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CHICAGO -- The American Board of Internal Medicine (ABIM) should not make recertification a once-a-decade high-stakes exam, but instead should find other ways to help physicians keep up to date in their specialty, several speakers said at Kidney Week here.

"I believe CME is a perfectly reasonable way of maintaining our legitimacy as intelligent practitioners," said , a nephrologist at the Medical College of Georgia, in Augusta, at a "town hall" session on recertification.

"We are not criminals, we want to [get better] at everything we do. I think maintenance of certification (MOC) has just gotten a little out of hand," Nahman said. "This idea of [testing to keep] your certification irritates me; you can't take that away from me! I worked like a dog to get certified. Leave me alone!"

, chair of the American Society of Nephrology (ASN) task force on recertification, presented six draft recommendations that the task force had developed to guide the ASN leadership when it works with ABIM on the recertification issue:

Continue discussion with ASN members and other stakeholders regarding the pathway for remaining certified. This discussion involves two questions:

• Should the ASN support recertification?
• Should the ASN support a single recertification entity or process with accountability to nephrologists and kidney professional organizations, versus continuing to support all options for recertification?

Establish an independent recertification oversight committee comprising nephrology professional organizations and other key stakeholder to advise and approve ABIM recertification policies and activities if ASN were to accept ABIM as the single recertifying entity.

Permanently eliminate Practice Assessment, Patient Voice, and Patient Safety requirements for maintenance of certification.

High-quality, relevant educational activities (approved CME and maintenance of certification [MOC]) should be the foundation for obtaining recertification credentials.

Eliminate the high-stakes examination and move to more frequent low-stakes assessment (assessment for learning, not of learning).

Simplify any web-based information concerning CME/MOC activities for lifelong learning available to nephrologists, with more complete information (requirements, cost, other) and transparency.

The ABIM is considering adding options for recertification exams to be taken every 2 years or every 5 years, in addition to the 10-year exam. "I would say that the bottom line from ASN and almost all specialty societies is that we thought both options were not options to continue with, and that ABIM should pause and rethink those alternative options," said Rosenberg, of the University of Minnesota in Minneapolis, adding that ABIM is planning to issue a decision on the matter in December.

In general, the committee "has hit a spot where we wanted to pause and put out our progress to the membership," Rosenberg said, noting that the recommendations also were . "The goal is to continue to have these discussions."

Task force member , a nephrologist in Sioux Falls, S.D., said colleagues and friends told her that "they really vowed to keep their internal medicine certification just because they want to be better nephrologists, but after the MOC [exam], everyone I talked to said, 'I'm not going to do it anymore,' so is it really helping us or doing some harm?"

, a nephrologist in Temple Terrace, Fla., echoed those remarks. "The majority of the nephrology community does not want to take another test," he said. "We do not want another recertification exam. I'm not a fellow for the rest of my life; now we just want to make sure I'm keeping up to date, and it has not been proven that taking the test proves I'm keeping up to date ... It does not affect the care or the quality [that we deliver]."

Instead, "If we're going to insist on MOC, we need to cancel the monopoly of ABIM so that other boards are on there, so ABIM cannot dictate unilaterally to physicians," he continued. "If you just want a standard of care, that can be done by other boards. And the re-testing has to go away, period ... To hang everything on a high-stakes exam is what's killing us."

Rosenberg, the task force chair, said after the town hall ended that he wasn't surprised by what he had heard. "I think that's what we've been hearing, whether it's when we systematically surveyed all our membership or listened to [town halls like] this. It's important to know that people can be heard if they want to be heard."

"The task force is struggling with this issue, trying to come up with recommendations," he said. "We're polarized as a task force and I think we kind of designed it that way because we have pro-ABIM people and anti-ABIM people, and we hope that tension will help us come up with the best answers."

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