In 1989 after finishing my residency in Internal Medicine at the University of Washington, I sat down and took the Internal Medicine Boards. I didn't study, didn't look at any information about the test at all ahead of time and passed in the top 10%. It made perfect sense that it would go that way: I had been eating, drinking and sleeping (sometimes) internal medicine for 3 solid years in an excellent program, studying all the time and practicing under recognized opinion leaders in the field. Prior to that I had eaten, drunk and slept the entire field of medicine for 4 years at Johns Hopkins School of Medicine where my mind was positively marinated in everything that was then thought to be true about physiology, pathophysiology and care of patients. When I took the test it was the last time I would ever have to take it. I was forever certified with American Board of Internal Medicine, and the next year all of the doctors who passed the test would have to re-take it every 10 y...
The cost of health care in the US is higher than anywhere else in the world, and yet we are not healthier than our peer nations. In fact, in terms of such measures as infant mortality and life span, we don't measure up. Why is this? Many people involved in providing or receiving care have some pretty good ideas about what costs so much, and what we can do to reduce costs and improve quality. Sharing these stories is an important step in creating affordable universal health care.