Tuesday, March 5, 2013

The ABA Screws Anesthesia Residents

It's been a busy time over at the American Board of Anesthesiology headquarters. Besides the changes to MOCA recertification requirements, they have also altered how anesthesia residents will be board certified in the first place. Previously an anesthesiologist takes his written, or Part 1, exam shortly after finishing his residency. Once that has been successfully passed, he then takes the dreaded oral, or Part 2, examination. When both exams are completed, voila, another board certified anesthesiologist is christened into the world.

But the ABA has now changed the paradigm. Starting with the CA-1 class beginning July, 2013, the written exam has been split into two parts. The Basic exam will be administered during residency training. This is followed by an Advanced exam taken after residency before moving on to the oral exam. The trick is that the Basic exam has to be successfully passed within two attempts or the resident will be deemed incompetent and will not be allowed to graduate. Thus he could be stuck in anesthesia residency for four or five years if he were so unlucky.

This places extraordinary pressure on already overworked residents. In my time, many of us graduated residency then took a couple of weeks off from work to prepare for our Part 1 exam. Some people even delayed taking the test for a year or more. This only delayed their board certification but they were still able to practice during that time as a "board eligible" anesthesiologist. Now these poor residents can't even get to the starting gate of their careers unless they pass this test. The sadists at the ABA know no bounds.


  1. Well that sucks. Is there any explanation/reason/excuse as to WHY?

  2. Your guess is as good as mine.

  3. I think the motivation is clearly cash-based. These exams are money makers. If I ever find a bunch of spare time lying around I'm going to start bringing class action lawsuits against all the board examiners. First target: The NBME for Step 2 CS. Can anyone explain to me the benefit of charging medical students $1,000+ (not including travel and expenses) for an exam 97% pass rate?

  4. The staged examinations cost no more than the traditional examination, although it is obviously more expensive to create and score more examinations. The motivation of the American Board of Anesthesiology is encourage trainees to study earlier in their training to make better anesthesiologists out of them. In-training examination scores are relatively flat until the CA3 year. The motivation is to force CA1s to read the textbooks during the year and not just focus on accomplishing the part-tasks that also need to be learned, like endotracheal tube and vascular access placement.

    1. I don't believe it. I think its $$. The total cost may be the same this year, but in the future the cost will no doubt increase. The case study they added to moca is a complete waste of time and in no way increased my knowledge base, or changed quality of care. It's $$$ all the way. Have you seen their new building and the salaries the executives make? The make a great deal more than most anesthesiologists - no call, no risk.

  5. Completely agree with the change. Experience is important but without a solid fundamental knowledge base is an anesthesiologist better than a CRNA?

  6. Definitely DISAGREE with the changes- The amount of time, effort, and finances it takes to prepare and complete these requirements, combined with that the argument that the requirements don't reflect a substantial enough increase in one's knowledge base is a very unreasonable demand to place on anesthesiologists- Most of whom already struggle with limited time and resources. There are other ways to encourage studying and make better anesthesiologists. Have to agree that the changes do question the motivation of the people making them.