll put all of this behind you.
And you’ll need the board certification – states like California are no longer allowing physicians to even get a medical license without a completed residency.
When I was a chief resident we fired a woman for being end-state incompetent. But she sued and she was able to get back into the program to complete it. In the same program, a few years before, we fired a black resident for incompetence and she sued and won $10M in a settlement against UCLA in pediatrics.

I too have NBPAS certification and nobody will hire me. I live in Texas and the state of Texas has passed balls renting Hospital from even asking for board certification, they’re supposed to on experience no, but nobody is abiding by the law. I actually did take my recertification exam with abfm and they sent me a letter saying they had a software malfunction and they kept my $1,200 and tell me to retake it the next time it came around refusing to give me an immediate retake. My abms / abfm was about to expire so I had scramble and get a certification through NBPAS. I think what they are doing is great every hospital and recruiting agency now refuses to hire me when they were falling all over themselves previous 10-years. It’s like telling everyone in the United States they can only graduate from one college and all the others are considered fake. Abfm is a joke they actually give us the answers to the Moc exams whereas NBPAS doesn’t require that all that CME purchased solely through them so they can’t give us the answers we actually have to know the material and just submit are completed CME hours. We can pick whatever subject we want to do our CME in whereas abfm insists it all be Family Med and they pick the subjects for us and they call it “MOC.”

For the time being if employment options are important to a physician then it’s best to be certified through the ABMS. You could of course always open your own practice, in which case nobody cares whether you are or whom you are certified through. However, with the current lawsuits against ABMS it’s unlikely for only a single governing body to exist for board certification which goes against antitrust laws. This process would be expedited quite quickly if doctors during this disasterous pandemic times would revolt and refuse to continue certification only through the ABMS. But most docs have their heads down, bust seeing patients, busy paying down debt … and that makes it tough for us to really stand up for what’s important to us.

THANK YOU for the article, comments and information!!
Gee.
I’ve practiced as a FP for nearly 25 years and been having problems passing the ABFM boards. As a Hospitalist for 14 years, board’s questions have been 90+% over women, hormones, pregnancy, delivery, pediatrics, rashes, Medicare—.
Gee.
It hit me that, of course, the ones that write the questions are FPs, and likely also members of the AAFP, with access, as me, to the current AAFP board review and sample questions. So, they likely go out of their way to ask other than as presented within the review. Yep. Gotta be.
Ridiculous.
They know full well I’m a Hospitalist, and the have a special boards for Hospitalists, so why not give me that one?? They profess to represent FPs, so ———??
Thank you for informing me about the NBPAS!!
I just applied for theirs. After all, if it’s that easy for NPs ——
My contract says I have to stay “board certified” in FM. It doesn’t say with the ABFM!!
So —-
Soon this will be fun.
Either way, thank you!!
dave

I am shocked to read all of this… I run a rather large company with over 10 million dollars in revenue and I studied in Germany. I completed the USMLE exams with an above average score and I am thinking now “hmm I wanted to complete my residency in the U.S. but then come back and continue running my company… I really love medicine. Besides, my company is providing educational content to universities and I personally contribute here and create content for the speciality I am interested in.” So my logic was: “well if I continue working for my company and just produce content for internal medicine, at least 4 hours per day, I should be able to re-certify easily, right?” So I really think about resigning as a CEO and doing the residency in the U.S. I do wish to work as a doctor later when I’m older. Now I am shocked to read all this nonsense. This is drowning the U.S. doctors and destroying their creativity. It is literally a prohibition from EVER doing any creative work since you risk losing your certification if you don’t constantly live in that circus and ride that clownery carousel. I am now really having second thoughts about moving to the states, even though I am more than happy with my USMLE score. IT’s like you have to take exams until you die? No wonder doctors never invent anything these days in the U.S.

Thank you for sharing your thoughts. In all fairness there are some better opportunities available than even a few years ago. I think the practice of medicine is genuinely interesting if you can do it outside of the standard insurance model. Congrats on your USMLE score. I think that’s likely a good motivation to believe that you have enough passion for medicine that you might enjoy practicing it. You can certify with NBPAS after your initial certification with ABMS (ABIM) and go from there.
Fortunately, virtual care is also growing and is becoming much more popular and so that might give you the opportunity to work remotely.

Hi everyone. I have been a physician for 25 plus years. I was supposed to retake my ABFM boards back in 2016. I was so distraught at tbe time as I was going through some personal issues that I ended up letting it lapse. I have found it increasinly hard to find work but have found some areas that have not cared one way or the other. But everytime I apply I feel this” burden’” of not being BC. Its really depressing. Now I can understand why so many doctors commit suicide. For what? Because they spend their life proud of being a doctor, yet they cant spend time with their loved ones because they have all of this hanging over their heads constantly? They begin to feel they dont measure up to what they should be as no one really seems to care how they feel. This whole process has gotten out of hand to say the least. It is supposed to be voluntary not mandatory process to take the biards. However the Abms has become a monopoly and its crushing doctors. Yet not enough doctors stand up to them. I always thought the Abfm should just give CME to keep up with all the topics. I myself have been in a lot of other areas of practice besides office based family medicine, but I cant even take just an exam in the area I am practicing in. Its ridiculous, expensive, and exhausting! The Abfm doesn’t even let you take the ongoing questions to keep certified if everything has lapsed. You have to sit for the one day exam again. Some people are not good test takers also so something really should be done about that. What difference does it make whether you choose to take a 1 day or a series of questions? It doesnt make sense. Sorry to go on about this but the NBPAS has it right. With this latter board certification can you apply for license across borders? I want to thank all of you doctors for taking the time to comment

If you are in a better place now perhaps you can reconsider taking the board if the ABFM certification is really important for your job hunts. If you call around to local smaller clinics you’ll find a lot of jobs. The “real” world cares more about your competence than your certification but the big players like KP and Providence etc they are gonna want to minimize their risk exposure as much as possible. Fortunately the ABMS is no longer a monopoly with the NBPAS with plenty of good power behind it so you should be able to use your NBPAS to get decent work opportunities. But, don’t expect UCLA or Mayo Clinic to accept it.

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