For 7 years I have been living a life of shame. I have been fearful that I would be discovered and called a fraud. Constantly feeling inadequate and not worthy of my initials M.D. “Why?” you may ask. Because for almost 7 years I had not attained the title of “Board Certified”. I have taken the Medical College Admissions Test (aka MCAT). I have been to medical school for 4 years and graduated. I took the required Step 1, Step 2, Step 2CK, and Step 3 and passed those exams without difficulty. I successfully matched into a residency program. I completed my internship year and 2 years of residency. I even did a fellowship in geriatrics. Yet I still had hesistancy in taking my final test, my board exam. So why was this test my unicorn?

As I began to practice medicine I learned that I was well prepared not only due to my medical school education but also my training from internship and residency. Of course there was a steep learning curve in becoming confident in practicing on my own and developing my own style. However, after practicing for 2 years I felt I was ready to take the exam. To be honest I didn’t really take time to study 🤦🏾‍♀️ because in my mind after practicing for 2 years I had covered most of what I thought was going to be covered. Needless to say I failed 😔.

Okay! So I took a step back and of course chastised myself…how could I be so naive to think that I didn’t need to put forth effort! I had erroneously assumed that all the training and testing I had done up to now was enough to prepare me for this board exam. cue Denice Williams Silly of Me. Picking myself up and brushing myself off I formulated a plan to study and work at the same time; however, as life would have it I became pregnant! I put off taking the test for a year using the time to enjoy my pregnancy and the birth of my son. After a year I prepared to take it again this time opting to work full time and care for my son full time. And again I failed!

Options for non-board certified docs

Feeling defeated and broken I started looking at what my options were for practicing as a non-board certified physician. To my surprise and chagrin there wasn’t much information about options and what I did find seemed to suggest that I was up a creek without a paddle. I finally opened up to a colleague and found that they too had struggled with their initial certification. They encouraged me not to give up and recommended some techniques that had helped them in their preparation. Could we be the only ones that struggled with this exam? Carefully I opened up to a few select people and found out that I was not alone. When I asked why they had not said something they replied “why hadn’t I?” When I answered them “embarrassment” and “shame” where my reasons. Where had this feeling come from? Where had the notion that struggle at this level was somehow a weakness or something to be ashamed of come from?

Still unempowered, I kept my secret to myself and the chosen few I had opened up to and prepared to take the exam again. I partnered with others who like me had not passed and we studied together and supported each other during the lows of doubt and insecurity. I worked full time, studied when I could, and was a mother the whole way through; and I failed.

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Wow, that word even now as I type it hurts. I had taken this test a total of 3 times and had yet to pass. I began to spiral down a dark hole. How was I going to support my family? How was I going to pay back my massive student loan debt? As a single parent, I am the sole provider for me and my son. In one year I would lose my board eligibility; essentially my career as a physician was on the brink of being over as well as my means of supporting my family!

There are few options nowadays for physicians who do not have the desired title of Board Certified. Hospitals privileges are unattainable, insurance companies unwilling too “allow” you to be a provider for their patients. Practices refrain from wanting you if you are not Board-Certified/Board Eligible (BC/BE). Four years of medical school, 3 years of residency, MCAT, USMLE exams all completed, state licensure obtained, DEA license purchased, and still one exam preventing me from the career I long desired, dreamed, and dedicated my early youth for. There was no other choice—something had to change. I contacted the American Board of Internal Medicine (ABIM) to see what my options were as this was my last year of eligibility. My prime question centered around my options if I didn’t pass this year. On the website there was a statement

“A candidate who is no longer Board Eligible may nevertheless apply for a certifying examination, but only if the candidate has: (i) completed at least one year of retraining in the relevant specialty after the expiry of the candidate’s period of Board Eligibility, but no more than seven years before the application; and (ii) met all other requirements for Board Certification in effect at that time. Retraining will require the successful completion of at least one year of additional residency/fellowship training in an ACGME-accredited U.S. training program or an RCPSC-accredited Canadian training program and an attestation from the program that the candidate has demonstrated the requisite competency for unsupervised practice. Candidates and diplomates remain subject to other ABIM policies and requirements for certification, such as the Re-examination policy.”

What is retraining?

When I called to get more information about what a retraining year would entail there was no available information and I was referred back to my residency program director. How absurd and frustrating that the organization who developed the rules and policies had no information to offer! No guidance about what the required retraining year would look like.

I nevertheless followed their instructions because I had no choice and reached out to my former director. She to her dismay had no concrete information about what a retraining year looked like either. She assured me she would contact the ABIM and see what she could learn but advised me not to give up; since I had one last year to take the exam. She suggested that I get in touch with the Testing Center on campus to see if I had a testing or learning disability. Could that be it? Did I have an undiagnosed learning or testing disability that evaded me for years only now to rear its head? She doubted it but it needed to be evaluated.

After speaking with the counselor, it became clear that she agreed; it was highly unlikely that I had a learning or testing disability that had not previously shown up. So what was the issue? Well one of the pieces that the counselor helped me discover was that I have a hard time trusting myself and taking a leap of faith in myself. Another issue was that I have a tendency to answer the question that I think I’m being asked not the question that is being asked. So armed with this, I decided I needed to take a step back and focus solely on this exam and being a mom. So I did. I quit my job, neglected my friends and devoted myself to my son and my exam. I fought through self-doubt constantly. I second guessed myself on every question. Thinking I was missing something. Fearing that I somehow did not learn what I needed to in 8 years of training. Why did I feel this way; because others before me had seemingly passed this test with ease. Here I was on the brink of failure with no safety net; nothing to fall back on. Despite years of caring for patients and living my dream I was in jeopardy of losing it all. I doubted my calling. I never doubted God, but I doubted that I heard Him correctly. I doubted that I was on His path for my life. I was ashamed and alone. I bore this shame in secret because to do otherwise was considered taboo and a marker of weakness.

Test Anxiety

As the exam grew closer my anxiety increased and my confidence dwindled. In the last month of the exam I lived and breathed nothing else. My parents looked after my son while I studied. With each question I answered correctly my confidence grew and with each question I missed it was shattered into a million pieces. The few people that I opened up to about my failure would ask how the studying was going…others would offer prayers and well wishes. I felt inadequate, fraudulent I couldn’t figure out how I was able to take care of patients but still was not deemed worthy based on a test. I then came across three quotes from Michelle Obama:

“When you are struggling, and you start thinking about giving up, I want you to remember something that my husband and I have talked about since we first started this journey nearly a decade ago—something that has carried us through every moment in this White House and every moment of our lives—and that is the power of hope. The belief that something better is always possible if you’re willing to work for it and fight for it.” – Michelle Obama

“Am I good enough? Yes I am.”– Michelle Obama

“If my future were determined just by my performance on a standardized test, I wouldn’t be here. I guarantee you that.”― Michelle Obama

The day came and I sat for the exam and as I was logged in by the proctor I also prayed. I thanked God for my calling and vocation. Once I did that, I began my exam. When I finished I felt spent; I truly had done all that I could. If this was not enough I had no idea what the next step was and apparently neither did those at the ABIM. But what I knew for sure was that no matter what the test said…I was enough. While I seemingly had to pass this test in order to continue on the traditional path of medicine I would not let it determine or limit my future. I am a doctor and I always will be.

Kharia J. Holmes, MD is a mother, daughter, sister, friend, and internal medicine physician who lives in Maryland. She enjoys making patients and others laugh because laughter is truly the best medicine. Her ImPerfect Life and shenanigans can be caught on Instagram @TheImPerfectMD and her thoughts, fashion, and life story can be read on her blog