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Blog: The board exam, part I
I am taking the board exam, again.
I will sit for the Endocrine Board Exam in 2 days (November 15). By the time this is posted later this week, I will have taken the exam.
Yes, believe it or not, I am 59 years old, and I still take exams; big exams, that is. And costly for sure. When I took a look at my CV, to recall the exams and certifications that I took since graduation from medical school, I came across the list at the end of this post.
The list is shortened: While I passed all the exams listed (except for the New Zealand Evaluating Exam and the Jordanian Boards of Internal Medicine and Endocrinology, from which I was exempted based on other exams), there were some I flunked.
The Canadian medical exam I passed on the second attempt.
I flunked the U.S. medical exam, more than once!
The USMLE are now the same for all. There used to be two versions/editions in the old days, one for U.S. medical graduates (called the National Board Exam) and one for foreign (international) graduates. In my time, the latter was called the FMGEMS. The exam consisted of two parts, basic and clinical.
When I decided to take the U.S. medical exams, I took the 2 parts together. I passed the clinical part and flunked the basic part (71%, with the passing score of 75%). So, I took the basic part three more times; I flunked the first two attempts, (scores of 72% and 73%, respectively).
I finally passed after the fourth attempt. Luckily, ECFMG does not limit the number of exam attempts.
So, how did I pass the FGEMS, at last? I studied, and studied very hard.
Here is the story.
When I got very serious about coming to America, I decided that I would need to study for the basic medical exam. One must pass this basic part (together with the clinical part, and the TOEFL English test), to be granted a J-1 Exchange visa and to be able to apply for residency in the U.S.
The prior attempts at the basic exam were done without studying. I thought that I could pass with just the clinical knowledge and was confident that I would be able to remember all the materials needed to pass the exam, such as biochemistry, anatomy, physiology, etc, which I had taken in medical school, some years prior. But the first three attempts without studying did not do the trick.
A pediatrician friend of mine, who was also doing residency at Hamad General Hospital in Doha, Qatar, and I decided to study together for the basic medical exam. We would spend 6 hours daily, after work, from 6-12 p.m. (alternating his house and mine), studying together. Our families (kids were young) would be willing to dedicate one of the kids’ rooms for our study. His kids and mine would be guided by their mothers to try to stay quiet while playing, and foods and beverages would be provided to us, all the time, and on demand (And I take this opportunity to thank our families for that kind treatment and support).
After 3 months of intensive exam prepping, my friend and I took the exam. There was no exam center in Doha, so we had to take the exam out of the country, in Amman, Jordan. But what was going to be a 2-day trip took 1 month, and what was going to cost few hundred dollars for flight and lodging ended up costing thousands of dollars. Instead of Amman, the exam center was moved to Larnaca, Cyprus. Instead of staying a couple of days, my friend and I stayed a whole month. And while the flight from Doha to Larnaca cost us few hundred dollars, the return tickets cost us $3,000 each!
How come?
The rest of the story to be told in Part 2.
But, my friend and I both passed the FMGEMS exam, and we both got very high scores.
This upcoming endocrine board exam will be the third (recertification) U.S. board exam that I would take so far, one in internal medicine (2006) and two in endocrinology (2008, 2018). Prior to these three board exams, I took the original board exams in internal medicine and endocrinology, soon after finishing residency (1994) and fellowship (1997), respectively.
The preparation for the exam is overwhelming. How can I find the time to sit in my basement for few hours each evening, for several weeks before the exam? How can the body of an average 50 or 60-year-old human being endure this kind of a task that requires tremendous physical and mental demands? At the end of the day, and after 10 hours or so of mental and physical exhaustion in the clinic and the hospital, plus numerous other administrative and other tasks?
The costs for the board exam and the MOC program are staggering (thousands of dollars for the board test, board reviews MCQ books, MOCs, etc).
Let alone the worries about flunking the exam and the anxiety. What will happen to focusing on the patients and taking diligent and dedicated care of them, and enduring the endless tasks and regulations that go with that?. After all, is there any extra time to be spent on the family and on the various pleasures of (normal) life?
In my opinion (and many physicians would concur), the American Board of Internal Medicine (ABIM) has unnecessarily put thousands of physicians around the country into this ridiculous recertification exam process. I am not going to delve into the politics of the recertification exams and MOC. The ABIM and its leadership has already received all kinds of criticism and accusations, from numerous medical organizations and physicians, across the country.
But, the ABIM has bestowed a generous bounty on physicians: If you are a subspecialist in IM (endocrine, in my case), you could opt out of the primary specialty board, and just take the subspecialty board.
Now, here is the sarcasm:
The ABIM decided to impose the recertification exams through the Maintenance of Certification (MOC) program in the early 1990’s. At that time, the ABIM decided to exempt all certified physicians by then from taking the recertification board exam every 10 years. The ABIM considered these physicians as “grandfathers
This has created two categories of physicians: Those physicians who were certified by the early 90’s (a whole generation) and those who would be certified thereafter (another whole generation). And the two generations will likely coexist for perhaps a generation or so (2-3 decades).
So, what was the ABIM’s logic in creating these two populations of doctors? That is, did the ABIM recertification program confirm that the prior (senior) generation were less qualified/credentialed to be competent clinicians than the next (junior) generation?
I will let the ABIM answer the above question.
Whatever the answer, at the end of the day, physicians had to cave in, and they have been forced to do the recertification exams, by their employers, and in some cases by insurance companies and other bodies.
And so, I will take the board exam this Thursday. I will write Part 2 of this post in the near future. If I pass, I will be happy; if not, I will be sad and embarrassed before my colleagues and patients, and I will be guilty that I did not prepare well.
In either case, I still do not believe that I am 59 and still taking exams and will continue to take exams for the rest of my professional life!
* Exams (certifications) that I have taken, since graduation from medical school:
- 1987 MCCEE (Canada)
- 1988 Arab Board of Medical Specialties, Internal Medicine (First Part)
- 1992 Board Eligible: Internal Medicine (Arab Board of Med. Specialties)
- 1992 ECFMG Certification, FMGEMS (USA)
- 1993 FLEX Certification (USA)
- 1994 Board Certification: American Board of Internal Medicine (ABIM)
- 1996 NZREX, parts I and II exempt (Evaluating Exam of New Zealand)
- 1997 Board Certification (American Board of Endocrinology)
- 1998 Certificate of the Jordanian Medical Council in Internal Medicine
- 1999 Certificate of the Jordanian Medical Council in Endocrinology
- 2006 Board Recertification in American Board of Internal Medicine
- 2008 Board Recertification in American Board of Endocrinology
- 2010 Endocrine Certificate of Neck Ultrasound (ECNU) of the American College of Endocrinology
- 2018 Pending: Board Recertification in American Board Endocrinology