Focused Practice in Hospital Medicine Worth the Additional Cost


Focused Practice in Hospital Medicine Worth the Additional Cost

Why are we being required to fork over an extra $380 for the Focused Practice in Hospital Medicine MOC? This feels like the icing on the cake of already a major ripoff.

Dr. Ragan

Grass Valley, Calif.

Dr. Hospitalist responds: Thank you for your frank reaction to the much-anticipated American Board of Internal Medicine (ABIM) Focused Practice in Hospital Medicine (FPHM) Maintenance of Certification (MOC) program. As you noted, an additional fee is required to participate in this recertification program.

To my knowledge, any and all fees associated with recertification are paid to ABIM. No other organization benefits from the added cost, so your question might be more appropriately addressed to ABIM (see “Focused Practice in Hospital Medicine,” May 2010, p. 1). But because you asked the question, I am happy to respond with my thoughts.

Participation in the FPHM MOC program is not mandatory. I am not aware of any organization that is requiring hospitalists to participate. I don’t expect that your lack of participation will affect your ability to obtain hospital privileges. Like any new MOC program, I would expect some up-front administrative costs associated with developing and administering the practice-improvement modules and the secure examination.

It’s up to you and others to decide whether this added recognition is worth the cost. I can tell you that I have made the decision to participate. I fully expect to be part of the inaugural class of ABIM diplomates with this added recognition by the end of the year.

What went into my own decision to participate? I can tell you that I am a practicing hospitalist who makes a salary typical of most hospitalists. I am frugal with my money and certainly do not view the added cost as an insignificant amount of money. Like most hospitalists, I am not only busy with my professional life, but I have plenty of family commitments as well.

I expect the exam will be rigorous, and the requirements of the practice-improvement modules will be demanding. I would not want it any other way. In the fast-changing healthcare environment, I believe that hospitalists will be challenged to think about what it means to care for a hospitalized patient. To succeed in the future, hospitalists will be expected to not only participate, but also lead QI efforts at their institutions. The FPHM MOC will distinguish me as a hospitalist with added qualifications in the field of QI.

So how about it, Dr. Ragan? Will you join me?

What Certification Requirements Should a Hospitalist Program Have for Its Physicians?

I hope you can help me with some questions I have concerning starting a hospitalist program at my medical center. Are there certain requirements (e.g., board certification in internal medicine, ACLS, etc.) that need to be met, or is that up to the facility? The physician interested in the position is board-certified in infectious disease. Any direction you can give me on this would be greatly appreciated.

Marisa Sellers,

Medical Staff Coordinator,

Hartselle Medical Center,

Hartselle, Ala.

Dr. Hospitalist responds: Congratulations on your medical center’s decision to establish a hospitalist program. Over the past decade, HM has been the fastest-growing field in all of American medicine. The majority of the country’s acute-care hospitals have hospitalists on staff.

Approximately 85% of the country’s hospitalists received training in internal medicine. Most of the other hospitalists received training in pediatrics or family medicine. While most hospitalists are general internists, some also have additional subspecialty training, which seems to be the case of the physician at your medical center. As you know, different medical facilities have different requirements of their medical staff. At the acute-care hospital where I work clinically, maintenance of board certification is required of all medical staff. I know that is not the case for all hospitals, yet I’m not aware of any hospitals with hospitalist-specific medical staff requirements.

Do you have a problem or concern that you’d like Dr. Hospitalist to address? E-mail your questions to

Most of the hospitalists who are internists will be either board-eligible or board-certified with the American Board of Internal Medicine (ABIM). You should be aware that ABIM has developed a new program, the Recognition of Focused Practice (RFP) in Hospital Medicine. As part of this maintenance of certification (MOC) program, ABIM diplomates will have the opportunity to take the first ABIM Hospital Medicine examination in October. For more information about this exam, ABIM’s rationale for recognizing a focused practice in HM, and any other questions about this program, please visit the ABIM Web site at


I have heard from hospitalists trained as family physicians who are interested in RFP as hospitalists. It is my understanding that the American Board of Family Medicine is studying the ABIM program and working to develop a similar program for hospitalists with family medicine board certifications.

Regarding your question about hospitalists and the American Heart Association’s advanced cardiac life support (ACLS) training and certification: While I think it is a great idea for hospitalists to receive this training and maintain this certification, I am not aware of any mandate for hospitalists to be uniformly ACLS-certified. I think this is an issue the medical staff at your medical center will have to decide; basically, what is in the best interests of your patients?

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