Proposal for delay in oral boards stirs controversy

An effort 10 years ago to delay the oral boards by a year met with resistance from fellowship directors and failed. A recent proposal to delay the boards by two years is again being met with opposition, mainly from residents. Radiology is the only medical specialty that continues to hold its oral exams in the last year of residency. Whether that will change remains to be seen, as this age-old battle plays itself out.

"The fourth year of residency is totally dysfunctional. We've created the most accelerated seniority system in the history of employment, where we have individuals with the most training that do the least work and take no call," said Dr. Stephen Baker, president of the Society of Chairmen in Academic Radiology Departments.

It was at the recent SCARD meeting in Denver that members voted nearly unanimous support for recommending a two-year delay in the oral exam for residents. A straw poll of approximately 100 members of the Association of Program Directors in Radiology, who met conjointly with SCARD, showed strong support for further discussion to delay the oral board exam. Resistance to the idea came from chief residents, also meeting in Denver. They said the current date gives residents time to solidify their education and a delay would put too much demand on them while in clinical practice.

"An advantage to the current setup is that those who pass the boards are fully qualified to practice radiology, whereas with a delay, they'd have to contend with a provisional one- or two-year period of noncertification," said Dr. David Hodges, a third-year resident at Wake Forest University, who was at the meeting in Denver.

That concern may be a red herring, however, as "board eligible" or "board admissible" is the standard wording in hospital contracts, said Fred Gaschen, executive vice president of Radiological Associates of Sacramento, one of the largest private practices in the country. He said that the delay would not have an impact on the ability of these physicians to get privileges at hospitals.

Gaschen also wouldn't expect a loss of productivity from working residents studying for the orals. He likened the situation to that of neuroradiologists at his practice who recently completed their Certificate of Added Qualification.

"It was difficult for them, working full time and studying for a board exam, but the practice never saw a drop in their productivity," Gaschen said.

The delay could, however, have an impact on track to partnership, he said. Practices could stipulate that partnership comes with passing the orals.

Program directors and radiology chairs agree that a delayed exam would have to be modified to reflect some degree of specialization gained on the job by working residents. Changes to the exam are the purview of the American Board of Radiology. As of this writing, the ABR has not publicly commented on the proposal.

Some radiologists, such as Dr. Vijay Rao, radiology chair at Thomas Jefferson University, consider oral exams an anachronism in the highly technologically advanced field of radiology. She suggests the exam should be computerized and residents given the option of taking it in modules to allow flexibility and alleviate stress. Rao takes the issue further, saying that perhaps the entire residency program needs to be restructured.

"We have to ask ourselves some tough questions, such as, 'What is the value or utility of having a separate clinical year versus incorporating it into the training?' and 'Do we want to have all generalist radiologists, or do we want their training to be more specialized?'," she said.

The biggest backlash may yet come from private practitioners, on whose dime these phantom radiologists would have to study if the orals were delayed two years.

"If you use the oral boards as a certification of competence, then how can you delay the test while putting these people out into practice? Would you want an incompetent radiologist reading your study out in practice while he/she is distracted by the need to study while on the job? Not me," said Dr. David Dowe, chief operating officer and medical director of Atlantic Medical Imaging in Galloway, NJ.