What a Digital Health Doc Has Learned by Recertifying His Boards – Healthcare Blog
What a Digital Health Doc Has Learned by Recertifying His Boards – Healthcare Blog
By matthew holt | Published: 2025-10-15 17:29:00 | Source: The Health Care Blog
Written by Jean-Luc Neptune
I recently received good news that I passed the American Board of Internal Medicine (ABIM) recertification exam. As a little background, ABIM is a national physician evaluation organization that accredits physicians practicing internal medicine and its subspecialties (every other specialty has its own accrediting body such as ABOG for OB/GYNs and ABS for surgeons). Physicians practicing in most clinical settings need to be board certified to be certified and eligible to practice. Board certification can be achieved by taking an exam every 10 years or by participating in a continuing education process known as LKA (Longitudinal Knowledge Assessment). I decided to do the big 10 year test instead of taking the LKA approach. For my fellow ABIM-certified physicians wondering why I was doing the 10-year test versus an LKA, I’m happy to have a side discussion, but it was largely a matter of career timing.
It should be noted that board certification is different from the USMLE (United States Medical Licensing Examination), which is the first in a series of licensing hurdles that doctors face in medical school and residency, which includes 3 separate exams (USMLE Steps 1, 2, and 3). After completing the USMLE steps, obtaining a medical license is a separate state-mediated process (I am active in NY and inactive in PA) and has its own set of requirements that one needs to meet in order to practice in any state. If you want to be able to prescribe controlled substances (opioids, benzos, stimulants, etc.), you will need a separate license from the DEA (Drug Enforcement Administration, which is a federal entity). Simply put, you need to complete a lot of training, get high scores on many standardized tests, and obtain a bunch of certifications (which cost a lot of money, btw) to be able to practice medicine in the USA.
What I learned while preparing for the ABIM recertification exam:
1.) There is a lot to know to become a doctor!
To prepare for the exam, I used the New England Journal of Medicine (NEJM) review course that included nearly 2,000 detailed case studies covering all areas of the subspecialty of internal medicine. If you think that each case involves mastering dozens of medical knowledge, then the test requires a doctor to remember tens of thousands of distinct pieces of information for just one specialty (remember that medical vocabulary alone consists of tens of thousands of words). In addition, individual facts mean nothing without mastery of the underlying concepts, models, and frameworks of biology, biochemistry, human anatomy, physiology, pathophysiology, public health, etc. Then there are all the things you need to know for your specific specialty: medications, diagnostic frameworks, treatment guidelines, and so on. It’s a lot. There’s a reason why it takes the better part of a decade to gain any proficiency as a doctor. So when I hear a non-doc say they’ve been reading about XYZ and “I think I know almost as much as my doctor!”, my answer is always “No, you don’t.” never. Not even a little. Stop it
2.) There is a lot that we as doctors do not know!
What was particularly striking to me when I did my review was the number of times I encountered a situation or presentation where:
- It is not clear what causes the disease,
- The natural history of the disease is unclear,
- We don’t know how to treat the disease
- We know how to treat the disease but we do not know how the treatment works.
- We don’t know what treatment is most effective, or
- We don’t know which diagnostic test is best.
- And on and on and on…
It is estimated that there are more than 50,000 (!!) active journals in the field of biomedical sciences Publish over 3 million (!!!!) articles annually. Despite all this knowledge generation, there is still a lot we don’t know about the human body and how it works. I think some people find doctors arrogant, but anyone who really knows doctors and doctor culture can tell you that doctors possess a deep sense of humility that comes from knowing you know very little.
3.) One day soon a computer doctor will definitely become smarter than a human doctor.
The whole time I was preparing for the test, I kept telling myself that there was nothing I was doing that a sufficiently advanced computer couldn’t do.
If you abstract from what most doctors do (diagnose disease and prescribe treatment), it is pretty clear at this point in the history of AI development that a computer will be able to do most of what a doctor does very soon.
Making a diagnosis is conceptually straightforward: gathering information about a patient’s condition and evaluating complex patterns that include the patient’s history, signs, symptoms, and various tests. While human doctors are capable of recognizing hundreds and thousands of patterns, there are human limits to our abilities that are driven by our limited memory, past experiences, and ability to access information. However, today’s AI systems have access to almost unlimited information and more powerful pattern recognition algorithms, and will soon be able to identify patterns of disease better than even the best doctors.
The description of treatment is also fairly straightforward: based on the characteristics of that patient, the disease, the nature/stage of the disease, patient preferences, etc. We recommend what the literature (clinical guidelines, peer-reviewed studies, etc.) has shown to be the most effective treatment that will result in the least amount of harm. As humans, there are only so many newspaper articles we can read, and only a limited amount of information we can store in our brains. AI systems have access to the accumulated knowledge of all of humanity, and will soon be able to review all the literature in an instant to guide treatment decisions.
Recently published research already shows this AI systems can match or exceed the performance of human doctors. Many people will object and say that machines don’t really do reasoning, which is true at the moment, but reasoning technology is likely not that far away. Given that these technologies are improving at an exponential rate, it is quite clear that an unambiguously better machine will overwhelm the cognitive performance of a human doctor in a very short period of time – at most, 10 years. I am convinced that there will soon come a day when patients will ask their doctor, “What does the AI system recommend?”
4.) What a computer can’t do yet is be a human (at least not yet).
In studies that show computer performance on par with a doctor, what is often overlooked is that the computer works through a nicely abbreviated case presentation (like the ones you used to study for boards) with all the relevant data. What these studies miss is that one of the most important roles of a doctor is to communicate with another human being to access the information necessary to reach a diagnosis and recommend treatment. It is rare as doctors that we get a nice summary with all the relevant information. Often times, the other person is emotionally disturbed, under the influence of a substance, lying, or unconscious. Much of what we can do as human doctors is piece together a story using our human senses (sight, smell, touch, hearing – fortunately, not taste) to guide our judgement. A large part of medical training is learning about human psychology, human culture, and human history which we then use to inform the sciences we have mastered.
Another important aspect of being a human physician is our role as advisors, advocates and stewards of the care of individual patients and broader patient groups. Ultimately, patients need someone to help them understand a serious diagnosis, or support them in making difficult choices about treatment options. The modern medical system has evolved into a transactional model in which doctors and patients are often stripped of deeper human interactions, but new technologies offer an opportunity to perhaps reduce the administrative burden on doctors and patients so that more time can be spent in person-to-person therapeutic interactions.
One day, we’ll have machines technologically advanced enough to fully emulate humans (it’s interesting to note that the original Blade Runner Tyrell Corporation Nexus-6 “replicas” exist in the fictional year 2019.) but for now there’s nothing better than a human.
5.) Technology can help make us better doctors right now.
What a lot of people don’t know is that the day job as a doctor kind of sucks. For every hour of direct clinical care provided The average doctor spends another two hours dealing with administrative tasks. Most doctors didn’t sign up to spend their careers entering data into horribly designed electronic medical records, waiting to get pre-authorized from insurance, or asking patients for the same information over and over again. I’m excited that my role at Commure gives me the opportunity to contribute to technology that makes life better for doctors and patients.
Ambient writing is a transformative technology that helps physicians reduce the administrative burden of documenting care, by up to 80%, reducing physician burnout and allowing physicians to regain the joy of practicing medicine. Co-Pilot’s technologies put all the medical research ever published at the doctor’s fingertips in a way that reminds me of how access to the Internet (and sources like UpToDate) changed how care was delivered 25 years ago. Finally, Agentic AI helps reduce the “sloppy” work of being a doctor by automating repetitive tasks that are not worthy of human attention and making them routine.
I know that the introduction of new technology makes many people fear for the future of employment, which is a reasonable concern in these uncertain times. However, there is a lot of care that we are not providing because we do not have the resources, and I think the story for the next several years will be using technology to catch up with what we should have been doing in the first place. I encourage my physician brothers and sisters to resist fighting technology and instead work to make technology fit our needs. The development of modern electronic medical records has occurred at the expense of the physician to make life better for other stakeholders rather than the bedside. We can’t let that happen this time.
(AI Certification: I certify that this article was written without using any AI utilities at all, but with some editing by my human wife.)
J.L. Neptune, MD, an internal medicine physician based in New York City, is the executive medical director at Commure.
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