Doctors Cheat! Can You Trust Them?

  • Posted on: Feb 11 2012
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At least that’s the raging, incredulous headline on CNN health these days. It seems to have started with the report aired by Anderson Cooper. An Army radiologist failed his boards. He blames the fact that he didn’t use old test questions as the cause. AC360, a widely watched show, airs this and the outrage is palpable.

For those who haven’t read the story above or seen the segment, CNN has declared that radiologists and dermatologists now (and, by extrapolation, many other physician specialties) memorize their board questions and write them down immediately after the test so that they can be passed on to future test takers as a way to help them prepare. The goal being to improve the chances of a younger colleague passing the exam thereby increasing the prestige of a program who can say they graduate 100% board-certified physicians.

I’d like to mention a few points before we all rush to judgement.

  1. All physicians endeavor to be board certified
  2. All residency programs encourage their graduating residents to become board certified. In fact, many put intense pressure on residents to pass their “in-service” exams which are like board prep exams by threatening academic probation, decreased surgical case volume, less freedom for outside pursuit of interests (e.g. moonlighting)
  3. Failing to become board certified is a black mark that can seriously impede a physician from becoming successful quickly–a requirement to help eliminate the average $136,000 debt accrued from medical school
  4. Most board certifying exams automatically fail the bottom xx% of test takers. In other words, if there’s 100 physicians taking the exam and they all get over 95% on the exam, they will fail the lowest xx number of takers. It’s the equivalent of getting straight A’s but taking an F because someone got an “higher” A.
  5. Board exams, including that for the American Board of Otolaryngology, include a statement that says something to the effect that the test taker pledges not to reveal the content of the board exam to others. It’s essentially a confidentiality agreement.
  6. Physicians who take the exam are not provided with the answers to the exam. They only find out if they pass or do not pass. So if a doctor does memorize the questions, he/she cannot provide absolute knowledge of the correct answer–only what they think it probably was.

I will not argue the point about the radiologist being a “sore loser.” Some have pointed out that he’s just angry he failed and wants to take others down with him. It appears that same thing is also occurring in the dermatology world. I don’t care if he was mad, that’s not the point. I will also not pretend that it’s not a rampant problem in other specialties as well and if any journalist digs, I’d be surprised if they found a specialty where it wasn’t a well-established activity.

I would like to acknowledge the following and leave it at that for your comments:

  • I don’t argue that it is immoral to pass on questions. A physician signs a pledge not to reveal test content and then does just that is obviously an issue of integrity
  • I also believe it’s unethical to fail a physician who got a 97% on the exam just because “the board” has to fail someone. If a physician demonstrates an appropriate level of competency, they should pass. Likewise, in the same system, if the majority of physicians in the specialty get no more than 20% correct on the test, should they be board-certified simply because they weren’t the ones who got 5% correct?
This is why it’s justified in the minds of many physicians. The 2nd point is a greater injustice than the first.
Another reason? Imagine you’re a physician struggling to build a thriving practice and you hire a new physician from residency. That physician is well-qualified with exceptional recommendations and passed all of their tests with exceptional aptitude. The new physician is trying to build their practice, bring in money rather than being a drain, often trying to finally start their family, perhaps owning a home for the first time over the age of 30, and is working 60+ hours a week. Their test is upcoming. If they fail that test, the practice will suffer as will their own reputation. You feel that the physician certainly would pass, but weighing the risks of not passing versus those of helping a young colleague whose struggles with which your are intimately familiar to get through a rite of passage you must decide whether to provide your knowledge or not.
I’m not justifying the behavior, rather I’m trying to show that there is more to the psychology of violating that pledge than simply making a conscious decision to cheat for the sake of cheating.
The boards could fix this problem by first, changing the questions every year. Second, they could have a pass based on merit, not based on a bell curve.
When all is said and done, I think what matters for physicians is not where did they train or how high their grades were. I think what matters is do they provide safe, compassionate, and quality care. A scantron sheet will never be able to evaluate more than one of those. I’d argue board certification allows a physician to demonstrate that they’re safe, but compassion and quality are characteristics that only can be demonstrated to patients individually. As patients, we have a right to expect all 3. As a physician, I have a duty to provide all 3.
–Richard D. Thrasher III, MD


Posted in: Controversial Medicine, General Medical, Interesting Stuff

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