ABPN subspecialty exams

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Phantom Spike

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Just thought I'd rant a little. Why are the ABPN subspecialty certification exams so expensive? They're just computer-based exams that last a few hours, but they cost $1900 each!

Is anyone applying for the 2009 exams? Are they really worth the time, effort, and especially expense for neurologists who plan to go into private practice? I'm thinking specifically of clinical neurophysiology, vascular neurology and sleep (the last two can still be taken without a fellowship, through the grandfathering process). Do they benefit you in any way?
 
Phantom Spike said:
Just thought I'd rant a little. Why are the ABPN subspecialty certification exams so expensive? They're just computer-based exams that last a few hours, but they cost $1900 each!

Is anyone applying for the 2009 exams? Are they really worth the time, effort, and especially expense for neurologists who plan to go into private practice? I'm thinking specifically of clinical neurophysiology, vascular neurology and sleep (the last two can still be taken without a fellowship, through the grandfathering process). Do they benefit you in any way?
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Hey Phantom. Yeah, the $$$ totally bites, doesn't it? I just sent in my app for the neurophys test. Ouch.

Subspec certification is probably not "necessary" for private practice, but if you're in an academic setting, or if you want to gradually carve out a really subspecialized niche, you probably need to do it.

IMHO, some are more "worth it" than others. Sleep and neurophys are good examples, since those may be "required" by accrediting bodies if you are ever in a position to be a medical director of a sleep lab or epilepsy center.

Vascular strikes me as a waste of time. Perhaps it's just my non-interest in the field talking, but general neurologists see so much stroke that I have to ask how much more training you need in order to look at an MRI and prescribe aspirin? :meanie:
 
neurologist said:
Vascular strikes me as a waste of time. Perhaps it's just my non-interest in the field talking, but general neurologists see so much stroke that I have to ask how much more training you need in order to look at an MRI and prescribe aspirin? :meanie:
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The case I've heard made for the vascular neurology certification in private practice is that it enables you to market yourself as a stroke specialist and thus eligible for appointment to directorship of a stroke center (with concomitant higher income). That said, I know plenty of neurologists who have assumed such positions without this certification or a vascular fellowship. I also haven't heard that certification will ever really become required for such positions, either (unlike sleep certification, which is I think is probably the most useful, career-wise, of all the subspecialty certifications offered by the ABPN currently).

Is being certified in clinical neurophysiology sufficient to be director of an epilepsy lab in an academic center? Or do you need to be certified by the American Board of Clinical Neurophysiology?
 
Phantom Spike said:
Is being certified in clinical neurophysiology sufficient to be director of an epilepsy lab in an academic center? Or do you need to be certified by the American Board of Clinical Neurophysiology?
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CNP fellowships are one year. They (ACGME) require you to pick two areas of strenght (EEG, EMG, Intraoper, Sleep). Truly this is not enough to become an epileptologist, unless you have done other training. EMU experience is needed, particularly ECOG and phase II monitoring. Epilepsy fellowships typically are 2 years. To become an academic epileptologist, I would expect also some clinical research contributions. I do not expect that a 1-year CNP fellow would be "a director of an academic epilepsy center" with ABCN certification but no other experience.
I am a PD for CNP. We offer an Epilepsy fellowship track for 2 years. I personally have 3 certifications, and would need the Epilepsy (ABPN) to continue holding a fellowship program (4th board). I have not recertified for ABCN, now they are 10 year certificates. However, it is a rite of passage for an academic epileptologist.

Keep in mind that epileptologists, EMGers, and Sleep MDs subsidize academic neurology departments. So, if you are concerned about earning potential, academia might not be the best for you.
 
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neurologist said:
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Not sure what you mean here. There is no ABPN "Epilepsy" board, just the added qual in CNP.
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It has been approved in principle. Implementation is expected between 2011-2013. There is no added qual in CNP anymore, but subspecialty of CNP.

3 certifications: Neurology (ABPN), CNP (ABPN), CNP (ABCN). My work is primarily Epilepsy, thus, the need for Epilepsy (ABPN) if I want to continue being PD for our currently non-ACGME approved Epilepsy Fellowship.
 
Vascular strikes me as a waste of time. Perhaps it's just my non-interest in the field talking, but general neurologists see so much stroke that I have to ask how much more training you need in order to look at an MRI and prescribe aspirin? :meanie:[/quote]
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This is a ridiculous comment. You do not need vascular neurology or even general neuro training to prescribe aspirin. Even a primary care physician can look at the 'radiology report' and prescribe aspirin in his/her office. But you need 'vascular neurology' training to 'treat' strokes in this day and age. There is much more to acute stroke treatment than looking at plain CT/MRI and giving ASA, even more than IV TPA within 3 hours. Treating strokes at a large center (academic or community) requires being able to interpret advanced neuroimaging, utilize vascular ultrasound with clinical decision making to initiate intravenous or endovascular thrombolytic therapy. In 'general neuro', you have enough time in the clinic to do a 'literature search' and scratch your head and end up prescribing steroids. In the 21st century, telemedicine has ensured that stroke docs 'treat' strokes as a full time job. In the ER, you have to analyze CT or MRA/perfusion studies all the time depending on where you are (many times even post-process raw perfusion images) and also utilize added info from vascular ultrasound to treat strokes. And yes, there are billing codes for all these. You do not look at radiology reads to make clinical decisions. Many stroke docs are moving into endovascular as well. Even if you choose to stay non-invasive, it is a full time job that needs separate training and certification. Like any field, the initial experts always grandfathered into this, but all new guys need to get trained through a specified pathway. Yes, if you are in the middle of nowhere, then you can pretty much be the 'neuro' guy for strokes. Internists can read ECGs too and theoretically know how to manage MI but cannot do it in real life.
In the outpatient stroke clinics you also get to see pts with complicated intra and extracranial stenosis and evaluate regarding further treatment.
Even JCAHO mandates that stroke centers need physicians certified in 'vascular neurology'. Many states (MA, TX, FL,..) already have laws that mandate that EMS take acute stroke pts 'not to the nearest ER, but the nearest stroke center', other states are in the process of making these laws. This is making telemedine very useful and stroke docs evaluate and 'treat' strokes full time. Also remember that of all neurologic illnesses, stroke has the largest healthcare burden.
Being certified in 'vascular neurology' with advancing cerebrovasc medicine is extremely useful.
 
Strokeguy said:
Being certified in 'vascular neurology' with advancing cerebrovasc medicine is extremely useful.
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Agree. I practice in TX. Many hospitals want to become Stroke Centers, but are in need to recruit ABPN certified Vascular Neurologists.

Keep in mind that the "grandfathering" period to take this examination is about to pass. If you are unable to take the 2009 exam, you have to do an ACGME approved Vascular Neurology fellowship. There might be a few neurologists considering doing this. Late registration ends on Dec. 1st, 2008.

"After the 2009 examination, all applicants other than those initially approved during the “grandfathering period” are required to submit documentation of successful completion of one year of ACGME-accredited fellowship training in vascular neurology that did not begin before the time general residency training in neurology or child neurology, including time spent in combined training programs, was completed."

Source: http://www.abpn.com/vn.htm
 
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