Over the past few years, there has been much discussion about needed changes in how internists maintain their ABIM certification.
Over the past few years, there has been much discussion about needed changes in how internists maintain their American Board of Internal Medicine (ABIM) certification. Some of the issues revolve around the need to obtain Maintenance of Certification (MOC) points by taking an examination every 10 years and the cost of participation and recertification. Many feel that state requirements for CME hours (for example, 50 hours a year in New Jersey) should suffice as proof of staying up-to-date with current standards of care. Changes are being made with input from clinicians, and it looks like the examinations will be replaced with a less onerous form of evaluation.
Contrast that with Endocrine Certification in Neck Ultrasound (ECNU). I was certified a few years ago, and it was a difficult process. In addition to undergoing training and taking an examination, I needed to attest that I did a certain number (I think it was 130) of ultrasound studies a year. I also needed to submit images of the studies I had performed, and the reports had to be very detailed-more detailed than 90% of the reports I receive from radiologists.
Fine. I get that. They want to make sure that I know what I’m doing before I receive the stamp of approval. Well, now I have to recertify. Part of that process includes 50 hours of ECNU-approved CME hours. And not just any thyroid cancer conference-not even every lecture at a conference such as the World Congress on Thyroid Cancer. Just specific American Association of Clinical Endocrinologists (AACE)/ECNU-approved sessions. I recently received a list of approved CME opportunities. None are free. Each hour costs $100 on average, plus the cost of travel and lodging and the lost revenue from not being in the office. I also have to attest that I do 100 studies a year. And I have to submit images of some ultrasounds I’ve done.
So, if someone has been trained and certified, and continues to do 100 ultrasounds a year, what else is to be gained from these very specific CME hours? I had to sit down and crunch the numbers to decide whether this is worth both the money and the effort.
Some insurance companies will not pay for in-office ultrasound studies unless the physician is ECNU certified. And ultrasounds and ultrasound-guided biopsies are the two main procedures endocrinologists have. Moreover, there is definitely a clinical benefit to doing an ultrasound study yourself (as I said, reports from radiologists often lack detail).
But ultrasound machines are expensive, and machine maintenance is a continuing expense. In addition, I’m sure eventually our unit is going to need to be replaced.
I suppose that since I am doing the requisite number of studies each year, it is still worth it to recertify and do the tests in the office. For now. Unless the process changes, I think this is the last time I’ll do this. Maybe I can retire before I’m due again.