Several DO and MD primary care physicians recently noted to me the grueling commitment of preparing for their respective medical boards. These exemplary practice leaders have been physicians for several decades – and plan to continue working for the foreseeable future. Each of the physicians I spoke with is a PCMH champion with an outstanding reputation for serving their patients and the surrounding Macomb, Oakland and Wayne County communities.
Why do physicians with a career history of providing high quality care have to continue to take a board re-examinations every six years? I’m looking for a reasonable answer, but the response currently seems to be, “so they don’t get kicked out of a health plan.” At the same time, I can’t help but ponder the big business behind board certifications. Consider the cost of the board examinations and the prep programs including pre-tests, times the number of physicians taking them and it’s hard to deny the financial implications/advantages of keeping the status quo.
At a time when we aggressively aim to attract and retain primary care physicians, we need to remove barriers that prevent senior physicians in the field from staying. This problem is of notable concern in underserved areas where primary care physicians may be opting out of full-time physician status but want to stay engaged as a community physician resource. The financial and mental costs associated with the actual exam, pre-tests and preparation serve as further inducement for rural physicians to retire too soon, often to the detriment of the community.
Adding to the frustration (forgive the digression), is that Board exams for family practice physicians are peppered with questions a community-based physician striving to provide population-based care will likely never encounter. The fact is that the board examinations as they currently stand are archaic in their continued focus on acute care. Where is the recognition of population health? That’s the future of primary care. How about the five social determinants of health? Today’s PCPs are trying very hard to be good stewards of care, especially in the era of Choosing Wisely and the Triple Aim. Board exams need to incorporate this mindset.
As a member of the Patient Centered Primary Care Collaborative (PCPCC), I see the number of PCPs leaving practice before their time – it’s not just a rural area phenomenon. Easing rules on board-certified senior physicians could help reverse the trend. For example, a milestone combination of age 60 with 30+ years of practice and currently practicing in a BCBSM designated or NCQA recognized patient centered medical home could qualify as an exemption from taking boards. Another option is to create a point system for PCPs in private practice using key criteria such as PCMH certification, CME hours and quality scores – or quality improvement programs that address population health.
Let’s be creative in addressing a new designation, such as board certified emeritus. Senior PCPs can retain the benefits and prestige that come with the designation and communities retain much needed primary care physicians.