A long time ago, if you were sick, a man would come to your house and try to help you. That man was a doctor. How would you know he was the doctor? It was easy. He had a black bag with doctor tools in it. Plus, people in town called him “Doc.”
As medicine improved, being a doctor required a lot more education. There were a lot of discoveries, which led to a lot of new treatments and cures for problems that previously were beyond help. Along with those discoveries, they figured out some of the established treatments were way off. And many of them were downright harmful. “Wait, wait… guys, you’re never going to believe this. Putting leeches all over someone who is very ill actually makes them worse! Oh man, I feel terrible about that one now!” That kind of conversation was happening all the time in those days.
Fast forward to today, there is an unimaginable amount of data accessible to help with the vast majority of human disease and injury. This is great news because there is so much in our armamentarium to help fix problems. But along with the great news comes a catch: the details of the best medical treatments are so specific that only an expert in that field knows if each diagnosis and treatment is the best one.
It’s like when I go to a mechanic. I can’t begin to understand if the white paper-fan-looking thing being dirty is actually a problem or if I’m being scammed. It looks like one of those paper decorations that you open like an accordion to wrap into a round shape and hang from the ceiling. My car may blow up because of this thing or it may not even be a part of my car. The problem is—I’m not enough of an expert to know if the guy I’m talking to is an expert.
What’s the Deal with the Board?
To fix this problem in medicine, some very smart doctors got together and said, “Let’s form an official board and certify doctors who are actually competent according to our standards.” This happened in each field: emergency medicine, general surgery, radiology, ophthalmology, and so on. The Board of Ophthalmology does what every one of these boards does. They create a list of tasks you must accomplish in order to be certified by them. The tasks are designed to be impossible to complete unless you’re actually very competent at your job.
What’s the Exam All About?
There are a written exam and an oral exam. They may only be taken almost a year apart from each other, and you’re not even allowed to attempt the first exam until you’ve completed your residency. The oral boards involve flying to the city they choose and spending hours in front of small groups of experts in each field of ophthalmology. They ask, “How will you handle a patient with…” then describe a problem in which they are a world expert. It’s designed to be stressful and to identify fakers who know big words but not the answers.
The written exam is so difficult it’s silly. It requires knowledge memorized from a set of 13 textbooks (about one bookshelf) detailing each nuance of ophthalmology. The written exam is difficult the same way that doing an Ironman triathlon is difficult. It’s a fair comparison for two reasons:
- The practice before it and completion of it require a level of effort that makes the word “difficult” seem so small and incomplete for the misery involved.
- No human alive can decide to wake up one day and complete it successfully without very intense training and preparation.
Once you pass those two tests, you are officially a board certified ophthalmologist. “I can’t believe they actually did it, the mad lads!” says the board as they sign your certificate. The piece of paper they sign says you’re a Diplomate of the American Board of Ophthalmology, and you can tell they mean it because all 19 of the board directors sign it.
All of this happens to provide a way for patients to know who is the real item and who may still be operating under old country doctor standards. It’s a way to have a seal of approval from the experts, so a patient can know if their doctor is actually an expert in what they’re doing. In the end, it is a piece of paper on the wall to show a level of credentialing a bit like the black doctor bag of days past.
Now, and back then, they both represent competency with current medical treatment. There’s just so much involved in that competency in modern medicine that it takes a whole board of directors to determine it.