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Urban Legends

From: The Hospitalist, July 2010

Dispelling the myths of the Focused Practice in Hospital Medicine    

by Jeff Glasheen, MD, SFHM

Jeff Glasheen, MD, SFHM

Registration for the Focused Practice in Hospital Medicine (FPHM) Maintenance of Certification (MOC) through the American Board of Internal Medicine (ABIM) opened March 15. Since then, hundreds of board-certified IM physicians have registered to complete their MOC through the FPHM. For those of you who haven’t gone through MOC yet, it is required every 10 years in order to maintain your board certification.

As a member of the committee tasked with helping ABIM develop the FPHM, as well as write the FPHM examination, I’m frequently asked questions about this process, especially since FPHM was featured on the May 2010 cover of this magazine. Some of the questions stem from the perplexity associated with this significant change to the MOC process. Others arise from misinformation and apprehension, and could rightly be called urban legends. Here is a sample of those questions, with their respective veracity.

Does This Certification Mean I’ll No Longer be an Internist?

No. I clearly remember the day I found out I passed the ABIM certification exam; it represented the culmination of years of work, the pinnacle. All those long hours of study, late-night admissions, and exam preparation had finally paid off. I was a board-certified internist! I cherish my board certification and hold it out as recognition of my mastery of the field of IM. As such, I certainly understand the concern that entering the FPHM will somehow result in “losing” IM certification. However, this just isn’t true.

First, all diplomates—ABIM terminology for those enrolled in the board (re)certification process—in the FPHM are certified as internists. This is simply, as the name suggests, recognition of focused practice in HM—the core certification is still in IM. We are still internists—just internists who have focused our practice to hospital care. The formal board designation will read: ABIM Board Certified in Internal Medicine with a Focused Practice in Hospital Medicine.

The FPHM is certification in internal medicine by the ABIM. This carries the same weight and meaning as the regular internal medicine MOC. All credentialing boards that recognize the ABIM MOC in IM will recognize the FPHM.

Will Hospital Credentialing Boards Recognize This Certification?

Yes. The FPHM is certification in IM by the ABIM. This carries the same weight and meaning as the regular IM MOC. All credentialing boards that recognize the ABIM MOC in IM will recognize the FPHM.

Is the FPHM MOC More Rigorous Than the Regular IM MOC?

Yes, and it was intentional. It is recognized that hospitalists do things that make them “special” by acquiring and refining skills learned experientially outside of a supervised training program. Thus, one can attain FPHM board designation only after three years of practice as a hospitalist. The problem is that this is largely unsupervised time (unlike a fellowship), so the threshold to ensure we have achieved a level of competency has to be established through the MOC process.

As such, the bar for the MOC for FPHM has been set higher. The upshot is that to maintain designation of FPHM, hospitalists are required to achieve 60 self-evaluation points every three years, compared with 100 points every 10 years for IM MOC. Forty of those 60 points must come in the form of Practice Improvement Modules, or PIMs. While more rigorous, it only makes sense that a group committed to the improvement of healthcare quality would commit to higher levels of quality assurance.

Will the FPHM Confer Subspecialty Status to Hospitalists?

No. This is where there has been the greatest deal of controversy surrounding the FPHM program. FPHM is not a subspecialty certification. Rather, it is MOC for IM physicians who focus their practice in the hospital setting. The American Board of Medical Specialties (ABMS), the group that oversees the ABIM, is very clear that only training-based subspecialties can be deemed board-certified subspecialties.

Still, the new FPHM will differentiate hospitalists from nonhospitalists. To me, this is semantics, and the recognition that comes with the FPHM is enough to recognize what I do as “special.”

Will the Examination for the FPHM Reflect What I Do?

Yes. I’ve had several colleagues tell me they’ve heard that the examination will contain elements not found on the standard MOC test. This is true, but it also is the major benefit of the new test. As reported on the ABIM website, the FPHM MOC exam will consist of roughly 45% inpatient medicine, 15% consultative and comanagement work, 15% transitions and ambulatory medicine, 15% patient safety/quality improvement, 5% epidemiology, and 5% ethics and end-of-life care. In this respect, it better reflects what most of us spend most of our time doing—inpatient care, consultative medicine, and transitions of care. Those three areas comprise nearly 75% of the examination. The one area that is new is the focus on patient safety and quality. However, for a field built on the promise of improving the quality, safety, and efficiency of healthcare, this is a welcome change.

Will I Be Able to Prepare for the FPHM Exam?

Yes. Because the FPHM utilizes a different exam than the standard IM MOC, some physicians are concerned that they there are no avenues for preparation, but this is not true. While the exam will weigh various portions of the test differently (e.g., less ambulatory and more inpatient content), the inpatient content will be similar to what is currently on the standard MOC test. After all, heart failure, cellulitis, and pulmonary embolism are the same, regardless of the test it shows up on.

The difference is that there will be more of it—a good thing for the practicing hospitalist. Many of the standard IM test preparation options will help you prepare for the FPHM exam. The ABIM also offers HM knowledge modules as part of the enrollment fee, which, while not meant to be preparation for the exam, can help you identify gaps in your knowledge. The blueprint for the exam is on the ABIM website and can give you clues to areas in which to prepare.

It is true that there will be patient safety and QI content on the HM test, which might not be available for study in typical board review books. However, much of this is the kind of information hospitalists live every day, such as handoffs, transitions of care, and infection control.

Should I Fear the Change?

Humans are intrinsically wired to dislike change. It’s that old saw about choosing the devil we know rather than the devil we don’t. My guess is that much of the concern around the new process stems from this human sentiment—it’s just easier to not do the FPHM and go down the standard IM MOC route. We must avoid this temptation.

The FPHM is a key step in solidifying HM’s status in the healthcare milieu. It gives us credibility in a way no other designation can. It also allows those of us who are serious about an HM career to differentiate ourselves from those who masquerade as hospitalists. And, most importantly, it allows us to demonstrate to our patients our sincere commitment to improving the quality of the inpatient systems that envelop them at their sickest moments.

For that reason alone, I’m enrolling in the FPHM MOC. TH

Dr. Glasheen is physician editor of The Hospitalist.


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