According to an ABIM website in 2001 the first year of the current re-certification test for internists 92% passed, in 2004, 86 %passed the re-certification exam ( now called maintenance of certification or MOC) while in 2005 84% passed, now we are told the pass rate is down to 75%.
Is the test harder or less relevant to what internists do and need to know or is the knowledge base of the internists falling in proportion to the test scores? Are younger internists not as sharp as the older docs, a position 180 degrees from the views expressed a while back in an Annals of Internal Medicine editorial by Dr. Christine Cassel in which she defended and accepted an unusually poorly done article- see here for some comments regarding that issue- that claimed as physicians aged so did the quality of their care.
Dr. Cassel, President and CEO of the American Board of Internal Medicine (ABIM) defends the test and opines that perhaps the current cohort of internists are less competitive,whatever that means.She also wonders if those who take the test early (certification has a ten year cycle and some docs may take the test early and she thinks those may be less prepared because they will have another chance before they are defrocked.)
I have a theory that could actually be tested by surveys of the test takers. Could the decrement be due to more general internists limiting their practice to office patient encounters? If you never treat seriously ill patients in an in-patient setting how current do you feel you should be in regard to a wide variety of medical conditions? Your practice is more involved in seeing if your patient is at goal for this or that and have they had their bone density and flu shot than the choice of antibiotics for a seriously ill patient with pneumonia or sepsis or how to manage emergent upper GI bleeding. It would be interesting to know if internists who practice as hospitalists do better than those whose office day is closer to that of the typical family practice physician.