Sept. 25, 2011
Journal of the American Board of Family Medicine
In his response to my letter Dr. Puffer does not address the factors which disadvantage some physicians taking the ABFM recertification exams. For example aren’t physicians in solo practice disadvantaged because they may not have the time to prepare for the exams? In addition they may not be able to afford the expense of taking a board review exam which some physicians take. Both of these factors disadvantage these physicians.
Another that recertification overlooks is that once in practice most physicians tailor their practices to their abilities, the availability of specialists, and to the demographics of their patient base. The point is that after physicians pass their initial certification exams, recertification should not be punitive. It should take their individualities into consideration and alert them to competencies where they may need remedial study. The current pass/fail approach is unfair and an unnecessary source of stress.
Finally, with its punitive approach, the ABFM presumes that passing a recertification exam is a guarantee of competence and advertises the same to the public. In doing so it assumes the powers of a licensing body, a power that it was never intended to have. Worse it implies that physicians cannot be trusted to remain competent on their own. This sends a misleading message to the public.
Assimilating the ever-increasing body of medical data that becomes available will increasingly make life for primary care doctors more difficult. In addition the vast amount of paper work (which has reached crisis levels for some) that is thrown at them from all quarters complicates their work days and decreases their job satisfaction.
The biggest challenge for the ABFM in the upcoming years will be to understand the many varieties of family medicine and primary care and how to help the individual physician stay current in a way that is positive, constructive, and most of all not punitive.
Edward J. Volpintesta MD