Thursday, May 26, 2016

MOC: How the American Board of Pediatrics Failed this Nursing Physician

To the American Board of Pediatrics:

I took and passed my recertification exam in Washington State last fall and would like to express my sincere gratitude to your organization for setting up more hoops for pediatricians to jump through under the guise of helping us stay up-to-date.  The first hurdle was the exam application and the second was the testing day experience, which was one of the most demeaning of my entire life.  Below are my thoughts.

My daughter would be 9 months old and still nursing when I took the exam.  The recertification test duration is six hours with a 20 minute break for lunch. When I inquired about adequate time to pump and store milk, your office informed me I was the first and only pediatrician in the United States to request an accommodation.  Consideration for 20 extra minutes required application as a “disabled” physician.

My “disability” request involved submitting a letter by me outlining my needs, obtaining a second letter detailing the same from my Obstetrician, to include his CV, medical license, and credentials.  Obviously, this application process was instituted to discourage anyone from requesting schedule variances.  My heart should have been bursting with delight when you allowed me time to pump milk to feed my daughter. 

While swiping our credit cards to fund this atrocity known as Maintenance of Certification, maybe your group could take a few moments to streamline your rigid and archaic application process?  It is not exactly rocket science or is keeping track of so much money simply too exhausting? 

The morning of the test I left my home at 6:30am in order to reach the testing site by 10am, which required travel across the Puget Sound by ferry.  Upon arrival, I was allowed only one small locker for my things with no exceptions for those with additional necessary medical equipment.  My $1200 breast pump had to be placed on top of the bank of lockers with no assurances it would remain there throughout the testing period. 

The staff was unwilling to put it anywhere else for safe keeping.  We were warned not to leave valuables inside our vehicles, because the testing site was in a high crime area.  Desperate to keep both valuables, I tried putting the pump motor and my wallet in the locker but to no avail. 

The alternative option was to place the pump inside the locker and my purse with my credit cards and identification on top. Figuring it was less likely my breast pump would be stolen; I took my chances and placed my purse inside the locker.  Why couldn’t an exception be made for storing necessary medical equipment?  In light of my “disability”, is that even legal?  

The very intensive search process ensued as I presented my driver license, turned out each and every pocket in my clothing, and was “wanded” like a common criminal.  I have more sympathy for them now that I have been subjected to such measures.  Finally, testing began.  Emerging three hours later, I was relieved to see my breast pump still sitting on top of the bank of lockers.

No room was available for pumping, so I was told to use the bathroom.  I ate lunch, went to the restroom, and discovered one plug next to the sink.  Unable to use the counter with others needing to wash their hands after using the facilities, I would have to sit on the floor.  I returned to the waiting room mulling over how to resolve this situation. 

Finding a plug in the waiting room, I began to set up my pump and put on my hands-free pumping bra.  The room contained about 20 young men waiting to take their truck driver tests, hairstyling certification exams, and other trade competency assessments.  Horrified, the testing center attendant jumped up and demanded, “What are you doing?”  My answer was, “If you are unable to find a private room for my activities, this waiting room is going to witness quite a show.”

Surprisingly, she went to find the site manager and they found me a more private location.  Isn’t there a federal law that guarantees nursing mothers are provided appropriate accommodations, with one electrical outlet far enough from a water source to ensure safety from electrocution?

Basically, I am a hard-working pediatrician with 12 years of post-high school education and 14 years in practice.  By 7:30pm, I returned home feeling beaten down and humiliated.  Why would any physician submit to this degrading process to “recertify” board competency?  It is absolutely unacceptable. 

All testing sites should have adequate storage for required belongings, a testing site should be within 30-60 minutes of our home or workplace, and in compliance with federal law, adequate facilities should be available to properly attend to our medical needs.

Many female physicians, including me, postponed their child bearing in order to complete our educations.  I had three children aged 4, 2, and 9 months when recertifying.  These regulations place undue burden on those of us who have young families.  If we are “disabled”, then why are we not accommodated in compliance with federal standards? 

Is the American Board of Pediatrics as callous as they seem?  Maybe individuals on the Board of Directors did not breastfeed their young children and cannot spare a drop of empathy for medical needs of fellow physicians?  Maybe things would be different if pediatricians could prevent the American Board of Pediatrics employees from paying their bills and feeding their children?  Wait, we actually could do that if we refused to comply with your unreasonable demands.  Hmmm…


Niran S. Al-Agba, MD, FAAP

Silverdale Pediatrics, LLP


  1. This is horrifying considering that the AAP should be the most supportive of the specialty boards! I can't believe no one has asked for an accommodation before...they are full of it. I'm FP and was thrilled to see that at the annual AAFP conference, they had pumping rooms located conveniently throughout the conference area. It almost (but not quite) made me wish I was pumping again. But I made sure to tell everyone I could how much I appreciated it!

    I hope your comments make someone stop and think. And change a few policies.

    1. It was a devastating experience but I hope this helps others move medical organizations forward to change. The AAFP sounds like they are light years ahead of the AAP. My hats are off to the family practice organization for joining the 21st century!

  2. We need to make reform happen. Whether the ABP makes their process easier or we all jump ship to NBPAS, it has to happen!