The Problem with Standardized Testing

I am not a big fan of how the standardized testing industry has invaded medicine. My biggest issue is that it is hugely expensive, both in time and money, and its benefits are unclear to me. I've probably put $5000 into testing registration and fees, and missed a week of work. This doesn't seem like a lot, but when you consider that every physician finishing training undergoes this, that's a significant economic cost. If this conferred a reasonable benefit, I'd be all for it. But I'm not sure it does.

We want all our physicians to meet a standard - perhaps "Board certification" - because presumably, it identifies well-trained, competent, and professional doctors and excludes those who are irresponsible, incompetent, or unethical. But do we know this? I've never seen any studies that show that those who fail the Boards harm patients or that those who don't are safer. How do we know where to set the bar? Is it an arbitrary cutoff that some committee decides?

For every medical test I order, I have some sense of its sensitivity and specificity; how likely it will catch a disease if someone has it and how likely someone without the disease will have a negative test. What is the sensitivity and specificity of our standardized tests? Is it worth the economic burden we impose on our physicians to take them?