The titular “it” is enshitification, particularly of the “let’s digitize everything” type.
Next year will be a full decade since my initial board certification in oncology, and with that comes another set of multiple choice questions for quarterly completion. We can debate whether ABIM’s MOC scheme is fair — I think not — but still being the law of the land, it led me to think about board prep for the first time since 2018, when I completed my hematology boards.
Being an over-preparer (as people who finish medical school tend to be), I started looking into the size and cost of ASCO-SEP “ASCO” is the American Society of Clinical Oncology. “SEP” stands for “Self-Evaluation Program”. “ASCO-SEP” was something oncology fellowship programs gave to their trainees free of charge some time during their second or third year of fellowship to get them ready for the board exam. This was less from the goodness of their hearts and more because fellowships were graded — and to the best of my knowledge still are — on the percent of their graduates who pass the boards on the first attempt. A rate lower than around 80% would raise all sorts of flags and could lead to audits, suspensions and even closures. So, mid and low-tier programs would overselect on good test takers during fellowship match season, with interesting consequences (the discussion of which is better left for some other time). and was dismayed to learn that it is no longer a physicial book published every 3 or so years which one could use as a reference, doorstop or paper weight long after passing the boards, but rather a 12-month digital subscription with no option for a print copy. You would think that ditching print would lead to all sorts of dematerialization efficiencies — no typesetting, no printing, storage, etc — that could potentially lower the price and make it more affordable for everyone. Alas, if there were any efficiencies to begin with, they didn’t trickle down to the end-user: the cost of subscription for members if $550. And did I mention it was only for a year? Enshittification in action.
ASCO’s quirky sibling is ASH, the American Society of Hematology, which publishes ASH-SAP. “SAP” is for “Self-Assessment Program”, and the fact that they chose different acronyms for the same thing tells you much about the world of medicine. It is a smaller organization with fewer members yet it managed to put out a print copy for $60 over the digital-only offering — a more than fair price for a textbook. This is not the first time ASH has been on the right side of history.
So if anyone knows anyone in the ASCO leadership, please nudge them over to the ASH approach. Maybe you can mention ASH-SAP explicitly and let memetic forces do their magic. And if you can influence decisions at ASH, whatever you do don’t highlight that ASCO-SEP is digital-only and please don’t talk about efficiencies, lockup and similar matters lest hematologists get any wrong ideas.