Career

A Time to Be Recognized


 

Like so many things in HM, the story of how hospitalists first learned about the focused practice program is a modern one.

It started with a text message, which led to a blog post, which reached thousands of readers, many of them hospitalists interested in how to bolster their bona fides in a specialty known for its explosive growth in recent years.

Now, hospitalists certified in internal medicine have the opportunity to reinforce their commitment to the specialty by maintaining their certification through the Focused Practice in Hospital Medicine pathway offered by the American Board of Internal Medicine (ABIM). The Focused Practice in Hospital Medicine (FPHM) Maintenance of Certification (MOC) program enables hospitalists to distinguish their practice within the larger specialty of internal medicine.

ABIM Focused Practice in Hospital Medicine Certification Checklist

Program requirements for ABIM Focused Practice in Hospital Medicine:

  • Current or previous ABIM certification in internal medicine;
  • Valid, unrestricted medical license and confirmation of good standing in the local practice community;
  • ACLS certification;
  • At least three years of HM practice experience;
  • Attestation by the diplomate and a senior hospital officer that the diplomate meets thresholds for internal-medicine practice in the hospital setting and professional commitment to hospital medicine;
  • 100 MOC points comprising self-assessment of medical knowledge and practice performance relevant to HM, followed by ongoing (e.g., every three years) self-assessment in HM to maintain the certification;
  • A passing grade on an ABIM MOC examination in HM; and
  • A fee of $380 if you already are enrolled in MOC. The program fee for new enrollment in MOC is $1,950.

Source: www.abim.org

The Evolution of FPHM

The new pathway has been years in the making, and it reflects the growing influence of HM in healthcare, according to ABIM Chief Medical Officer Eric Holmboe, MD. He sees the FPHM as the result of a combination of factors, including the fact that the specialty now has more than 30,000 hospitalists practicing nationwide. “If you look at the past years, this has been a viable and vibrant practice,” he says. “If you look at the number of people doing hospital medicine, it’s a factor.”

For Holmboe, it also is a shift in how individuals are recognized based on their practice areas. “This is an acknowledgement by ABIM and the American Board of Medical Specialties to look at Maintenance of Certification in terms of what the individual actually does,” he explains. “Hospitalists play a very important role in the hospital.”

He also credits the leadership of the HM movement—especially pioneers like Robert Wachter, MD, FHM. One of HM’s most ardent champions, Dr. Wachter, chief of the hospital medicine division, professor, and associate chair of the Department of Medicine at the University of California at San Francisco, worked with ABIM to find a way to recognize hospitalists’ specialized skill sets and their commitment to inpatient medicine. After more than a decade of advocating for a board-certified process to recognize the field, Dr. Wachter, an ABIM board member, began receiving multiple text messages from colleagues announcing that ABIM had approved the focused-practice program. He wrote a post on his blog, Wachter’s World (www.wachtersworld.com), that outlined the need for the FPHM and the significance for aspiring hospitalists.

“In any case, this is an important milestone for the field,” Dr. Wachter wrote in his Sept. 23, 2009, blog entry, “Board Certification for Hospitalists: It’s Heeeere!” “In fact, when I first began speaking to groups of hospitalists nearly 15 years ago, I often showed a slide listing the elements of a true specialty, and one by one we’ve ticked them off,” wrote Dr. Wachter, a former SHM president. “The only unchecked box was recognition of the field as a legitimate ‘specialty,’ as codified by the ABMS board certification process.”

Unchecked, that is, until now.

Although hospitalists’ MOC must be current in order to apply for FPHM, hospitalists can begin the FPHM application process at any time. Hospitalists do not need to wait until their next MOC renewal.

In early 2011, the medical world will be introduced to the first internists recognized for their focus in HM. For Holmboe, the FPHM is the beginning of an even larger movement.

“The goal is continued interest: getting people involved in quality in their hospital and encouraging people to change behaviors and be recognized by patients and credentialists as valuable,” he says. “That’s the primary mission of ABIM: using certification to improve care.”

Fellow in Hospital Medicine Spotlight

O’Neil Pyke, MD, FHM

Dr. Pyke is a clinical instructor at Commonwealth Medical College and a medical director at the Wyoming Valley Health Care System in Wilkes-Barre, Pa. He also serves as a consultant for various hospitalist programs, most actively for his own private consulting company, AMP Hospitalist Consulting, which partners with Salem, N.H.-based physician staffing company Medicus Healthcare Solutions.

Undergraduate Education: Queens College, City University of New York, Flushing, N.Y.

Medical School: Ohio State University College of Medicine and Public Health, Columbus

Notable: Dr. Pyke was born in Jamaica and moved to New York during high school. He says he owes everything to his parents. His parents, who had no education beyond high school, pushed Dr. Pyke and his siblings to achieve more than they did. His sister is an OB-GYN and his brother is pursuing a medical degree.

FYI: Dr. Pyke enjoys playing golf, cheering for his beloved Ohio State Buckeyes, and spends every Friday night with his wife and two daughters—he even admits to watching “chick flicks” on family night.

For more information about the FHM designation, visit www.hospitalmedicine.org/fellows.

Requirements and Process

Shortly after the program’s approval, ABIM, which administers the FPHM program, went to work in defining the process for the FPHM application and building infrastructure to support the tests. Holmboe expects ABIM will be ready to process pre-applications by April or May. While some details may change, the FPHM application will dovetail with ABIM’s MOC process.

Although hospitalists’ MOC must be current in order to apply for FPHM, hospitalists can begin the FPHM application process at any time. Hospitalists do not need to wait until their next MOC renewal.

Before beginning the application process, hospitalists should ensure that they are eligible. ABIM requires FPHM candidates to have:

  • A current or previous ABIM certification in internal medicine;
  • A valid, unrestricted medical license and confirmation of good standing in the local practice community;
  • ACLS certification; and
  • At least three years of hospital medicine practice experience.

Candidates who meet the requirements can then begin the enrollment process by:

  1. Submitting attestations. Both the hospitalist and a senior officer at the hospital must provide attestations that demonstrate the hospitalist’s experience in HM and his or her commitment to the principles of the specialty.
  2. Performing a self-assessment. Hospitalists must quantify their experience in HM through an MOC self-assessment. Candidates must achieve at least 100 MOC points. Successful applicants must submit a new self-assessment every three years. The self-assessment can be conducted before or after the exam.
  3. Taking the MOC examination in Hospital Medicine. Registration for the first HM examination will begin in May. The exam will be conducted in October, and diplomates can take the exam at any time in the process.

Passing the exam and completing the other requirements will earn ABIM diplomats recognition as “Board Certified in Internal Medicine with a Focused Practice in Hospital Medicine.” ABIM will notify successful applicants in late 2010 and ship personalized certificates in early 2011. TH

Brendon Shank is a freelance writer based in Philadelphia.

Hospitalist, Defined

“What’s a hospitalist?” Despite the growth of the specialty and the more than 30,000 hospitalists around the world, it’s a question that hospitalists hear every day. While individual answers might vary, SHM is helping hospitalists with their job description by updating the definition of both “hospital medicine” and “hospitalist.”

“The healthcare sector and hospital medicine are advancing together at an unprecedented rate,” says SHM President Scott Flanders, MD, FHM. “SHM saw these changes as an opportunity to better define the specialty and the individuals that practice it.”

The new HM definition exemplifies SHM’s efforts to include multiple roles and activities within the specialty, including nonphysician providers “who engage in clinical care, teaching, research, or leadership in the field of general hospital medicine.” It also incorporates other concepts that have become core to hospital medicine, such as collaboration and QI.

The new hospitalist definition starts simply: “a physician who specializes in the practice of hospital medicine.” It goes on to detail the training and certification that many hospitalists undergo and references the newly created Fellow in Hospital Medicine program and the new Recognition of Focused Practice in HM program created by ABIM.

“These concepts are the very center of what it means to be a hospitalist and practice hospital medicine,” Dr. Flanders says. “They are the driving force behind the ways that hospital medicine is transforming healthcare and revolutionizing how we take care of patients.”


Definitions

Hospital Medicine: A medical specialty dedicated to the delivery of comprehensive medical care to hospitalized patients. Practitioners of hospital medicine include physicians (“hospitalists”) and nonphysician providers who engage in clinical care, teaching, research, or leadership in the field of general hospital medicine. In addition to their core expertise managing the clinical problems of acutely ill, hospitalized patients, hospital medicine practitioners work to enhance the performance of hospitals and healthcare systems by:

  • Providing prompt and complete attention to all patient care needs including diagnosis, treatment, and the performance of medical procedures (within their scope of practice).
  • Employing quality and process improvement techniques.
  • Collaborating, communicating, and coordinating with all physicians and healthcare personnel caring for hospitalized patients.
  • Safe transitioning of patient care within the hospital, and from the hospital to the community, which may include oversight of care in post-acute-care facilities.
  • Efficient use of hospital and healthcare resources.

Hospitalist: A physician who specializes in the practice of hospital medicine. Following medical school, hospitalists typically undergo residency training in general internal medicine, general pediatrics, or family practice, but may also receive training in other medical disciplines. Some hospitalists undergo additional post-residency training specifically focused on hospital medicine, or acquire other indicators of expertise in the field, such as the Society of Hospital Medicine’s Fellowship in Hospital Medicine (FHM) or the American Board of Internal Medicine’s Recognition of Focused Practice (RFP) in Hospital Medicine.

SHM Leadership Academy Positions Hospitalists for the Next Level

To find the future leaders of HM, you don’t have to look any further than SHM’s Leadership Academy. The hands-on training for hospitalists, program administrators, and others in the specialty continues to receive rave reviews from participants.

“The feedback we receive from academy attendees is always overwhelmingly positive,” says Tina Budnitz, SHM’s senior advisor for quality improvement. “After they take Level I, they’re eager for Level II. After they take Level II, they’re eager for even more.”

Budnitz estimates the Leadership Academy now boasts more than 1,200 graduates.

The most recent Level I session in Scottsdale, Ariz., included a facilitator at each table to spark discussion about leadership styles and related issues among the attendees, all of whom are responsible for management roles in an HM practice. The room received real-world training in understanding their natural leadership styles, conflict resolution and negotiation, financial management, and understanding the needs of a hospital CEO.

The academy also teaches “financial storytelling”—the art of interpreting all the numbers involved in running a HM practice and weaving them together into a narrative for hospital leaders. “I spoke with one hospitalist who planned on taking the skills from Leadership Academy to start her own program,” says Budnitz. “It’s exciting to see this course get ideas started.”

The next Leadership Academy is Sept. 13-16 in San Juan, Puerto Rico. Register at www.hospitalmedicine.org/leadership.

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