Isn’t It Ironic? (Don’t You Critically Think?)
It’s like rain on your wedding day. It’s free answers to an exam you’ve already paid thousands of dollars for and are kicking and screaming to complete. And it’s an email from Doximity, a platform built for physicians by physicians, telling you exactly how to use AI to pass the American Board of Internal Medicine’s Longitudinal Knowledge Assessment while the ABIM carefully crafted rules to prevent cheating but somehow forgot to mention anything about artificial intelligence.
I actually laughed out loud when I got the email on December 16, 2025. The timing was perfect. It’s December, I have sick patients to see, holidays to plan, and inevitably my Quarter 4 ABIM LKA questions are due by December 31st. “Don’t let the 5-minute timer stress you out!”, the email cheerfully advises. DoxGPT searches the current literature to find clinical answers fast. Here’s the step-by-step guide Doximity provides:
- Read the question.
- Ask DoxGPT about the clinical concept, like screening age for colonoscopy.
- Get a concise, evidence-based summary in seconds.
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Let me make sure I understand this correctly…
According to the ABIM’s own published rules for the LKA, I am explicitly prohibited from copying questions, sharing questions with others, or reproducing exam content in any way. I sign agreements to this effect like I’m guarding nuclear launch codes. We’re not allowed to copy. We’re not allowed to paste. We’re not allowed to screenshot. We’re not allowed to discuss questions with colleagues. But nowhere in the ABIM’s guidelines does it say I cannot use AI. Nowhere does it say I cannot screenshot the question with my phone, which technically isn’t copying because that’s photographing. Nowhere does it say I cannot feed that photograph into DoxGPT, which is built on ChatGPT, which uses who knows what data anyway, and get the answer in three seconds flat (wifi dependent of course).
The rules say open book. They don’t say closed AI. They don’t say closed screen. They don’t mention ChatGPT, Claude, Gemini, or DeepSeek because medicine lags so far behind technology that we’re still catching up to concepts that became ubiquitous years ago. My residency hospital was one of the last to convert to electronic medical records. Most of my residency I was still writing hand notes. In fact, I think only the emergency department had an electronic system, and none of us even knew what to do with it. This was years ago when they first started mandating that by a certain date everyone had to have electronic medical records. Medicine doesn’t move fast. Technology does. And here we are in 2025 with board certification exams that were designed in 2005 before AI existed, rules that prohibit sharing but not machine learning, and a physician platform openly advertising the loophole.
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So what exactly are we testing here? My ability to click? My WiFi speed? My subscription choices? My capacity to navigate the Doximity interface and copy-paste a question into an AI chatbot? This is not education. This is not an assessment. What it is, is a very expensive ritual. And the irony isn’t just rich. It’s morbidly obese with a BMI over 40 with MASH and OSA and still getting denied GLP-1 incretin medication coverage.
Maybe we should just rename the whole thing. The AIBIM. The AIBMS, American Intelligence Board of Medical Specialties. At least then we’d be honest about what we’re measuring. And here’s the kicker: I’ve used AI on practice questions before and it got them wrong while I got them right. So not only is the test absurd, the AI cheat code doesn’t even work reliably. But you know what? I might just play around with it anyway to see if DoxGPT performs better than my perimenopausal brain fog. Open screen, not open book. Keep posted for a followup article if there’s any bandwidth left.
Let me zoom out for a second and paint you a picture of what practicing medicine actually looks like right now because the ABIM LKA questions sure as hell don’t reflect it. I spend my days fighting insurance denials for evidence-based treatments. Patient with obesity, sleep apnea, and fatty liver disease needs a GLP-1 agonist? Kaiser says the BMI has to be 39 or 40, depending on which corporate algorithm is making medical decisions without a medical license that day. They want a sleep study first even though she’s already diagnosed, and good luck getting that scheduled within six months. Meanwhile I’m supposed to be memorizing screening ages for colonoscopy on a 5-minute timer while my patient can’t breathe at night. This is what clinical medicine looks like now. We’re not practicing evidence-based care. We’re practicing PBM-approved, insurance-authorized, corporate-algorithm-filtered care while fighting for the right to treat diagnosed conditions with FDA-approved medications, and in our spare time we’re supposed to take tests that measure nothing about this reality.
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The ABIM LKA claims to assess ongoing competence, lifelong learning, evidence-based practice. What it actually measures is my tolerance for 5-minute timers while juggling patients and holidays and administrative hell, my willingness to pay fees for the privilege of this torture, and my compliance with a system that profits from physician exhaustion. It does not measure whether I can diagnose and treat real patients, whether I keep up with literature that matters to my practice, or whether I’m a competent, caring, effective physician. And it certainly doesn’t account for the fact that some of us are perimenopausal with brain fog, some of us are dealing with post-COVID cognitive issues, some of us just got new diagnoses with new medications that make us sleepy or sleepless, and some of us are just exhausted from fighting a system that makes it harder to practice medicine every single day.
What happens if I fail after five years of this quarterly ritual? Do I lose certification? Start over? Pay more fees for more tests that measure nothing? Or do I just say fuck it, take the test in two days, click C for everything, and let the chips fall where they may? Or maybe I’ll screenshot the questions, upload them to DoxGPT, and see what happens. The fact that I’m even considering it proves how absurd this entire system has become.
Dr. Paul Teirstein, founder and president of the National Board of Physicians and Surgeons, has been fighting this fight for years. NBPAS was created because the ABIM has been using our fees for purposes that don’t advance our careers or protect us as physicians. In his recent Wall Street Journal op-ed, Teirstein called out the American Board of Medical Specialties for consolidating control over continuous board certification in ways that burden physicians without demonstrable benefit to patient care. This year alone, NBPAS has taken this work beyond individual hospitals directly to government officials and policymakers concerned with physician workforce sustainability and retention. And here’s what this Doximity email actually does for Teirstein’s case: it proves the entire ABIM exam structure is obsolete. If a major physician platform is openly advertising AI tools to game the system, if the rules were written before AI existed and haven’t been updated, if the test can theoretically be passed by feeding questions into a chatbot, then what exactly are we paying for? What are we testing? What is the point?
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NBPAS offers board certification without the bullshit, but it’s not 100 percent accepted in every state or every hospital yet, which makes physicians scared to drop ABMS certification even as it bleeds us dry. But we’re already in scary uncharted territory. Doctors are leaving medicine. Nurses are leaving. In New York City as I write this piece and procrastinate this test, 12 major hospitals are on the verge of closure or renegotiating salaries under financial strain. Medicine is changing NOW. Insurance is changing NOW. PBMs are changing NOW. Coverage is changing NOW. You want to keep us or lose us? Stop making it so hard for us to be doctors when we’re already doctors. Stop making it so easy for non-physicians to practice medicine fraudulently while demanding we jump through hoops that serve no purpose except generating revenue for organizations that aren’t accountable to anyone.
NBPAS and Direct Primary Care align beautifully in philosophy. DPC gives me time to practice medicine, time to read, time to learn, time to watch webinars and earn those extra letters behind my name because I’m not spending 75 percent of my day on prior authorizations and insurance appeals for my own payment. I joke that DPC lets me actually be the kind of doctor the ABIM pretends their test creates. NBPAS offers the same freedom from bureaucratic nonsense. You’re already a competent physician. You’re already learning. You don’t need to pay thousands of dollars every decade to prove it to a monopoly. Both represent physician autonomy and the radical idea that we should be able to practice medicine without drowning in administrative quicksand.
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So here’s the fix. Abolish this test. I’m serious. But also, this is objectively hilarious. If you’re going to replace doctors with AI, start with the fucking exams. If AI can answer board certification questions, if platforms are advertising this capability, if the rules haven’t caught up to technology, then the exams are meaningless. Either assess clinical reasoning in a way that actually matters or stop charging us thousands of dollars for glorified open-screen Googling. We all get together. The majority of physicians support alternatives like NBPAS. We advocate for reform. We try desperately to push our hospitals and credentialing committees to recognize that ABMS isn’t the only option and maybe it shouldn’t be the option at all. We stop paying for the privilege of being tortured by tests that measure nothing while medicine collapses around us.
Thank you, Dr. Teirstein, for creating this pathway and making this your passion. Thank you for building something that matches beautifully with the DPC movement and allows us that extra freedom, extra time, extra autonomy that is immeasurable in value. And thank you for giving us an alternative, because this Doximity email might actually further your fight. If this is what ABIM allows as the baseline of physician education, if this is the standard we’re held to, if this is what we’re paying for, then no wonder medicine is collapsing.
Isn’t it ironic? Don’t you think? A little too ironic. And yeah, I really do think.
If you’re going to replace doctors with AI, start with the fucking exams. If AI can answer board certification questions, if platforms are advertising this capability, if the rules haven’t caught up to technology, then the exams are meaningless.
