In an historic decision at its October 2006 board meeting, the American Board of Internal Medicine (ABIM) agreed to move forward to develop a process for Focused Recognition of Hospital Medicine through ABIM’s Maintenance of Certification (MOC). This is the first time ABIM has offered focused recognition for any subset of internal medicine. In addition, this brings recognition to the uniqueness of hospitalists, who dedicate their professional careers to managing the care of acutely ill patients and creating a better healthcare delivery process at their local hospitals.
This whole concept started when the SHM Board approved a resolution in February 2004, outlining the need to recognize hospitalists as unique providers of healthcare. At the time, the SHM Board asked SHM staff and leadership to work with existing certifying organizations, such as ABIM, to develop a mechanism for hospitalists to have a formal credential recognizing hospital medicine.
Because more than 80% of hospitalists are initially trained in internal medicine, SHM leadership decided that it made sense to first approach ABIM. At the same time SHM had plans to develop similar solutions for hospitalists who are trained initially as pediatricians, family practitioners, and osteopaths (all of which are certified by boards other than ABIM).
Soon after the 2004 SHM Board meeting, SHM executive staff approached key leaders at ABIM. ABIM held a retreat in 2004 to discuss new models of certification. Later the ABIM Board encouraged meetings with SHM to keep hospital medicine within internal medicine.
In April 2005 ABIM and SHM leadership agreed that recognition of hospitalists initially trained in internal medicine might be achieved by modifying the existing MOC process. At that time the ABIM Board was concerned that any changes to the certification system might fragment the internal medicine community. To its credit the ABIM Board did not let these concerns block the process. ABIM soon convened a range of stakeholders in internal medicine to address these issues.
This group of stakeholders was broadly drawn from the leadership at SHM, the American College of Physicians, the Society of General Internal Medicine, all medical subspecialties, the Alliance for Academic Internal Medicine, the Association of American Medical Colleges, the AMA, the Residency Review Committee, and ABIM itself. These stakeholders met in December 2005, May 2006, and again in September 2006.
In preparation for these meetings SHM had developed its comprehensive Core Competencies in Hospital Medicine that was published as a supplement to the first issue of the Journal of Hospital Medicine (JHM) in February 2006. This was a powerful, tangible set of circumstances for hospital medicine.
When people began questioning what made hospital medicine unique among internal medicine disciplines or what was the substance of hospital medicine, being able to hand them the Core Competencies and to walk them through this thoughtful document was very important. In the same way, establishing our own repository for medical advances in hospital medicine via JHM also supported the development of a new field in internal medicine.
It’s been helpful that other key trends have taken shape in the last few years. The Alliance for Academic Internal Medicine (AAIM), representing the Association of Professors of Medicine (APM) and the Association of Directors of Programs in Internal Medicine (APDIM) and others, worked closely with ACP and the rest of the specialties in internal medicine to redesign the internal medicine residency so that it reflects the current and future practice environment.