This is the year I complete my second recertification for the American Board of Internal Medicine (ABIM). Prior to 1990, the ABIM issued certificates that were good for life. Beginning in 1990 and through 2013, all certificates were issued for a 10-year duration. All those prior lifetime certificates were honored, so those holding them were deemed “grandfathered” and have not had to recertify. The rest of us are now on the recertification pathway, renewing every 10 years. Although the date has been set at 10 years, the recertification process has become more regimented since January 2014, when the ABIM moved to a continuous program requiring evidence of new learning and maintenance of quality in your practice every two years.
This ratcheting up of requirements and adding increased increments of progress hasn’t come without controversy. Last year a petition was started and signed by 19,000 physicians protesting the changes and arguing the ABIM should go back to the methodology of taking a test every 10 years. Even this was a moderate position; many were clamoring for the abolition of maintenance of certification (MOC) all together.
I represented the Society of Hospital Medicine (SHM) in July 2014 at a summit in Philadelphia called by the ABIM Foundation. Each of the medical subspecialties was given an opportunity to speak to the ABIM leadership and the audience of fellow representatives about the impact of MOC. As members of a relatively youthful field, hospitalists are less focused on how the “grandfathers” are being treated and more concerned about the confusing process and lack of opportunity to incorporate our daily hospitalist-focused work effort easily into the process.
As a result of that petition, many letters written to the board, and the outspoken representatives at the ABIM summit, the ABIM has responded with a plan to make elements of the process more friendly and open, as well as one to further plan and adapt.
Clearly, this is a process in evolution. Hospitalists are committed to lifelong learning. I think we can expect that with more transparency in all aspects of our lives, personal and professional, our patients, our hospitals, and payers…will all be expecting to see just exactly how committed we are to lifelong learning and self-improvement.
It’s our turn…
In 2009, some bold steps were taken with the announcement of the new Focused Practice in Hospital Medicine (FPHM) that, hopefully, will impact hospitalists for many years to come. SHM’s partnership with the ABIM began with work five years prior, creating a focused declaration of hospital medicine competence. Initially, this was set up as a pilot project to be evaluated for success along the way, to see if the concept would become permanent. The work was announced, and the inaugural class of 175 physicians entered the process. Since that time, 555 physicians have earned the FPHM certificate. What’s even more impressive is that we have seen a surge recently in the number of entrants. There are now 3,300 hospitalists enrolled in the pathway.
While this growth is great, we estimate that there are 44,000 hospitalists in the U.S. We know that many are newer hospitalists and not yet up for recertification. Our goal is to get every hospitalist entering the pathway when it is his or her time, just like I’m doing now. It is my time!
As we steadily progress in distinguishing and defining our field, we need as many hospitalists as possible to raise their hands and say that they proudly practice hospital medicine and have taken the steps to learn the special knowledge and gain the special skills needed to succeed in the hospital. The ABIM certification program is still in the pilot phase. One of the key markers of success to determine if it will be continued is the number of participants. I am writing this column as another way to encourage us all to stand up and be counted.
So, we know things have changed, and we know things will be changing more, but what about now? What do we need to do to navigate the process to gain our FPHM certificate today?
1. Enter the process: You can’t win if you don’t play. Entering FPHM is easier than ever. The requirement for current active ACLS has been removed. Now it is a declaration that you see 1,000 patients a year or that you had 3,000 encounters in the last three years and pay the supplemental fee.
2. Earn 100 “points”: You have five years, with a mix of Part II and Part IV activities at least every two years, and the secure exam. You must have the patient voice and patient safety module credit as part of this every five years block.
2a. Medical Knowledge Self-Assessment (Part II): Show what you know or learn on an ongoing basis. You can do these at home, work, or with a buddy, or, even better, sign up for a group learning session, usually offered as a pre-course at society meetings. HM15 will be offering a pre-course that will offer Part II credit. SHM’s Hospital QI and Patient Safety Medical Knowledge Module is available at www.shmlearningportal.org.
2b. Practice Improvement (Part IV): Show that you are trying to improve your practice. Again, the ABIM website lists many possibilities for improvement activities that count and has a practice improvement module (PIM) selector tool (select “hospital medicine” and “inpatient”). Here are some of my favorite PIMs.
Team PIM. Complete a self-assessment of your team skills, get 10 members of your hospital multidisciplinary team to fill out an evaluation on you, and then review with a trusted colleague. This PIM also satisfies both patient voice and patient safety requirements (10 points).
SHM Project BOOST or SHM’s Glycemic Control Mentored Implementation Program. Do either of these at your hospital to earn 20 points.
Clinical Supervisor PIM. For those of you who work with residents or students. Observe 10 visits by learners, then follow up with a chart look-back, feedback to the learner, and a plan for improving learning (20 points).
3. Take a test! The secure exam is given every 10 years and counts for 20 points. What is great about this FPHM test is that it is focused on all the stuff you do every day in your job. It’s a hospitalist test, not an outpatient clinic doctor test. It focuses on inpatient clinical medicine and palliative care, plus patient safety and quality. You can use the current study materials (MedStudy, MKSAP [Medical Knowledge Self-Assessment Program], and the like); just skip the purely ambulatory material. Focused study materials will be available in the next year. Look for the HM15 exam preparation guide, which will direct you to HM15 sessions that cross over with the ABIM/ABFM [American Board of Family Medicine] Hospital Medicine exam.
If you would like other tools for studying for the consultative co-management and quality and patient safety sections of the exam, check out SHM Learning Portal.
It’s complicated, right? But each time I look at it or read one of these articles, it gets a bit simpler. The overall process for internal medicine certification now mirrors this one, with very few differences. Remember, the ABFM process is identical for hospitalists trained in family medicine. Hopefully, this column will help you get off the fence and come down on the side of representing what you do every day at work in the hospital.
Be proud, take the more pertinent path, be a hospitalist! Twenty points.