Focused Practice in Hospital Medicine

Some in her HM group think Cathleen Ammann, MD, is the guinea pig. Dr. Ammann, the medical director of the hospital medicine division at Wentworth-Douglass Hospital in Dover, N.H., will be one of the first to complete her American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) through the new Focused Practice in Hospital Medicine (FPHM) pathway. Dr. Ammann—and the hospital administration—sees things a little differently.

“Am I the guinea pig or a pioneer?” a hospitalist in Dr. Ammann’s group asked her recently. “I definitely see it as being a pioneer. When you look back in another 10 years, hospital medicine might be a specialty with its own certification. I know it’s a little corny, but I look forward to getting in on that at the ground floor.”

Dr. Ammann is one of about 175 hospitalists who have signed up to recertify through FPHM. Her internal-medicine (IM) certification expires at the end of the year, so she will be taking the recertification exam Oct. 25.

“I hope the test focuses more on what I’m doing … stroke, quality measures,” she says. “Hospitalists know that stuff like the back of our hand. … I think it will work out well for me, but I also think it will be great for our program to have a director who has a Focused Practice in Hospital Medicine. It shows my commitment, and we can hold that up to the rest of the organization and say we really have someone who is concentrated in this field.”

Why Should I Pay Extra?

Why Should I Pay Extra?The Focused Practice in Hospital MOC will cost diplomates an extra $380, and Dr. Holmboe of ABIM says it’s fair to question the additional fee. Most of the added costs are operational—extra administration, extra attestation, and auditing.

“We’re actually carving out a new exam,” Dr. Holmboe explains. “The two biggest drivers were the committee for the new test to create the exam and the infrastructure changes to the website.”

Dr. Holmboe also points out that although the test will cost more than a general IM MOC ($1,570), it remains less than a subspecialty MOC.—JC

Dr. Ammann sums up the thinking of many HM leaders who’ve been working with ABIM and the American Board of Medical Specialties to launch the MOC pathway for hospitalists: Not only does a focused practice certification allow the more than 30,000 hospitalists in the U.S. to define themselves as different, it also provides hospitalists an MOC process and secured examination more acutely tailored to their skill sets and daily practice. The new pathway also requires ACLS certification and stresses continued “maintenance of competency,” according to SHM leaders, through a triennial self-evaluation requirement (60 self-evaluation points, with at least 20 points from medical knowledge modules and 40 points from completion of practice performance modules). The traditional IM MOC requires a practice-improvement module (PIM) every 10 years.

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