The American Board of Internal Medicine Is a Joke

The other day, a gang of doctors robbed me. They call themselves the American Board of Internal Medicine, and something tells me I’m not the only one.

For context, I’ll start with my bio. After graduating high school in 1995, I pursued a four-year undergraduate degree, followed by a four-year medical degree. From there, I required three years of on-the-job training in internal medicine (termed a residency) after which I worked independently for one year as a general practitioner. I subsequently opted to pursue a three-year subspecialty training (termed a fellowship) in nephrology, aka the study of the kidneys.

Along the way, I took a three-step licensing exam, went to various professional meetings, paid all sorts of fees, and so on. One would imagine these activities, along with the 15-year journey after high school, would have mercifully set me free.

The American Board of Internal Medicine (ABIM) does not agree.

The ABIM, you see, is a self-appointed entity that has tasked itself with providing board certification, a sort of seal of approval meant to indicate that a medical practitioner is not a quack. It is not a licensing body, nor is it an educational institution. It is simply…well, many are not sure exactly what it is. That said, one thing is certain—the doctors at the top of the ABIM pyramid make double or triple what practicing physicians make. And given the absence of other certifying entities, the ABIM has had a monopoly. (Thankfully, that could be changing.)

In any event, in my era, board certification has involved paying hundreds of dollars to take a full-day test and repeating the process every 10 years. The process must be duplicated for every specialty—in my case, both internal medicine and nephrology.

In 2006, by paying for and passing an exam, I became board certified in internal medicine. In 2016, I did the same thing again. As for nephrology, it was 2009 followed by 2019. And that’s when the seeds of robbery were planted.

To be more specific, I took the nephrology recertification exam on October 23, 2019. Scored out of 800, a passing score was considered 386 or above. As this report shows, I received an 800. (This is not about boasting—it’s about being genuinely perplexed.)

Thinking I had sufficiently proven my nephrologic competence through 2029, I disengaged from the ABIM for several years (i.e. deleted their periodic emails without necessarily reading them). This naivete made me a perfect candidate for what was to come.

In September 2024, while reapplying for hospital privileges in Rochester, New York, I was told I was no longer certified in nephrology, meaning my privileges could not be renewed.

How could this be?! I thought.

I reintroduced myself to the ABIM website and, after a mild struggle with the password, accessed my personal portal. Immediately, the problem was clear:

Maintenance of Certification (MOC)

Despite having earned myself the aforementioned 10-year pass, I needed to pay an annual fee to maintain my certification.

Making up for lost time, and accounting for late fees, I owed the organization $1,365.

There was, of course, one other factor. I needed to earn so-called MOC points to prove that I was still learning. For that, I had to submit Continuing Medical Education (CME) credits that I earn regularly and receive the necessary MOC conversion.

In other words, without performing a duplicative clerical task and paying the ABIM four figures, the above exam would be rendered irrelevant and I would be out of a job.

Sure, you could call this certification.

But as a budding writer looking to expand his vocabulary, I—like Dr. Glaucomflecken—prefer another word: extortion.