It’s official. I am a “recognized” hospitalist. I’m certified. I’m special.
Although I’ve always felt that HM was special, that it’s a field with its own defined body of knowledge, area of expertise, and dedicated providers, it is now official. It is special; I am special. I got the letter in the mail the other day to prove it.
The correspondence arrived in an important-looking white envelope, with a return address stamped with the “American Board of Internal Medicine” insignia. The letter itself congratulated me on becoming a member of the first class of internists to complete their Maintenance of Certification (MOC) with Recognition of Focused Practice in Hospital Medicine (FPHM). As you’ve no doubt heard, the ABIM developed this MOC process to recognize hospitalists who’ve been in practice for at least three years after their initial certification in internal medicine (IM).
This is the first ABIM certification program that recognizes physician expertise in a field that is not tied directly to either residency or specialty fellowship training. In other words, unlike the cardiology certification exam, which requires a physician to have completed a fellowship training program, the FPHM allows for clinical experience to substitute for fellowship training. While the FPHM does not confer true “specialty status” (like the cardiology certification exam does), it does, as the moniker implies, recognize that we have focused our practice.
Implicit within that is the understanding that this focus brings with it a level of expertise that distinguishes hospitalists from nonhospitalists. This is a massive step forward for HM, as it lends significant credibility to the work we do and helps the public better understand what a hospitalist is and does. Most important, it helps set apart that cadre of true hospitalists who are dedicating their careers to fundamentally improving the care and outcomes of hospitalized patients.
It is this last point that came to mind as I reviewed this month’s cover story on value-based purchasing (see “Value-Based Purchasing Raises the Stakes,” p. 1).
Sticky Yet Crucial Point
One of the sticking points that I’ve heard from some hospitalists is that the FPHM requires a three-year cycle of self-evaluation. For those new to this process, let’s clear up some of the nomenclature. When IM residents graduate, they are eligible to sit for the ABIM certification exam. Upon passage, they are board-certified internists and can choose to enter into the maintenance of certification process. This is a 10-year process whereby diplomates (ABIM-speak for those certified as a specialist, with a diploma in medicine; not to be confused with a diplomat—a person who conducts negotiations and maintains political rest through the tactful handling of delicate situations, something perhaps more appropriate to the bulk of patient situations we encounter) must complete self-evaluation of medical knowledge modules, self-evaluation of practice performance, and ultimately a secure exam. This is where the FPHM differs.
The 10-year cycle for MOC is maintained for FPHM, such that diplomates only recertify every 10 years. However, the self-evaluation must occur every three years to maintain one’s certification. In other words, fail to keep up with the self-evaluation process, and your FPHM is revoked. This is different than the MOC for IM, and it is why some hospitalists are choosing not to enroll in the FPHM. This is a mistake.
For many hospitalists, this extra evaluation, especially the practice improvement, is seen as an undue burden. Why is it that hospitalists should have to do more frequent self-evaluation than other specialists? My answer is that this is an important part of what defines our hospitalist specialty—that is, our ability to go beyond the individual patient encounter to fundamentally improve outcomes for the patients under our care. This is not done through “good doctoring.” Hospitalists are not necessarily better doctors than nonhospitalists. Rather, we have embodied a commitment to process and quality improvement within the hospital. This is what our patients need from us. This is what makes us hospitalists. This is what makes us special.