Options for non-board certified physicians
Still unempowered, I kept my secret to myself and the chosen few I had opened up to and prepared to take the exam again. I partnered with others who like me had not passed and we studied together and supported each other during the lows of doubt and insecurity. I worked full time, studied when I could, and was a mother the whole way through; and I failed.
Wow, that word even now as I type it hurts. I had taken this test a total of 3 times and had yet to pass. I began to spiral down a dark hole. How was I going to support my family? How was I going to pay back my massive student loan debt? As a single parent, I am the sole provider for me and my son. In one year I would lose my board eligibility; essentially my career as a physician was on the brink of being over as well as my means of supporting my family!
There are few options now a days for physicians who do not have the desired title of Board Certified. Hospitals privileges are unattainable, insurance companies unwilling too “allow” you to be a provider for their patients. Practices refrain from wanting you if you are not BC/BE. Four years of medical school, 3 years of residency, MCAT, USMLE exams all completed, state licensure obtained, DEA license purchased, and still one exam preventing me from the career I long desired, dreamed, and dedicated my early youth for. There was no other choice—something had to change. I contacted the ABIM to see what my options were as this was my last year of eligibility. My prime question centered around my options if I didn’t pass this year. On the website there was a statement:
“A candidate who is no longer Board Eligible may nevertheless apply for a certifying examination, but only if the candidate has: (i) completed at least one year of retraining in the relevant specialty after the expiry of the candidate’s period of Board Eligibility, but no more than seven years before the application; and (ii) met all other requirements for Board Certification in effect at that time. Retraining will require the successful completion of at least one year of additional residency/fellowship training in an ACGME-accredited U.S. training program or an RCPSC-accredited Canadian training program and an attestation from the program that the candidate has demonstrated the requisite competency for unsupervised practice. Candidates and diplomates remain subject to other ABIM policies and requirements for certification, such as the Re-examination policy.”
I nevertheless followed their instructions because I had no choice and reached out to my former director. She to her dismay had no concrete information about what a retraining year looked like either. She assured me she would contact the ABIM and see what she could learn but advised me not to give up; since I had one last year to take the exam. She suggested that I get in touch with the Testing Center on campus to see if I had a testing or learning disability. Could that be it? Did I have an undiagnosed learning or testing disability that evaded me for years only now to rear its head? She doubted it but it needed to be evaluated. Speaking with the counselor it became clear that she agreed; it was highly unlikely that I had a learning or testing disability that had not previously shown up. So what was the issue? Well one of the pieces that the counselor helped me discover was that I have a hard time trusting myself and taking a leap of faith in myself. Another issue was that I have a tendency to answer the question that I think I’m being asked not the question that is being asked.
So armed with this I decided I needed to take a step back and focus solely on this exam and being a mom. So I did. I quit my job, neglected my friends and devoted myself to my son and my exam. I fought through self-doubt constantly. I second guessed myself on every question. Thinking I was missing something. Fearing that I somehow did not learn what I needed to in 8 years of training. Why did I feel this way; because others before me had seemingly passed this test with ease. Here I was on the brink of failure with no safety net; nothing to fall back on. Despite years of caring for patients and living my dream I was in jeopardy of loosing it all. I doubted my calling. I never doubted God, but I doubted that I heard Him correctly. I doubted that I was on His path for my life. I was ashamed and alone. I bore this shame in secret because to do otherwise was considered taboo and a marker of weakness.
As the exam grew closer my anxiety increased and my confidence dwindled. In the last month of the exam I lived and breathed nothing else. My parents looked after my son while I studied. With each question I answered correctly my confidence grew and with each question I missed it was shattered into a million pieces. The few people that I opened up to about my failure would ask how the studying was going...others would offer prayers and well wishes. I felt inadequate, fraudulent I couldn’t figure out how I was able to take care of patients but still was not deemed worthy based on a test. I then came across three quotes from Michelle Obama:
“When you are struggling, and you start thinking about giving up, I want you to remember something that my husband and I have talked about since we first started this journey nearly a decade ago—something that has carried us through every moment in this White House and every moment of our lives—and that is the power of hope. The belief that something better is always possible if you’re willing to work for it and fight for it.” – Michelle Obama
“Am I good enough? Yes I am.”– Michelle Obama
“If my future were determined just by my performance on a standardized test, I wouldn’t be here. I guarantee you that.”― Michelle Obama
The day came and I sat for the exam and as I was logged in by the proctor I prayed. I thanked God for my calling and vocation and began my exam. When I finished I felt spent; I truly had done all that I could. If this was not enough I had no idea what the next step was and apparently neither did those at the ABIM. But what I knew for sure was that no matter what the test said I was enough. While I seemingly had to pass this test in order to continue on the traditional path of medicine I would not let it determine or limit my future. I am a doctor and I always will be.
Written By: Kharia J. Holmes
This article was originally published on WomenInWhiteCoats.com
Embracing my imperfection and striving for perfection through grace.