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What A Digital Health Doc Learned Recertifying His Boards

By JEAN LUC NEPTUNE

I recently got the good news that I passed the board recertification exam for the American Board of Internal Medicine (ABIM). As a bit of background, ABIM is a national physician evaluation organization that certifies physicians practicing internal medicine and its subspecialties (every other specialty has its own board certification body like ABOG for OB/GYNs and ABS for surgeons). Doctors practicing in most clinical environments need to be board-certified to be credentialed and eligible to work. Board certification can be accomplished by taking a test every 10 years or by participating in a continuing education process known as LKA (Longitudinal Knowledge Assessment). I decided to take the big 10-year test rather than pursue the LKA approach. For my fellow ABIM-certified docs out there who are wondering why I did the 10-year vs. the LKA, I’m happy to have a side discussion, but it was largely a career timing issue.

Of note, board certification is different from the USMLE (United States Medical Licensing Examination) which is the first in a series of licensing hurdles that doctors face in medical school and residency, involving 3 separate tests (USMLE Step 1, 2 and 3). After completing the USMLE steps, acquiring a medical license is a separate state-mediated process (I’m active in NY and inactive in PA) and has its own set of requirements that one needs to meet in order to practice in any one state. If you want to be able to prescribe controlled substances (opioids, benzos, stimulants, etc.), you will need a separate license from the DEA (the Drug Enforcement Administration, which is a federal entity). Simply put, you need to complete a lot of training, score highly on many standardized tests, and acquire a bunch of certifications (that cost a lot of money, BTW) to be able to practice medicine in the USofA.

What I learned in preparing for the ABIM recertification exam:

1.) There’s SO MUCH TO KNOW to be a doctor!

To prepare for the exam I used the New England Journal of Medicine (NEJM) review course which included roughly 2,000 detailed case studies that covered all the subspecialty areas of internal medicine. If you figure that each case involves mastery of dozens of pieces of medical knowledge, the exam requires a physician to remember tens of thousands of distinct pieces of information just for one specialty (remember that the medical vocabulary alone consists of tens of thousands of words). In addition, the individual facts mean nothing without a mastery of the basic underlying concepts, models, and frameworks of biology, biochemistry, human anatomy, physiology, pathophysiology, public health, etc. etc. Then there’s all the stuff you need to know for your specific speciality: medications, diagnostic frameworks, treatment guidelines, etc. It’s a lot. There’s a reason it takes the better part of a decade to gain any competency as a physician. So whenever I hear a non-doc saying that they’ve been reading up on XYZ and “I think I know almost as much as my doctor!”, my answer is always “No you don’t. Not at all. Not even a little bit. Stop it.”

2.) There is so much that we DON’T KNOW as doctors!

What was particularly striking to me as I did my review was how often I encountered a case or a presentation where:

  • It’s unclear what causes a disease,
  • The natural history of the disease is unclear,
  • We don’t know how to treat the disease,
  • We know how to treat the disease but we don’t how the treatment works,
  • We don’t know what treatment is most effective, or
  • We don’t know what diagnostic test is best.
  • And on, and on, and on…

It’s estimated that there are more than 50,000 (!!) active journals in the field of biomedical sciences publishing more than 3 million (!!!!) articles per year. Despite all this knowledge generation there’s still so much we don’t know about the human body and how it works. I think some people find doctors arrogant, but anyone who really knows doctors and physician culture can tell you that doctors possess a deep sense of humility that comes out of knowing that you actually know very little.

3.) Someday soon the computer doctor will FOR SURE be smarter than the human doctor.

The whole time I was preparing for the test, I kept telling myself that there was nothing I was doing that a sufficiently advanced computer couldn’t accomplish.

Continue reading…

THCB Gang Episode 145, Thursday November 21

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday November 21 at 1PM PT 4PM ET are regulars delivery & platform expert Vince Kuraitis (@VinceKuraitis) &  JL Neptune MD, now at Memora Health, digital health investment banker Steven Wardell (@StevenWardell); and longtime startup and corporate digital health exec Adam Kaufman (@adkaufman) who also writes the Bearing.on Health newsletter.

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

THCB Gang Episode 131, Thursday July 20

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday July 20 at 1pm PST 4pm EST are futurists Jeff Goldsmith; patient advocate Robin Farmanfarmaian (@Robinff3); Suntra Modern Recovery CEO JL Neptune (@JeanLucNeptune); and our special guest Investor at Bessemer Sofia Guerra (sofiaguerrar)

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

THCB Gang Episode 126, Thursday June 15

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday June 15 were double trouble futurists Jeff Goldsmith and Ian Morrison (@seccurve); patient safety expert and all around wit Michael Millenson (@mlmillenson); Suntra Modern Recovery CEO JL Neptune (@JeanLucNeptune); and policy expert consultant/author Rosemarie Day (@Rosemarie_Day1). Lots of discussion about United and their hold on the US health care system, the continued hype around AI, and where the rubber is meeting the road or not on health equity.

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

THCB Gang Episode 121, Thursday March 23

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday March 16 at 1PM PT 4PM ET are futurist Ian Morrison (@seccurve); writer Kim Bellard (@kimbbellard); Suntra Modern Recovery CEO JL Neptune (@JeanLucNeptune); and Olympic rower for 2 countries and all around dynamo DiME CEO Jennifer Goldsack, (@GoldsackJen).

The video will be below. If you’d rather listen to the episode, the audio is preserved from Friday as a weekly podcast available on our iTunes & Spotify channels

THCB Gang Episode 119, Thursday March 9

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday March 9 were writer Kim Bellard (@kimbbellard), benefits expert Jennifer Benz (@Jenbenz); Suntra Modern Recovery CEO JL Neptune; and special guest digital health investment banker Steven Wardell (@StevenWardell). Lots of conversation about Walgreens and the reaction to its non-sales of abortifacients and the possible outcomes. Then a round up of the latest in digital health financing.

If you’d rather listen, the “audio only” version is preserved as a weekly podcast available on our iTunes & Spotify channels — Matthew Holt

THCB Gang Episode 118, Thursday March 2

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday March 2 at 1PM PT 4PM ET are DiME CEO, & Olympic rower for 2 countries Jennifer Goldsack, (@GoldsackJen); writer Kim Bellard (@kimbbellard); benefits expert Jennifer Benz (@Jenbenz); and Suntra Modern Recovery CEO JL Neptune (@JeanLucNeptune). Today we have also a special guest –former Permanente Medical Group CEO Robbie Pearl @robertpearlmd, who is not shy with his opinions!

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

THCB Gang Episode 104, Thursday September 15 at 1pm PT, 4pm ET

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday September 15 patient safety expert and all around wit Michael Millenson (@mlmillenson); Suntra Modern Recovery CEO JL Neptune (@JeanLucNeptune); fierce patient activist Casey Quinlan (@MightyCasey); delivery & platforms expert Vince Kuraitis (@VinceKuraitis); &  policy expert consultant/author Rosemarie Day (@Rosemarie_Day1);

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

THCB Gang Episode 100, Thursday August 4

Joining Matthew Holt (@boltyboy) for the 100th #THCBGang on Thursday August 4 were Suntra Modern Recovery CEO JL Neptune (@JeanLucNeptune); Consumer advocate & CEO of AdaRose, Lygeia Ricciardi (@Lygeia);  and the Light Collective’s Andrea Downing (@bravebosom). Sadly fierce patient activist Casey Quinlan (@MightyCasey) had a Mets party flare up and couldn’t join at the last minute. There was a lot of chat about data and privacy, and even some ideas about what a future where patients data flowed but patients rights were respected might look like!

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

THCB Gang Episode 96, Thursday June 16

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday June 16 were medical historian Mike Magee (@drmikemagee); patient safety expert and all around wit Michael Millenson (@mlmillenson); Queen of all employer benefits Jennifer Benz (@jenbenz); and Suntra Modern Recovery CEO JL Neptune (@JeanLucNeptune), who these days also hosts the Is It Serious podcast. We got into mental health, patient safety, drug advertising and whether the Jan 6 committee will make a difference.

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.