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An Historic Moment for Hospital Medicine


 

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.

Will the first hospitalist claim Hospital Medicine Focused Recognition in 2008 or 2009? The exact date is difficult to predict. That it will happen and that it will be meaningful, though, is more certain now than ever.

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.

Further, throughout healthcare there has been an increasing call for performance standards and quality improvement—all in the context of using resources more efficiently. There has been a movement to reshape healthcare centered on the patient and delivered by teams of health professionals, as well as increasing calls to coordinate care across locales and providers so as to improve patient safety and provide the best care.

In addition, the growth of hospital medicine has accelerated in the last few years. The fact that data not only from SHM but also from the American Hospital Association (AHA) and others show that more than 15,000 hospitalists now practice at more than 2,000 hospitals illustrates that that the size and influence of hospitalists comprise an indisputable trend.

And for many hospitals the driver for developing hospital medicine groups is the need to have on-site health professionals who are committed to changes in quality, systems improvement, patient safety, and efficiency.

Whether you call this a tipping point à la Malcolm Gladwell (The Tipping Point, New York City: Little, Brown and Company; 2000) or a perfect storm, to its credit ABIM—with the support of ACP, AAIM, and others—saw an opportunity to develop meaningful changes to MOC as a means of identifying hospitalists and of motivating the self study and improvement in skills and knowledge so important to meet the demands of healthcare delivery in the 21st century.

Now the hard work begins. In October 2006 the ABIM Board of Directors approved appointment of an ABIM Committee on Hospital Medicine Focused Recognition (HMFR). This work group will make recommendations to the ABIM Board in 2007 regarding the requirements for evidence of proficiency in HMFR in the MOC process as well as recommending policy of how HMFR would relate to the rest of ABIM certification and MOC in internal medicine.

SHM and hospital medicine leaders intend to play a key role in helping ABIM shape the details of the HMFR process so that it’s meaningful to the hospitalists who choose to get HMFR during their MOC—as well as to those who employ hospitalists, the physicians and other health professionals that hospitalists work with, the hospitals we work in, and the patients we care for.

At the same time ABIM must approach the American Board of Medical Specialties (ABMS) because the ABMS will ultimately need to accept the HMFR process before ABIM can put this new process in place. This is a significant hurdle to clear, but the ABIM Board is committed to using its resources and powers of persuasion to make this happen.

Even with the hard work and political battles ahead, it is difficult not to sit back and marvel at how far we have come. Our specialty is just 10 years old, but we now have more than 15,000 practitioners and are on our way to 30,000 or even 40,000. We have our own journal, our own specialty society, our own set of competencies, our own growing national annual meeting, our own textbooks, and a growing number of publications aimed at hospitalists.

Now with the help of ABIM and the blessing of ABMS, there is a serious prospect that the first recognition of hospital medicine in the certification process will become a reality.

Will the first hospitalist claim Hospital Medicine Focused Recognition in 2008 or 2009? The exact date is too difficult to predict. That it will happen and that it will be meaningful is more certain now than it has ever been. To all those who have had the foresight and leadership to make this a reality, we thank you. Now let’s get down to the difficult work of creating a process that will help hospitalists provide the best care to their patients and help them to be leaders of change and improvement at their institutions. TH

Dr. Wellikson has been CEO of SHM since 2000.

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