Health: How I Passed My Boards

A few weeks ago, I was huddled in a hotel conference room with a dozen other neurosurgeons as we braced ourselves for the most important test of our lives. We were in Houston. It was hot and muggy. We were anxious, and all of us were sweating before the test even started. After finishing college, four years of medical school, seven years of training and five years of practice, I was taking a test that would transform me from "board eligible" to "board certified." But only if I passed.

Dr. Julian Hoff, my longtime mentor, told me this would be one of the most indelible experiences of my life. As usual, he was right. I started the half-day process sitting across a table from two examiners, both senior neurosurgeons. Laid out on the tabletop between us were models of a skull, a head and a spine, as well as several laptop computers filled with brain-scan images. After a quick handshake, the fun began.

The examiners presented patient scenarios in rapid-fire sequence. A 45-year-old woman with persistent headaches. A 60-year-old man with unrelenting facial pain. A three-year-old child who has never been able to walk. We had to study the data, ask the right questions and make on-the-spot diagnoses. Our interlocutors had finely tuned poker faces and were instructed to give absolutely no feedback. I had no idea if they thought I was the greatest neurosurgeon who ever lived or totally out to lunch.

Whenever I try to explain the certification process to my friends and family, I'm reminded that the whole thing is rather mysterious and confusing. Board certification is the method the medical establishment uses to set standards and maintain quality of care in 24 broad areas of specialty. In the U.S. the process is administered by the American Board of Medical Specialties and is strictly voluntary. You can be a licensed, practicing neurosurgeon without ever passing the boards. The big pressure to take the exams comes from insurance companies, third-party payers and hospital administrators, who are more likely to promote someone who is board certified.

Patients like to see those certificates hanging on the office wall, of course, but a doctor who was certified many years ago and hasn't renewed that certification may not be up to speed on the most recent advances. In fact, younger doctors with a few years' practice under the belt are often the freshest. It can be instructive, however, to know if a doctor ever failed the exam--something that might reasonably be construed as a red flag. There are several websites, such as docboard.org that let you check up on your doctor by name or state.

In case you're wondering--I passed. I am now board certified and a diplomate of the American Board of Neurosurgery.

Sanjay Gupta is a (board-certified) neurosurgeon and CNN medical correspondent