Pa. physicians, national board spar over exam standards

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Scott Shapiro, president of the Pennsylvania Medical Society, and other critics say there is little evidence that memorizing for the tests will lead to better patient care.

Scott Shapiro treats patients with clogged arteries, heart failure, and other classic cardiovascular diseases that strike millions of adults.

Yet over the next year, the cardiologist says, he will spend dozens of hours cramming to learn intricate details about other conditions that he does not treat in his Abington practice, such as rare congenital heart defects.

He and other leaders of the Pennsylvania Medical Society are part of heated national debate over how to ensure that physicians maintain their skills. The society's board voted last month to take a position of no confidence in the American Board of Internal Medicine, a Philadelphia-based organization that administers certification exams to a quarter of all physicians in the United States.

In addition to claiming that the exams cover irrelevant material, Shapiro and other critics fault the board for requiring the tests only once every 10 years, leading physicians to take time away from their practices to enroll in costly review classes. They say there is little evidence that this concentrated rote memorization of facts contributes to better patient care.

Last week in Chicago, the American Medical Association's house of delegates chimed in, voting to call for an end to "any mandatory, secured recertifying examination" such as the one administered by the internal medicine board.

On May 5, however - before either vote - the board announced that it planned to offer an alternative that appeared to address some of the long-standing concerns. That option will be available starting in January 2018, allowing physicians to take shorter tests on a more frequent basis, some of them on a home computer instead of at a proctored testing site.

Not good enough, said Shapiro, the president of the society. He and Charles Cutler, the president-elect, say the details of the alternative option remain vague.

They and others also have faulted the internal medicine board for what they say is poor financial management. Among the flash points: a $2.3 million condominium on Washington Square that was purchased in 2008 by the board's foundation.

Richard J. Baron, president and chief executive officer of the American Board of Internal Medicine, said Thursday that he was disappointed by the Pennsylvania group's vote.

"We are focused on the idea that assessment of physicians is important for the doctors and for the public," he said. "It is a core professional responsibility."

He acknowledged that an exam once every 10 years may not work for every physician, but stressed that the alternative option must be developed with care, to maintain patients' confidence in what it means to be board-certified.

"That credential means something to the public because there are standards behind it," said Baron, a longtime internist who also worked for the federal Centers for Medicare and Medicaid Services. "We need to be careful that we preserve those standards so that what we're saying about doctors actually matters."

As for the condominium, Baron said it recently had been sold, for less than what the foundation paid for it - though he declined to say the exact price because the details have not yet been public recorded.

He said the condo was seen as an investment and also was used for business purposes, housing contractors and other out-of-town guests.

Shapiro, Cutler, and others also have accused the board of overpaying its staff. They pointed to the organization's Form 990 from the year 2013, where former chief executive Christine Cassel was listed as receiving more than $1 million in total compensation.

"We're talking about questions of millions of dollars being spent in ways that we take issue with," said Cutler, an internal medicine physician who practices in East Norriton.

He and other critics say they have no objection to maintaining their skills and keeping up with new developments - quite the contrary.

They read journal articles and attend conferences on a regular basis - but only in the areas of medicine that they actually practice.

"We want lifelong learning," Shapiro said. "That's the cornerstone of being a physician."

tavril@phillynews.com

215-854-2430@TomAvril1

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