It has been nearly nine years since Alone wrote1 about the ABPN and the MoC. He felt so seriously about this subject that he actually put in the effort to get a proper article out in front of psychiatrists’ faces in the Psychiatric Times. It became a TLP blog post a few months later2 3.

What has changed since 2013? Not a whole lot. They added a pilot program in September 2017 wherein a currently-board certified psychiatrist could opt-out of the MoC exam Alone eviscerated to instead read 40 ‘scholarly’ articles, answer 3-4 questions about them, and get three years of board cert time added on to your sentence.

Three years is a lot less than ten. More fees, of course. “But it’s easier, right?” Fail three or four of the 40 quizzes and you’ve failed the whole project. Over the five years I got emails about this from the ABPN there never was any clarity about remediation, or how serious they actually were about punishing failure. That was Alone’s point – the exam is meant to give the appearance of competence; it isn’t actually about measuring quality or assessing if your psychiatrist has met the minimum standardized benchmarks.

Fast forward to today, where I received this quarterly update from the Board:

In other words – we’re “concerned” about our monopoly and we’re “asking” you to advertize for us, for free, while still collecting your annual pizzo.

To my knowledge this is the first time the ABPN has actually recognized the NBPAS4 out loud. They wouldn’t dare name them in the email; it’s not about libel, it’s about hemorrhaging physicians one hyperlink away. I didn’t even know those new guys existed until a few months back myself (perhaps they have the same marketing budget as the ABPN).

They’re a serious contender now, JCAHO added them to their official list this past July5. No matter how that might’ve happened (a cash infusion?), it could no longer be ignored that the greatest future source of revenue to the ABPN (graduating residents/early career psychiatrists) finally have a choice when it comes to board certification. Hence, a message in the latest quarterly missive.

A message, in the opinion of this analysand, which reads like a threat. The psychiatrists are being bullied here but it’s the ABPN’s existence who is threatened. Many of their peers in the ABMS have been sued (as Alone mentioned in 2013) and/or have been driven towards meaningful, clinically relevant changes to their MoC. The ABPN has ignored all these efforts until now.

Why do you stay? Why would a psychiatrist stay? At a prior place of employment the cash bounty for board certification was 10 grand a year extra salary (gross). The tithe to the ABPN bit into that, but it wasn’t the financial hit, it was the time commitment to the ridiculous MoC standards which kept changing (especially during the Covid Years, when many of the onerous requirements faded away).

I can’t remember the last time a patient asked me if I was board certified. It isn’t relevant to daily clinical work. Alone cogently argues that it isn’t relevant period in the blogpost and oped. I only mention it when I’m using the Dad Voice in a letter to someone who is behaving badly (insurance companies, employers, et al). How much of a masochist do you have to be as a person, let alone physician, to perpetuate this sytem? The average age of a practicing, licensed psychiatrist in the US is 55 (as of 20186). That wasn’t a lot of decades of board-recert to get that income – what, two more times? 75 years old? It’s possible. Certainly a better plan to force docs to recert every 3 years.

There is little point in staying in this system now that legitimate choice exists. Alone ended his Times article by saying “Frantic activity as a defense against impotence.” He’s talking about fetishism, and he was talking about the ABPN. We might do well to reframe the statement as talking to the Psychiatrists instead: this frantic activity, these 40 articles, this annual fee, this three year diploma – it’s apparent to everyone how limp-dicked you are by staying in that marriage.




3 It remains depressing that Alone knew an op-ed in a trash/free/throw away journal like The Psychiatric Times would get more pageviews than a blog post on TLP.