Until Death (or Recertification) Do Us Part


The online membership forum of the Society of Interventional Radiology (SIR) blew up this week in response to an email announcement by the American Board of Radiology (ABR) that it will effectively be doing away with lifetime diagnostic radiology certificates for interventionalists whose original certificates pre-dated the introduction of time-limited certificates. Interventionalists were given two choices:

1.     You can keep your lifetime diagnostic certificate if you give up your (earned) interventional subspecialty certification, or

2.     You can keep your interventional certification, if you give up your lifetime diagnostic certification.

Talk about choice.

Keeping your lifetime certificate in diagnostic radiology and your time-limited certificate in interventional radiology—the option I chose 20 years ago when I voluntarily became one of the ABR’s new interventional certification guinea pigs—is no longer an option.

Interventional radiologists are trained in diagnostic radiology, just as interventional cardiologists are trained in general cardiology, and many interventionalists still interpret imaging – indeed it’s hard not to, if you’re using imaging to reach organs.

This latest top down mandate by the ABR is another example of the ongoing proclamations of the many American Board of Medical Specialties (ABMS) member boards that have infuriated so many well-meaning practicing physicians. It is yet another step in the insidious push by the ABMS to force physicians into increasingly onerous Maintenance of Certification (MOC) programs. Coincidentally (or not), these have turned out to be quite profitable for its member boards, whose asset war chests have grown quite handsomely—all funded by a new stream of MOC dollars from practicing physicians.

I’m not an ABR hater. In fact, I’m a staunch supporter of the board certification — so much so that the ABR recently recognized me with a Volunteer Service Award. I have served for many years as an oral examiner in both diagnostic and interventional radiology, on the ABR’s non-interpretive skills committee, and regularly on its Angoff Panel (a panel which tests the test) before each year’s electronic examinations. They’re time-consuming commitments, but ones that I view as my civic duty. Physicians are held to a very high standard—and rightfully so—and need to continually earn public trust. That’s the reason that I—like many other interventional radiologists—am upset. Our collective commitments to the public and to our profession only work if we can trust our boards.

The ABR proclaims in its volunteer manual that public trust is the first pillar of our profession. Public trust is, in fact, prioritized so much that the ABR includes professionalism as one of its six key MOC competencies—and something that’s now part of all of our electronic examinations. But, as reflected in the online comments of a number of interventional radiologists (e.g., “They cannot be trusted. Period.”), the ABR is failing the examination of real life—and losing the trust of its own diplomates.

When an organization listing public trust as its first professional pillar grants lifetime certification, it is not selling a widget. It is entering a covenant with that diplomate, who buys into ABR’s and ABMS’s word that lifetime means lifetime.

Almost 30 years ago, I entered another lifetime covenant, when I said “until death do us part.” If I told my wife that I’m no longer honoring that lifetime covenant, and just want to stay friends and continue our relationship in a transactional manner, conditional upon her meeting whatever “Maintenance of Companionship” requirements I decided arbitrarily, she would kick me to the curb. And, rightfully so. Telling her that maybe someday down the road, if she asks nicely, I’ll reinstitute that lifetime covenant would probably infuriate her even more. Based on several dozens of posts (and still climbing) on the SIR’s forum, that’s how many respected interventionalists are interpreting the ABR’s latest missive—as emotionally and passionately as victims of cheating spouses.

But, there’s a silver lining to this cloud. With my lifetime certification partner telling me that her over two-decade “until death do us part” promise secretly came with an asterisk, I am now free to explore other certification partners.For the last two years, I’ve watched closely the growth—and growing acceptance—of the National Board of Physicians and Surgeons (NBPAS).  Its Board of Trustees includes luminary thought leaders like Eric Topol and Michael Gibson with whom I’ve connected on social media. They, and their trustee colleagues, are forward thinking physicians who have chosen to prioritize patients, physicians, and integrity over ABMS bureaucracy. Shortly after receiving notification of “we changed the rules—take it or leave it” choices from the ABR, I applied for board recertification from NBPAS. I look forward to continuing my conversation with their leadership about how competition and transparency in the board marketplace can make board certification better for all of us—in the radiology community and beyond.

Public trust isn’t proclaimed. It is earned. If physicians can’t trust their boards, how can we expect the public to trust them?

About the author:

Richard Duszak, Jr., MD (@RichDuszak) is Professor and Vice Chair of Radiology at Emory University and Associate Editor of the Journal of the American College of Radiology.

Categories: Uncategorized

5 replies »

  1. Typical one sided ABMS board overreach with no input from its diplomates, then complaining when diplomates go to state legislatures to get relief. ABMScert and its greedy board chairs must be responsive to its diplomates or they will lose them over time

  2. Dr. Duszak, what a timely piece. Welcome to the MOC fight! There are so many of us working with NBPAS. Physicians absolutely cannot trust ABMS and the public should not either. We won in Texas, Oklahoma, and hopefully we can move things forward in Ohio this fall. ABMS is interested in one thing: $$$, and it has nothing to do with trust. It is about condos in the Cayman. Excellent piece. Thank you for jumping into the debate.

  3. Two points:
    1. Almost everyone specializes beyond their official listed specialty. We have interests that drive this or we have clientele that demand this. Some of us begin to focus on sepsis or joint diseases or back problems. Some on geriatric stuff. Whatever. Is it fair–or wise–to reduce our intensity in the things we love to do, to distract us for several months, in order to fulfill the dreamy wishes of the do-gooders?…based upon no evidentiary data of societal improvement?

    2. Maybe it is a good idea. But, is it fair? We live in this vast social group of competing animals. Do we want to make them compete with 25 yr olders until they are 70?…to stay on the cutting edge until they pass out from disgust and burnout? ….just because their occupations are deemed important?

    Is this done with lots of other occupations?…many of which are really important? We already have CME. We have mortality conferences. We have pharmacy and therapeutic committees. We have Grand Rounds. We have pulmonary and radiology and tumor boards.

    Isn’t this latest craze a little overdrawn? How high can you pile bureaucracy on one sector of the society? Could there be a financial conflict of interest in the promotors?

    Shouldn’t there be some type of accountability for promotors with bad ideas, those that don’t pan out?

  4. Lord Acton said it best: “Power corrupts; Absolute power corrupts absolutely.” And in the meantime our nation’s healthcare continues to exhibit its worsening cost and quality problems. The leaders of our healthcare industry have abandoned their social responsibilities to the business model of their individual institution’s market share.
    As compared to the health spending of the other OECD nation’s of the world, our nation’s health spending as a portion of our economy represented an excess of nearly $1 Trillion last year. For 25 years, our maternal mortality ratio has worsened annually. As compared last year to the best 4 of these 35 OECD nations, @800 women die annually in the United States from a pregnancy only because they lived in the wrong nation during their pregnancy. The apparent lack of their connection with reality would not generate much trust in the ABR and ABMS to pursue any meaningful impact on the cost and quality of our nation’s health care. The basis for the re-certification commitment has little to show for its effort, other than “it seems like a well-intended, good idea!”
    I offer one last observation as an emphasis for the ABR/ABMS effort. The mid-life white/non-hispanic death rate from drugs, alcohol and suicide jumped from 35 deaths per 100,000 citizens in 2000 to 80 deaths per 100,000 in 2015. It occurred throughout our nation and was unrelated to urbanization. It seemingly began in the Southwest region of our nation and eventually spread throughout our nation. Since 2000, the annual rate of change affected men and women similarly, although twice as common for men as compared to women. I only suggest that the specialization folks assume a more substantial connection with population health knowledge as a portion of their assessment responsibilities.

  5. Using ABR and ABMS and your trust in them as a proxy for the public’s trust is thin. So is invoking a spousal covenant. If you want to cite the high costs of MOC, fine, but even if it were free, your position would not change.

    There is a case to be made, but while above may not be full on straw men, you did not convince me that lifelong certification cannot be reassessed and new rules implemented.