Doctors 'Cheating' On Board Certifications 238
Maximum Prophet writes "After taking board exams, doctors have been routinely getting together to remember and reproduce as much of the exam as they can. These notes are then bound and reproduced. According to the American Board of Dermatology, the exams are protected by copyright laws, and any reproduction not approved by the board is illegal. While I have no doubt that the Board believes this, and pays lawyers to believe it as well, I don't think they understand copyright. Perhaps they should invest in better testing methods."
that happens on all sort of examination (Score:3, Informative)
Re:IT Certificate (Score:2, Informative)
Nah, they're protected by a very powerful union [uapd.com].
Not so sure about their "airplane notes" reasoning (Score:4, Informative)
The first 2 times I ran into this, at about the same time, was for FAA & FCC (Federal Aviation Admin., Fed. Comm. Comm.).
You used to have to have at minimum a 2nd Class Radio Telephone license from the FCC to be a broadcaster in radio. You could actually have a 3rd class only to talk if the station had someone else on duty with a 2nd class to actually run the equipment. The stations often didn't want to pay for a 2nd person with the higher level license, so...
For FCC testing back in the 60s & 70s, there used to be outfits that came to cities periodically that would guarantee passage after a weekend course (12 hrs per day) during which you would be taught the answers to the test questions. The way they got the answers is what is talked about here. It had likely been going on for some time already when I found out about, but the 70s is when I was working on my FAA & FCC licensing, so that when I knew about it.
There was the same thing for FAA written tests and I seem to remember hearing that the FAA stuff came first. This may be the actual reason for calling them "Airplane Tests".
A more global, widespread issue (Score:5, Informative)
This also happens for NCERT, Medical Entrance Examinations, Engineering Entrance Examinations among several others. No Legal action has been taken in the recent past to stop such recollection, despite the fact that it merely promotes rote learning, textual recall or fundamental pattern matching. Interestingly, in India, no one has referred to this practice as cheating, although it is. It is only in the past two years that Computer Aided Tests which shuffle questions and stagger timelines are being introduced to avoid this practice. Enforcement of legal sanctions in India especially across Educational boards, Varsities and Corporate Testing groups have not been easy.
Question papers, by themselves for any test are never copyrighted officially. Most Board question papers in India, Pakistan, Sri Lanka, Bangladesh and Nepal do not come with any Copyright notices. Boards and Academic members have until recently been in the dark about 'Copyright Law' and have little idea as to how it is enforced. A vast number of books published are not registered for copyright, nor do they have ISBN assigned to them.
Part of the issue is the inability to enforce exclusivity on 'recalled' or 'reproduced' testing material. Another part is ignorance of the full extent of 'Copyright Law' itself, though this is significant in nations like India and China where their implementation has only now begun.
Before you go nuts... (Score:5, Informative)
When a physician is described as "board-certified", that means that s/he has taken a specialty examination given (in almost all cases) by a member of the American Board of Medical Specialties. In some fields, this only has a written component; in others, especially surgical fields, oral examinations are standard as well as the writtens. These examinations serve to certify that you know that particular specialty. They are not required to practice medicine, and physicians are not limited by law to practice only in areas of medicine for which they have received formal training. Insurers providing coverage and hospitals allowing privileges outside of your area are a different matter, but as a matter of law, a general-practice MD can perform neurosurgery in his office.
A permanent, unrestricted medical license in the US is predicated on passing the US Medical Licensure Examination Steps 1, 2, and 3 (unless you're an osteopath and you take the COMLEX, but that's a small number of people and in any case the principle is very similar). Furthermore, you will have to do at least an internship (the first year of residency after medical school) in order to be granted a permanent, unrestricted medical license. (Graduates of non-US/Canada medical schools may have to do two or even three years of residency.)
So yes, people do get together and discuss things. In particular, memorizing questions serves the purpose of identifying what the question-makers think is important. This is not always trivial; as medical specialties have moved their written examinations onto computers in recent years and K-type (Choose A if 1 and 3 are right, B if 2 and 4 are right, C if 4 only is right, D is 1, 2, and 3 are right, and E if all are incorrect) questions have been eliminated, there has been a significant influx of new questions from younger examiners. Like all examiners, they tend to submit questions from their own interests rather than just covering a broad enough base to be sure that the examinee is capable of practicing safe medicine. The line between pass and fail has to fall somewhere, and if you're academically relatively weak, knowing the likely subject matter (or the likely rare association between two things) can make the difference between pass and fail.
The USMLE 1/2/3 all have prep courses and study books with sample questions, just like the SAT. If you don't study how the questions are asked, you are unlikely to do your best. However, the base of knowledge is just immense - Step 3 considers anything that you might encounter in a general practice to be fair game. To pass the test, you're going to need to know the stuff.
The specialty board examinations don't take anyone who couldn't 1) get a residency in that specialty and 2) pass their way through it (which is not a given - people fail out of residencies all the time). Dermatology, the subject of this article, is populated exclusively by people who gradated in the top 5-10% of their med school class. Their intelligence and drive to study isn't really in question. What's happening is mostly a matter of pride; even though only a vanishingly small percentage of people who take the test will fail, it is incredibly embarrassing to be the one who does.
Re:IT Certificate (Score:5, Informative)
I'm not opposed to Doctors getting compensated well - I'm opposed to them knifing me in the dark.
A common occurrence - I go to a doctor who's performing a procedure. Before the procedure I ask for an estimated amount. Yes, I understand it can change. Yes, I understand my insurance must pre-approce. I go home, come back and have the procedure performed. After the procedure I ask for my FINAL BILL so that I can pay it. So, I pay the bill and go home.
NINE WEEKS LATER... I get a bill in the mail for 25... 50... sometimes more. There's always some "forgotten" thing that didn't get billed, or an insurance mistake. WTF? Did they not understand? They had insurance approval, they got paid right away. What's the problem here?
I won't pay them - we had a final bill and that's that. You don't get to gouge me a second time. I call them and inform them that my bill was final and paid immediately at great cost and sacrifice to other areas of my life.
If my auto mechanic did this to me I'd tell him off... but for some reason Doctors think they can. No no and no.
Re:IT Certificate (Score:5, Informative)
Your insurance company changes these prices each year, and does not make them available for ready viewing by physicians, as that is not to their advantage. Your insurance company also sets deductibles and copays, and doesn't tell us what they are or how paid up your are on them. When we try to call your insurance company to figure this out, we get put on hold for 20 minutes (just like you) and as often as not are told we need to fill out form 2204-09, available on their website hosted in North Korea, to get permission to access information about your particular plan in order to make some guess about how much you're going to owe based on the procedure we think you're going to need and the particular agreement your plan has with our office.
If your physician gets paid right away by your insurance company, s/he is truly blessed. The insurance folks have 30 days to mull over the payment, and then can contest this and that and claim the diagnosis code needs another procedure code and so forth, with several weeks turnaround each time on muddied fax; they have little incentive to pay promptly. I can assure you they make as many mistakes paying us as they do billing you. And then we get to send you revised bills based on their (often) capricious decisions.
When patients call our office complaining about a bill, my preferred response is typically "fine," since I'd rather not spend another 40 minutes on the phone with your insurance company asking why the $120 we charged to remove your pre-cancerous mole shouldn't be bundled into the $10 toenail removal we did 2 months ago, and the 3 pages of paperwork designed in Kyrgyzstan where I can try to justify our billing to some insurance company bureaucrat. So we can get the $43 your insurance company has negotiated the $120 procedure down to. For the work we already did. I expect if we made your auto mechanic go through this bullshit 20 times a day they might just kill themselves with an air compressor.
Re:IT Certificate (Score:3, Informative)
Doctors... could you perhaps ask your billing office to do a statistical analysis on how much you actually ended up getting paid for various procedures?
Larger organizations will actually do this regularly, and there are actually consulting agencies that can do the analysis for small offices. For an example of some aggregate data:
http://www.medscape.com/features/slideshow/insurerreport [medscape.com]
There must be some positive benefit to working with the insurance companies or you would have found a better way?
Insurance companies have the customers captive. If you don't work with them, you don't get the patients in their pool.
The old fashioned style of solo private practice is gradually going extinct due to the overhead and lack of negotiating leverage vs. insurance companies. Now, if you're good at marketing and handling the business side of things, you may be able to do a "concierge" or "boutique" medical practice -- which is part of the reason for the popularity of specialties such as dermatology and cosmetic surgery (who handle lots of cash-only patients).
This is SO WRONG in SO MANY ways (Score:5, Informative)
I'm almost at a loss as to how to be informative on this post because it's so lacking in facts or actual observation.
1. Doctors are primarily (with a few notable exceptions like Kaiser-Permanente and the military health system) small partnerships of under 5 physicians. They don't run "big operations with high margins."
2. Hospitals are generally not-for profits (again some exceptions) with net excess revenues less the 5-7%, about the cost of capital replacement.
3. Doctors do expect compensation for the 4 years of college, 4 years of medical school, and 3-8 years of internship, residency, and fellowship, since they give up 7-12 years of post-college years of income generation for the same life expectancy. However, huge salaries for a few do not equate to massive salaries for all. Just like baseball players, a few get the big bucks, but many more play in the minor leagues. Check out the National Bureau for Labor Statistics data.
4. Some doctors make lots (neurosurgeons, for example), but then they also pay millions of dollars (YES, MILLIONS) of dollars in malpractice insurance because people expect perfection from doctors, not acknowledging how complex and variable human biology is.
5. The most complex part of the healthcare system is the insurance system, which is completely out of the control of the medical professionals.
6. AMA is not a union, has no collective bargaining rights, and has as its membership AT BEST maybe 10-15% of all physicians. It's a voluntary professional membership society.
7. The major evolving complexity in the state of healthcare in the US is the federal government, which through tax laws, federal mandates, and regulatory actions, have created a never-ending chain of requirements, complexity, and frustration. The decades long effort at vilification of the medical profession and poor financial management coupled with government regulation will give you increasingly lower quality of medical care delivered by less trained salaried employees.
8. On the plus side, technology can assist in improvement in the application of scientific knowledge to the delivery of care, but not if legislated and dictated by Congress and political forces.
The IT profession (at least NOT YET) doesn't have state regulated boards, mandatory licensing, bureaucratic payment policies, and direct government intervention in almost every aspect of your professional career.
captcha: digits (At least a triple entendre)