IT’S hard to believe that another 10 years have passed, but the proof is the 11-volume stack of medical review books at my bedside. It’s time for the decennial rite of cramming a thousand pages of facts for an eight-hour-long multiple choice test.

Doctors are licensed by their states to practice medicine, but they’re also expected to be “board-certified” in their particular field — surgery, obstetrics, pediatrics, etc. This certification comes from the professional organization of each field. In my case, it’s the American Board of Internal Medicine.

It used to be that you tackled those monstrous board exams just once after residency. Then you went into practice and never looked at a No. 2 pencil again. But in 1990, the boards decided that doctors should recertify every 10 years. This seemed reasonable, given how much medicine changes. Over time, though, the recertification process has become its own industry. The exam has been supplemented with a growing number of maintenance-of-certification, or M.O.C., requirements. Some are knowledge-based exercises, but many are “practice assessments” meant to improve care in your own practice that end up being just onerous paperwork. And the recertification process and associated materials cost doctors thousands of dollars.

This year the internal medicine board announced that doctors who didn’t participate would be publicly tagged as “not meeting M.O.C. requirements.” Many jobs require board-certification, so a number of doctors felt that this tactic amounted to extortion. More than 19,000 signed a petition in protest. They complained that the specialty boards are monopolies that control who can practice medicine and use this power to compel compliance and exorbitant fees. Worse, they argued that the recertification process might not even be effective.