Tuesday, April 26, 2016

How Re-Taking the Pathology Boards Ruined My Year

With all due respect to the American Board of Pathology last year sucked.

I am both lucky and unlucky. I only have to re-certify every 10 years (so sad for my 6 year OB/Gyn friends and my 7 year Peds friends). Lucky. I was the first class in pathology - they were a little behind the rest of the specialties - to have to re-take my boards. Unlucky. I could combine my general and subspecialty re-certification into one test. Lucky. I think this whole process is a ridiculous money making scheme like most other doctors in the country. Unlucky.

I started studying in early 2015 on a plane on the way back from a lab inspection. I wanted to take it a year early in case I had to do it again. I was really frustrated that I would have to take it in Tampa - most other specialties could do it at a testing site in their city. I signed up to take a half a week off and fly there in August. My path bro-in-law was going to do it with me, and a friend. We learned early on that there was a study guide online, which made me so happy I took a deep breath and a couple of months off. Path boards are very comprehensive, and while I sailed through the first time, I've never studied so hard for a test in my life.

I geared back up again in the Spring until I got an e-mail from the Board at the beginning of June. They were offering for me to be a part of a pilot program to take the test online. Not in August, but probably in September. I was so excited (no flying to Tampa!) I signed up right away and took a breather. Still, having that test loom over your head is like that kid in Peanuts with the rain cloud over his head, even on a sunny day.

Even with the study guide it wasn't easy. There were three hundred topics. Some of the topics on the general re-cert were so broad - "drugs and their metabolites" and "cerebrovascular disease" - that it left a lot of material to cover (in the case of the latter - it left me wondering what the heck to cover). On the cytology subspecialty exam guide it listed topics like - "thyroid, benign nodules" and "thyroid, malignant neoplasms" - um ok, so pretty much all of thyroid. I took notes during the summer.

It is a lot easier to study for your boards when you are coming out of your residency and you are so stoked to finally be doing what you set out to do and getting a decent salary for it after years (10 in my case) of training. Stuffing tons of minutiae into your head for months is a challenge but hey! You are at the end - so close to the carrot. Ten years later you have the carrot - you are living the life. And it's hard, it's different than what you expected, there are unexpected challenges but if you are like me you also get really excited by what you do and that helps you get through the hard days. Studying ten years into your practice is hard because you know that all that minutiae is at your fingertips whenever you need it and it is so pointless to stuff it all into your head again just to spit it out and get a certificate saying you can continue to do what you are already damn good at doing. But we doctors are mostly type A by the book individuals. So we do it anyway. But it doesn't mean we are happy about it.

August came and went and I got a call from my brother-in-law, who did fly to Tampa in August. I was so jealous of him being done. "You'll do all right, but I'm sure glad I studied." When he found out he passed and elatedly called me in October, I was still waiting to get my two week window to take it online. The computer program they were using was delayed, still working out kinks. The woman in Tampa I corresponded with in frustration was very kind and empathetic, but still. Rain cloud.

October passed into November and we pilot computer people finally got a nice extended window right around the holidays. Again many apologies and an offer to let us take it in March this year because of the delays and inconvenient timing. Hell no. I was getting that monster over with. I downloaded the program with the link - can't remember now why but that process took hours. And I did it on my own mac laptop - no hospital PC would take it. My brother-in-law had a partner taking the same pilot and their group had to buy her a laptop with a camera because she did not have one.

The technology blew me away. I was able to sit at home - they recorded me taking the test and there were all these rules for bathroom breaks and such. I was sitting in the exact same room I am in now typing this blog. I did set up a desk and chair instead of sitting on the couch because it felt more official and I was so nervous. It was nice to be able to have a glass of water next to me, and being at home was a lot easier than being at a testing site. I took it in late November. I felt really good about part of it but not about others. Anyone who has ever felt like they aced a general exam I'm jealous; I always feel like crap after they are over.

Here's another beef and I know I was a pilot but come on ABP 6-8 weeks??!! My friend who took the peds boards re-cert a month before me knew she passed within that week! It's on the computer how hard can it be to grade? I waited over the holidays and finally got an e-mail in mid-January learning that I passed. I was so elated I couldn't get my work done for two hours and had to stay late.

When I look back at last year - skipping weekly lunches with my partner to squeeze studying in, ruined weekends of cramming because I refused to study on vacation or on my time with kids, and overall being more testy in general and pessimistic about life I get really angry at this whole process. I know that pathology is closely following what internal medicine does, and I hear rumors of making this process a lot more palatable (shorter intervals, smaller tests, more related to your current practice), but the nice woman at the ABP who was my phone buddy last year tells me that is years down the road. I hope not ten. I don't think I can do that ever again.

Thanks to my sweet boyfriend and wonderful kids for putting up with me last year. And congratulations to my friend Trishie who found out she passed her MOC boards today (that she took at the beginning of March!) on the way to Disneyworld. She got me thinking and inspired this rant.


  1. SO SO glad I am old and don't have to do IM MOC (board certified in 1989, the last year before that started.) If I stay in HPM clinical practice, I'll have to recert in a few years. erp. Congrats on passing!!!

  2. Thanks. I'm so jealous of you and all my partners (except one he has to re-cert this year).

  3. So with you on this. I had to recert this year too. We are also on a 10 year cycle. Thankfully, we are allowed to take the test online at home with a proctor instead of a camera. I just found out I passed mine. Congratulations to us!! The whole thing is a huge hassle and truly nothing but a moneymaking scheme that has nothing to do with competence or quality of care.

    Miss hearing from you, btw! -gcs15

    1. gcs15 so great to hear your words! I hope you post soon you are an amazing writer. Congrats to you for jumping through the monkey hoop. We just got a letter from ABP that they are piloting a smaller more practice-based test in 2017 so I (knock on wood) won't ever have to do this again, yippee. Miss you too I think I owe you an e-mail! Much love, Giz


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