Board Certification for Hospitalists: It’s Heeeere!

In a little over a decade, the field of hospital medicine has achieved most of the milestones that characterize a specialty: the field is the fastest growing specialty in medical history, it has achieved wide recognition and acceptance, and there are textbooks, journals, conferences (including my 13th annual CME conference in SF beginning tomorrow, with 600 attendees), a core curriculum, a thriving professional society…

In fact, about the only thing we’ve been missing has been board certification. As you know, the American Board of Internal Medicine has been considering this issue for several years, and has spent hundreds, if not thousands, of person-hours developing a way to recognize the special focus of hospitalists within the broader context of its Maintenance of Certification program. The plan we developed (I’m on the ABIM’s board) is called “Recognition of Focused Practice” (RFP) – a pathway for practicing hospitalists to complete their maintenance of certification in hospital medicine, rather than the whole of general internal medicine (IM).

We developed the outlines of RFP-HM about 2 years ago; I described it then in the Journal of Hospital Medicine (here). In brief, to qualify, a hospitalist who is certified in IM (it is possible, but not guaranteed, that family medicine and pediatrics will develop similar pathways) will have to meet a certain inpatient volume requirement for 3 years, participate in hospital-focused self-evaluation and quality improvement modules (“Practice Improvement Module”, or PIM), and then pass a hospital medicine-focused exam. A superb committee of leaders in our field, chaired by Tulane’s Jeff Wiese, has been hard at work developing this test and fleshing out the rest of the process.

The ABIM has been fully committed to this pathway (and, I have to say, incredibly supportive of hospitalists more generally – special thanks to Chris Cassel, Dan Duffy, Lynn Langdon, Paul Poniatowski, Rich Baron, John Popovich, and many others). But there was another hurdle to cross before ABIM could launch its RFP in Hospital Medicine (RFP-HM). You see, ABIM is part of an umbrella organization of certifying boards called the American Board of Medical Specialties. ABMS has been thinking hard about RFP – and for good reason. Traditionally, board certification has been reserved for specialties defined by a discrete training experience (i.e., a residency or fellowship), and hospital medicine is arguing for a new kind of certification based on expertise acquired and focus demonstrated while in practice. This is a big deal: in a world in which a general internist might want to say, “I’m a diabetes expert, borne of my extensive experience in my primary care practice,” (and, for the word, “diabetes”, you can substitute about 1000 different areas to get a sense of the breadth of the problem) there are obvious slippery slope concerns.

Yet ABMS recognized the unique aspects of hospital medicine, and embraced an algorithm that the ABIM has used in thinking about whether a field might qualify for RFP: many physicians in the originating specialty (in our case, general internal medicine) only practice in the focus area, and many physicians never practice in this area. This criterion allowed us to argue that hospital medicine – a field in which more than 25,000 internists now only practice in the hospital and at least that number of general internists never do – qualified, while diabetes, or heart failure, or depression does not. (HIV medicine might be another appropriate contender.)

I write today because I received a number of text messages from ABIM colleagues a few hours ago (all followed by multiple exclamation points) informing me that ABMS has approved a pilot program of Recognition of Focused Practice in Hospital Medicine. As I understand it, the program will be ready to launch in about a year, and individuals interested in the specifics should keep their eyes on the ABIM website or contact the organization (some FAQs, not yet updated with today’s news, are here). I imagine that most of the initial participants will be folks nearing the end of their board certification cycle (i.e., approaching year 10), for whom doing MOC in hospital medicine will be more in sync with their professional focus than doing it in all of general medicine. Over time, if the market for hospitalists “values” this certificate, it’s possible that hospitalists will choose to pursue RFP before their initial certificate expires – time will tell.

In any case, this is an important milestone for the field. In fact, when I first began speaking to groups of hospitalists nearly 15 years ago, I often showed a slide listing the elements of a true specialty, and one-by-one we’ve ticked them off. The only unchecked box was recognition of the field as a legitimate “specialty,” as codified by the ABMS board certification process.

Unchecked, that is, until today.

10 Responses to “Board Certification for Hospitalists: It’s Heeeere!”

  1. menoalittle September 25, 2009 at 1:35 am #

    Bob,

    Congratulations on getting the recognition for this focused track of IM. It provides rewarding professional work and a lifestyle with finite boundaries of accountability.

    One would hope that the exam assures appropriate IM judgment but more so, proficiency in hand-offs and communication, in digitizing the art of medicine, and in using basic HIT. How can I forget, a test for typing accurately; vitally important!

    Proficiency in navigating and finding the patient endangering mistakes associated with EMRs and CPOEs to assure patient safety ought be tantamount for this Board.

    Best regards,

    Menoalittle

  2. watchley September 25, 2009 at 10:06 am #

    Bob,
    This truly is a great achievement that SHM, the early pioneers in our field and you should feel proud of. Hospitalists owe alot of thanks to you also for being the voice at ABIM table.

  3. Usman chaudhry September 26, 2009 at 4:35 pm #

    Do you have any idea if the SHM will do the board certification for hospitalist as a ” hospital medicine ” physician rather than confined to one board like ABIM. I don’t think anyone is considering this in ABFM or pediatrics , so we at this point rely on SHM for our hospitalist board certification.

  4. Bob Wachter September 28, 2009 at 12:50 am #

    Hi, Usman —

    SHM doesn’t do “board certification” per se — it is a professional society that does offer a “Fellowship in Hospital Medicine” that recognizes achievement in and commitment to the field, but not a formal certification. That is left to standard-setting boards like the American Board of Internal Medicine. As I mentioned, I do believe that the comparable boards for family medicine and pediatrics are considering this (they are well aware that large numbers of hospitalists come from their fields) but I have no way of knowing whether a comparable type of program to the ABIM’s is in the cards.

  5. Bob Wachter October 9, 2009 at 5:58 pm #

    There’s been a lot of interest in the topic of board certification among family physicians (and pediatricians) who are hospitalists. Here’s an article from this week’s AAFP News announcing that the American Board of Family Medicine is joining ABIM in the focused practice hospitalist certification program. Very good news.


  6. Bob Wachter October 12, 2009 at 4:12 pm #

    And here’s an article from today’s Modern Healthcare on the new focus practice pathway (may require subscription).


  7. Kenneth October 12, 2009 at 5:04 pm #

    I think this BC based on a physician’s ability while in practice is evidence to the quality of care being provided across the country by IMs. It’s been interesting to watch this specialty develop over the years. Indeed the best is yet to come.

  8. Ahmad December 13, 2009 at 5:36 pm #

    My question is about the examination.
    Is ABIM-MOC examination in hospital medicine separate and additional exam from ABIM re-certification exam? and Can I take both exams if I want to? I know I am not REQUIRED to take both, but how about if I LIKED to take both exams.

    I was board certified in IM in 2005 and full time hospitalist for 3 years but will not be eligible to take the re-certification exam of IM till 2011, so can I go for ABIM-MOC examination in hospital medicine in 2010 and then take the re-certification exam in ABIM in 2014?

    Fine regards,

  9. Eric Holmboe December 14, 2009 at 2:02 am #

    To Ahmad,
    Dr. Wachter notified me of your comment regarding the examination. The ABIM Task Force that developed the policy for Focused Practice in Hospital Medicine (FPHM) determined that diplomates who pursue FPHM cannot maintain their underlying IM certficate while in the FPHM program. However, individuals who change practice careers can switch back to the general IM pathway at any time they leave the FPHM program. There were a number of reasons for this decision, but the primary rationale was individuals who are truly focusing their practice within internal medicine are by definition not practicing in the broad domain of general IM. We will be posting addtional information about FPHM on our website (www.abim.org) soon after the first of the year.
    However, I appreciate the question and have made note of it as has Dr. Wachter.

    Sincerely,
    Eric S. Holmboe, MD
    Chief Medical Officer
    ABIM

  10. Nathan Ker July 29, 2010 at 4:54 am #

    I know that the ABFM is now offering the Recognition of Focused Practice in Hospital Medicine examination, and I am thrilled at the chance to take this examination, but the test is coordinated through the ABIM. This is a good idea.

    My question, however, is really geared towards my internist collegues–what did you do or study to prepare for your boards. Any suggestion of materials to consider for reveiw?

    Thanks in advance for your thoughts.

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