What have you learned in the past 10 years

“If you think in terms of a year, plant a seed; if in terms of ten years, plant trees; if in terms of 100 years, teach the people.”   -Confucius

Certain things are decennial ("occurring or being done every ten years"). Some examples include:

• The Grand Canyon is filled completely with fog. http://bit.ly/18kWsxn

• At a cost of more than $400 million, a census is taken in the United States.

• The American economy goes into recession. http://bit.ly/1OM1gRi

• The entire adult human skeleton is replaced. http://nyti.ms/1Plcavn

• Many American physicians take an examination to prove they deserve to continue practicing.

But the last of these items may change.

"The professional group that represents anesthesiologists will become the first medical board to scrap a widely criticized test that most physicians take every ten years to demonstrate that they are up-to-date in their specialties," reported The Washington Post on Sept. 9. (http://wapo.st/1ig1dks)

Instead, the American Board of Anesthesiology’s 50,000 members will take weekly online quizzes along with related educational materials. According to the Post, the Pediatrics Board is interested in this approach and the Internal Medicine Board is also exploring alternatives to the once-per-decade recertification examination approach.

Current recertification efforts were intended to ensure that physicians maintain the high levels of knowledge they possess when they complete their residencies and fellowships, and that they also master new information as it is generated long after they train. According to James P. Rathmell, secretary of the anesthesiology board, the approach resulted not in continuous learning, but rather in last-minute cramming every 10 years.

Salomon Imiak, MD, is an anesthesiologist in Florida. He says the new system has multiple advantages: “It’s extremely convenient, it’s less expensive, it’s less stressful, and it allows us to identify areas of lack of knowledge that we should improve.”

One major appeal of this new approach, it seems to me, is that practitioners can take these brief quizzes at times convenient to them. Currently, some of my fellow ophthalmologists tell me they have to take time away from their patients, even briefly closing their practices, in order to comply with the requirements of the recertification process.

Would it work in ophthalmology?

Given that ophthalmology is one of the specialties in which experts project a looming shortage of practitioners in the United States, I am not enthusiastic about anything that unnecessarily takes ophthalmologists away from the clinic or operating room.

I am in favor of an approach that reduces the financial burden on our young physicians (according to the American Association of Medical Colleges, the median debt of American medical school graduates is $180,000).

Lastly, dealing with the needs of their patients and the incredibly rapid pace of change in medicine-such as accountable-care organizations, ICD-10, meaningful use of electronic medical records, quality measures, etc.-is stress enough for young practitioners without adding to it if there are better alternatives.

I wonder whether a poll of American ophthalmologists would reveal support for a major change similar to that enacted by our anesthesiology colleagues.