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Saturday, May 29, 2010

ABRET's Policy on ABNM/CNIM Exams: Unfriendly and hindering Prospective Specialists?.

I recently received an email from one of our neuromonitoring colleagues with a serious concern about ABRET's policy on ABNM exams, I hope the ABRET officials read this blog article and also listen to practitioners in the field while drafting policies. 
Date: Tue, 25 May 2010 12:08:58 -0700
Subject: need your advice, thanks
From: yingliu.lin@gmail.com

To: edu@drmuni.com
Dear Dr. Muni
My name is pearl, I am a regular reader for your neuromonitoring blog, which really impressed me. I read your article about the critical comment on ABRET's new policy changes on the CNIM requirement, and I am so happy to see the good outcome.

Now I am bothered by ABNM’s new policy changes on applicant’s eligibility. Beginning Aug, 2010, the new policy requires all applicants to provide a statement from a qualifying, supervising neurophysiologist. The new policy defines “a qualifying supervising neurophysiologist is either and individual with board certification from the American board of neurophysiologic monitoring (I think the number of these people is less than 200 in US) ora licensed physician who is board certified in neurology by the American board of psychiatry and neurology and who has fellowship training in clinical neurophysiology including intraoperative neurophysiological monitoring (I don’t know how many people would be qualified for this criteria, even less?), which means if one is not trained by any of these qualifying neurophysiologists, he or she will not get a statement and lose the opportunity to take the exam. Another potential problem is that the exam itself won’t be the major factor to decide whether or not one is competent to be a certificated neurophysiologist because subjective opinions based on personal motives (something like competition) could block a competent person’s opportunity taking the exam. I personally think this is not like a job hunting situation, in which the references recommendation should play the important role in judging a person’s qualification. This is a testing, as long as a candidate meets all of the objective requirements, such as three years experience in the field of neuromonitoring, completing 300 cases, and Ph.D degree in neurophysiology or neuroscience, shouldn’t the exam itself be the first to talk? With the IOM growing so fast, younger qualified people in this field should be encouraged to become board certificated experts, instead of trying to restrict people taking the exam by adding some crap requirements for whatever reasons or purposes. This new change gives a small number of people privilege to determine whether or not one has chance to take the exam even if he or she meets all objective requirements, which undermines the fair competition.

I think you understand my points about this issue, may I know your thoughts, and what is your suggestion if one can not get a statement from a neurophysiologist for the crap reasons?

Thanks for your time; I am looking forward to hearing from you.

All the best
This issue was lingering in my mind for quite sometime, when Pearl wrote to me the above e-mail, I realized it is time to make a point on my blog, like Pearl few of my other colleagues who are veterans in this field of neuromonitoring also told me about these policies are rather callous, my friends on the phone expressed their concern about the shrewd and unfriendly policies of ABRET that is going to keep the qualified PhDs away and deprive the neuromonitoring field with only handful of ABNMs?. 
ABNM Exams policies are redundant and mundane , further appear to make the candidate miserable with too many useless requirements, in addition to those mundane policies, the exam board seems to fail many candidates, some very talented PhDs and MDs have been failed repeatedly, simply reflecting the motive of ABRET board to make more money out of the candidates in fees?, if this continues, I sincerely hope  that ABRET is going to be scrutinized and comes under the  radar of US exams regulatory boards.  This current article I am writing is mostly to talk about how their policies are framed to make the process of exam cumbersome and ridiculous.
Several months ago, ABRET reversed certain policies on CNIM following wide criticism of their CNIM exam requirements , they made it more realistic, appealing and useful to CNIM seekers.

This time, it is about ABNM exams, the number of ABNM certified neurophysiologists/neurologists are very few in US, as of 2008 there were only 128 D-ABNM. And, as per the latest numbers listed on ABNM website, there are only 144 diplomats received the D-ABNM. If the website is not updated in the last two years, it might be another 20-30 candidates in this last two years, adding to be around 175 or 180 diplomats. This is most likely the latest number, this is in all reality is an abysmal count considering the demand and need to have many such highly trained specialists. There is no other country or organization in US or outside to award ABNM, which means that the number quoted above is a global  ABNM, there are no such ABNM outside US. And, not even in UK or Canada is there such ABNM diplomats?.
Isn't this irony that an organization created to support, promote and safeguard the the field of modern patient care is blocking the prospects of so many PhDs. What is disturbing is the requirements from PhD/MDs to appear for exam, as you will notice in the accompanied E-mail message from Pearl,  in order to submit ABNM exam, a highly trained PhD holder with several years of experience in academia or industry, and possibly the PhDs would have had faculty experience, regardless of such high qualification and expertise, like a school student they have to get approval from a board certified Surgeon or a neurophysiologist with a D-ABNM. The application requirement is one of these must sign the application and recommend the candidate, this is ridiculous, ABRETs policy sounds like running  kinder garden school, does not look like a advanced medical care providers certification exam.
Why would someone with a PhD and tremendous experience have to stoop to a fellow neurophysiologist with a DBANM or a surgeon to file exam application, why?. Does this make any sense at all??. I can say that my neurophysiology/neuromonitoring CEO or supervisor is a Jerk and stupid, and may be the surgeon I work with do not have expert knowledge in brain and spine, or nervous system. Even neurologists do not have special and advanced knowledge as much as a Neurophysiologist, what a crap is this that a PhD has to go and get his application approved, this policy has to change.
ABRET and ABNM must realize that there are shortcomings in the number of D-ABNM, but there are also other issues like the ABNM's can't bill or claim cpt codes like an M.D can do?,  this is a terrible policy too!.  How many neurologists can set up a neuromonitoring test, prepare the patient, set up protocol, execute an appropriate test, monitor actively, interpret and analyze the data instantly and warn the surgeon about changes?. How many neurologists and spine surgeons and other surgeons really know or have comprehensive knowledge about neurophysiology, the intricacies of evoked potentials?. The clinical training and knowledge is not going to be of much use inside the OR, unless they were trained by a Neurophysiologist as to how to monitor and interpret the signals in the OR.
Hope the ABRET and ASNM look into these and do not bow down to the Medical Association, the neuromonitoring field is developed by decades of hard work and dedication of many neuroscientists and researchers in the field, after decades of establishing this field and make it to applicable in the clinical set up, the medical association and jobless clinicians want to steal away neuromonitoring field with their crap policies and subjugation of the monitoring professionals in the name of medical regulations deliberately designed to keep the MDs running the show?.
ABRET has to be thoughtful about their policies besides making PhDs in Neurophysiology and PhDs from related neuroscience fields with D-ABNM should be able to bill like an MD, including the medicare policies where an M.D oversight is currently a requirement, will the ABRET wake up and fight on these issues, as well as keep the exam policies user friendly and approachable for PhDs with experience in neuromonitoring?
This modern and growing health care field needs more doctorate level providers, especially those with PhD in Neurophysiology, or PhDs in allied field with extensive training in Neurophysiology.


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  2. I was just reading over this older post for the DABNM. Funny how the number of DABNM members is still around the same once you factor in those that have let their license lapse.