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Internal medicine physician Rajeev Khanna discusses his article, “I passed my medical boards at 63. And no, I was not having a midlife crisis.” He shares his journey of studying for the ABIM exams decades after medical school, balancing family skepticism, humor, and determination. Rajeev reflects on aging in medicine, the evolution of study tools, and the deeper purpose behind lifelong learning. Viewers will learn how passion, perseverance, and self-belief can redefine success at any age, and why ambition does not expire; it simply adapts. This episode delivers insight and motivation for anyone chasing a goal later in life.
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Transcipt
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Rajeev Khanna. He’s an internal medicine physician. Today’s KevinMD article is, “I passed my medical boards at 63 and no, I was not having a midlife crisis.” Rajeev, welcome to the show.
Rajeev Khanna: Thank you. Thank you for having me.
Kevin Pho: All right, so tell us a little bit about your story and then we’ll jump right into your KevinMD article.
Rajeev Khanna: All right, I’m an internal medicine physician based in Virginia. I’m 63 years old. I came to the U.S. at the age of 29, having done my med school and residency in internal medicine back in India. Then I came here, I was 29, had to do my residency all over again on a J-2 Visa. Then I went to North Dakota to work in an underserved area to get my green card, and that I’m sure would be two or three more podcasts. I’m putting them together, working in North Dakota. I’ve been in internal medicine practice for the last 28 or 29 years in Virginia, associated with certain hospitals, but mainly ambulatory outpatient internal medicine practice as of now.
How this article came about was, I’m part of a very big group here, law Medical Group. And one of the internal medicine parts of that. Recently UnitedHealth, Optum showed interest in acquiring the whole loud medical group. That brought into perspective where I was.
See, I passed my board. When I finished my residency, I got into practice. Those a year or two older than me got grandfathered into not repeating boards again. However, I was in that place where you had to retake the boards. The medicine got busy, the practice got busy, life blew up with the kids, and all got busy. I never needed to pass the boards again to practice. That doesn’t preclude you from practicing, so I never felt the need for it. Life was going on well. At 63, I was already thinking of playing more golf, making more time for myself, and maybe looking at some kind of retirement. Then this UnitedHealth thing happened. That brought me into focus: that if something doesn’t go through, maybe I need to look into where my education was or what my status was.
That brought into question, should I take my boards? Do I need to be board certified if I go out in the world? I didn’t need to do anything if I continued to do the way I was, but it piqued my interest. So back in late 2024, I signed up. I said, “Let’s see what’s going on.” At that time, I didn’t tell anyone, not even my wife or kids, that I signed up for the board. In case I failed, what was I going to tell them?
However, over the next four or five months, I did what I needed to do, and I did end up passing my boards with a good score and felt happy about it. Then I sat down and reflected upon what happened. And that’s how the article came about.
Kevin Pho: All right, so you had a decision point. You were 63 and you had a fork in the road, whether to take your boards or maybe retire and do something else that didn’t require board certification. Tell us the questions that you asked yourself to come up with that decision.
Rajeev Khanna: I still felt that I had it in me to do more. I didn’t have much left to prove to the world. I have a fairly busy practice, am very well known in the community out here, and am very well vested in the community. I really didn’t need to do much. But then I thought, “Let me at least look into what’s involved in passing the boards,” and looked at all the stuff that was out there. I made a decision to do more. “Let’s see how valuable I can be to myself.” That’s what made my decision to bring it on.
Kevin Pho: What was it like studying for the boards? As you said, you’ve been practicing internal medicine for 29-plus years. You already have an established practice and a great reputation in the community. What was it like coming home from a busy day in clinic and then having to study for the boards?
Rajeev Khanna: That’s where the whole story lies. That’s what made me do it. I would see patients all day long, and as I said, it’s a fairly busy practice: literally 40 to 45-plus internal medicine patients. Then you had to do the EMR and the notes. I would bring work home, and watching Netflix is where I caught up with my Netflix shows and did my notes. The day would get locked. On top of that, if I wanted to do something more, where to find the time?
I start my day at eight o’clock. I started getting to the office at seven o’clock in the morning, and one hour before the office started, I began looking into various resource materials. That was the main thing.
I have students rotate with me for observerships, and I was looking at what they were studying. All this UWorld and everything else wasn’t there when I passed my initial boards. I went to Boston for the Harvard Med School Harvard board review in internal medicine, did seven days, and took the exams.
But now, the amount of stuff that is out there, the TikTok videos, so many videos, and so much resource material, it’s amazing. That piqued my curiosity. It made it easier to get the information.
When I started reading about it, the other thing I realized, as I put it in my article, was that it took me a lot longer to retain stuff. I could still understand all the concepts and I still would have a vague remembrance, but it took me time to retain it. Eventually, I got into the rhythm of it. I would come home, and instead of watching shows or doing something, I started putting down time to use all these resource materials, MKSAP.
Then I looked at the MKSAP, the whole MKSAP. I mentioned in one of my articles, my daughter finished internal medicine. She just took the board. She’s waiting on her exam results, and she had MKSAP. I didn’t buy MKSAP, so I was looking at her books. I tried to open one and go through it. It needs so much time, so much information out there. I whittled it down to MKSAP Pearls. Then somebody said, “No, you just go ahead and do the UWorld.” So I bought and got UWorld questions and I started doing those.
The basic concepts were there, but they needed recalling. Medicine has evolved so much and so quickly. In the real world, I don’t need to know all these guidelines, especially with ChatGPT, open evidence, and UpToDate. If I need to tell somebody about guidelines, I just open up my computer, get the information, and give it to them. I really didn’t need to have all that in my brain all the time.
Things have changed tremendously. In the old times, you never had these kinds of things. When I did my medical school, there were no computers or anything. You had to remember everything. Gradually, I got things put together. And that’s how it started.
You mentioned a question: if I had known it was going to be this tedious and difficult, would I have started studying again? Well, I am glad I didn’t know it was difficult. It did put a dent in me. I felt, “Why am I doing it? I really don’t need to. I didn’t need this.”
But then every time I read something new, it piqued my curiosity and my interest. “This is something new that I’ve learned today. Can I put it into practice?” It’s a fact that when I went back and saw my patients, now every joint pain, myalgia, or fever brought ten more thoughts to my mind, and I would go back and read about it. It made me feel better. That feeling of making me feel better made me read more and more.
Kevin Pho: For those who aren’t familiar with the MKSAP, those are the review questions provided by the American College of Physicians. You said that you went through the MKSAP and you were doing reading. How many hours a day did you study to help prepare for the board? You said it was over a period of a few months.
Rajeev Khanna: I would say at least five to six. One hour in the morning, three to four hours in the evening. In the evening, between 5:30 and 10:30, wherever I could find time. In between patients, I would find a problem, go to UWorld, and do one or two questions.
I brought it on myself, but that’s how. Here and there, it was not cumulative, like seven hours. I never had that kind of time, but I would spend 10 minutes there, 15 minutes there, 20 minutes there. Instead of watching too many shows, I was spending more time studying.
Kevin Pho: And then when you took the exam with that amount of preparation, did you feel comfortable with all the questions that came your way on the exam?
Rajeev Khanna: First of all, my wife stood by me. “This guy’s gone crazy, but let’s do whatever he wants to do.” But the key thing was my kids. My daughter is an internal medicine resident, and it was good talking to her. I see where the ABIM is going, where internal medicine is going. She’s a new resident. She just finished. I see the difference between where I was and what these guys were doing.
It was good talking to them. My youngest one is in med school right now. My oldest one, he’s a nerd. He went into GW Med school but then left after one and a half years to go into IT.
I had different perspectives on my situation, and all these things added up, but I felt better and better as I went into it. When I went to take the exam, the biggest thing was I did not have that pressure of, “What would happen if I did not pass?” I really didn’t care. I would play more golf and go do more stuff. That pressure was not there. That’s what I feel is the difference between myself and my daughter taking the exam. She has a different kind of pressure scenario. I didn’t have that pressure.
I made them do a care package for me. When I did the exam at 63, I was probably the oldest one sitting in that room. I’m sure there were other physicians taking the exam at this age. But in that room that day, there were four or five other ABIM takers, and I was the oldest. I didn’t feel bad. I’m usually reasonably good with computers, so I could pace myself. I really didn’t have much problem.
Though, yes, I have a beef with ABIM on certain questions and the way they were presented or what kind of information they want us to carry out, but I’m sure they have their reasons. One thing that taking the ABIM did was to increase my curiosity, which I’m going to come to later, but it did make me feel better. It did make me feel rejuvenated, and I felt more relevant to myself.
Kevin Pho: Now, to be clear, what you did was different from the maintenance of certification. You actually let your initial certification lapse, so you had to take it from scratch, almost like for the first time. Now remind me, was it closed-book? Did you have any access to any resources during the exam?
Rajeev Khanna: Good question. You have access to UpToDate now. It is more or less closed-book, with this option that you can access UpToDate online for a certain version. But you have to do a block, three blocks, and you barely get time to read the question, think about it, and then reach out to UpToDate.
Remember, when you go to UpToDate, you are opening up another Pandora’s box. You suddenly need the key buzzword that you can plug into UpToDate to get some questions. Once I was done, I did access UpToDate. It does help. It gives you more confidence, but I’m not sure it helped me pass. You had to do your initial hard work to get to that point where you know what to put in UpToDate to get proper answers.
Yes, it does help. They have UpToDate for MOC nowadays.
Kevin Pho: You spent five hours a night studying over a period of months after seeing a busy day at clinic. Do you feel any resentment that you had to take it? I think the reason that you said you had to take it is because UnitedHealth was considering buying your practice, and they required their doctors to be board certified. Do you harbor any resentment that you had to go down this path and spend however many hours preparing for a board exam?
Rajeev Khanna: I’ve thought about it. First of all, no resentment. No resentment at all. In fact, I’m glad I did it. Did I need it? Or do ABIM, or do we have to have ABIM certification? That’s a topic for discussion on a different day. We do our continuing medical education and, as I said, with all this AI, UpToDate, and open evidence, you can continue working your way through day-to-day patient care. That does help you. You really don’t need the certified word behind you.
But once you are done, and the way our medical community is built up now with insurance companies, pharmacies, and everything else, once you have “board certified” behind you, it gives you a different presence or different connotations for that matter. Yes, it is helpful. Did it make me a better person? Yes, by feeling good about the whole situation and feeling that I can do this. Overall, no resentment at all. In fact, I’m glad I did it.
Kevin Pho: Tell me what kind of advice you have for older physicians if they’re on the edge of taking board certification or not. Do you have any advice or words of wisdom for other physicians who may be in your position?
Rajeev Khanna: I have one. I feel one way it has changed a few things for me. What I would suggest, or what my advice would be, is: Go for it. Try it. What’s the worst that could happen? You are still at the same place where you are. Nobody is stopping you from doing what you’re doing.
However, what it changed in me was it put me on a path of intellectual rejuvenation. I was in a rut. I didn’t need to know much. I was doing very well, making the same amount of money. But it puts your mind in a rut, in a constant. There’s no change; there’s no evolution.
For example, to put it into perspective, since I passed my board, I started reading about being old and longevity. That’s the new buzzword these days, along with AI. I’m hugely interested in AI and its effect on health care. The way therapeutics are changed, where the diagnostic challenges are changing. I’m looking into getting into some AI-related program that I can pass or read more about, and I’m getting more and more into longevity at this age, at 63. But again, evidence-based longevity. How did it all come through? If I had not gone through my board and known what more is out there, I probably wouldn’t have embarked on this path.
Now I’m setting up a longevity clinic as an offshoot of my practice, trying to cut down on seeing too many patients and develop it into a concierge practice. With that, it’s still evidence-based because at heart, I’m still an evidence-based allopathic physician. So that did change. It rejuvenated my mind. It makes you feel younger in the brain. My advice would be to go for it. You might find some curiosity, some new element. It will probably rejuvenate your brain, if nothing else.
Kevin Pho: We’re talking to Rajeev Khanna. He’s an internal medicine physician. Today’s KevinMD article is, “I passed my medical boards at 63.” Rajeev, let’s end with some take-home messages you want to leave with the KevinMD audience.
Rajeev Khanna: Well, as I’ve written in my article, dreams don’t die. They sag a little bit. Go for it. You might find a surprise at the end. Go for it. It will probably rejuvenate your brain, if nothing else. That would be my message. And thank you for having me, Kevin. It was a pleasure talking to you. I’m glad I did this.
Kevin Pho: Rajeev. Congratulations on passing the boards. Thanks again for sharing your story.