Informatics specialist David Knoepfler, MD, sat in the back row of a daylong HM12 pre-course that aimed to prepare hospitalists for the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) examination. The question-and-answer session was intended to help the longtime clinician pass his second certification renewal.
But it was utterly unnecessary.
Dr. Knoepfler is the chief medical information officer at Overlake Hospital Medical Center (http://www.overlakehospital.org/about-us/) in the Seattle suburb of Bellevue, Wash. As much as 90% of his time is spent on information technology (IT) duties, and since he is grandfathered, he does not need to get recertified. So why did he spend seven hours scribbling notes as though he was preparing for his first boards?
Pride in his career development, plain and simple.
“Despite my heavily administrative role, I want to stay in touch with the clinical side,” says Dr. Knoepfler, a practicing hospitalist for 20 years who hadn’t attended an SHM annual meeting in more than 10 years before participating in HM12 last month at the San Diego Convention Center. “I feel like I have to for my patients’ sake. Even if I’m doing 10 percent or 15 percent [of my time in clinical], I absolutely have to be practicing quality medicine.”
SHM’s annual meeting is a hotbed of lifelong learning. A majority of attendees each year say that the continuing medical education (CME) credits are a major draw. This year’s pre-course lineup included the MOC test preparation, hands-on classes in medical procedures and ultrasound usage, and a debut class on “How to Improve Performance in CMS’s Value-Based Purchasing Program,” which was led by SHM senior vice president Joseph Miller and
Patrick Torcson, MD, MMM, FAACP, SFHM, chair of SHM’s Performance Measurement and Reporting Committee.
Career development, of course, means different things to different people. Dr. Knoepfler might have been focused on updating his clinical knowledge, but he is a technology expert whose main duties are to integrate health IT into the daily routine of his 349-bed hospital. So whether listening in a pre-course, attending a workshop, or meeting old or new colleagues for a drink, he spent the four-day conference constantly looking for ways to improve his job performance.
“My ears are constantly listening for how can I tie this into our electronic health record,” Dr. Knoepfler adds. “Whether it’s a clinical topic, an administrative topic, an insurance topic, a governmental topic, for me, I’m going to take all those back and see how I can make our electronic record work with the practitioners rather than fight them.”
A Learning Process
Former SHM president Jeff Weise, MD, professor of medicine and residency program director at Tulane University Health Sciences Center in New Orleans, feels so strongly about the value of professional development and the ABIM’s MOC process for hospital medicine that he and several society staffers held an impromptu session between plenary addresses to tackle perceived confusion with the Focused Practice in Hospital Medicine (FPHM) MOC pathway.
Dr. Weise says that the FPHM pathway does not mean doctors give up board certification in internal medicine, nor does it apply only to academic or community physicians.
Dr. Torcson, who works at St. Tammany Parish Hospital in Covington, La., says that the certification should be viewed as a “meaningful affirmation” of HM’s solidified place in the healthcare system.
“It’s really the right thing to do for our developing specialty,” he says. “We really have to distinguish ourselves, and there’s really no better brand distinction than a professional designation based on board certification and maintenance of certification.”
Ethan Cumbler, MD, FACP, of the University of Colorado Denver, led a portion of the MOC pre-course at HM12. He says that those who attend SHM’s annual meeting are able to take advantage of communal learning, which provides benefits that those who study alone can’t absorb. Taking a pre-test just teaches whether participants answered correctly or not. Questioning why the answer is what it is, with interactive feedback, is “a learning process,” he says.
“There’s a very different feel to learning in a group setting with your peers than to sitting down with a journal or a magazine or a textbook or an online module,” Dr. Cumbler says. “Part of what makes this conference engaging is not just content, it’s the milieu. It’s a social milieu of our peers, and we’re learning together and we’re exploring these difficult issues together.
“My sense is that the people who come to this are probably a cut above,” adds Dr. Cumbler, whose University of Colorado In-Hospital Stroke QI Team was the 2012 recipient of SHM’s Award for Excellence in Teamwork in Quality Improvement. “They are people who are really committed to being more evidence-based and understanding what the evidence is and how they apply that to their patients.”
They are physicians like James Eppinette, MD, who became a hospitalist three years ago after 20 years in private practice as a primary-care physician (PCP). He joined a hospital-owned group at St. Francis Medical Center in Monroe, La., and HM12 was his first annual meeting—he attended because the meeting’s clinical focus provided him with professional development opportunities. He began with the pre-operative-care pre-course, an area in which he felt he wanted more exposure. From there, he bounced around clinical workshops.
“[HM12] has an incredible variety of tracks that you can pursue, so there’s something here for everybody,” Dr. Eppinette says, later adding that “my primary responsibility is clinical. That’s all I do is take care of people. I don’t manage people, I don’t run a practice, nor do I want to. That’s why I left 20 years of private practice to be a hospitalist. I just think it’s well set up structurally for an educational event.”
Dr. Eppinette, who took his notes back to the 12 hospitalists and nine pulmonologists in his hospitalist group, says that the decision to attend HM12 came from his increasing satisfaction with his late-career job change.
“I didn’t know how I would like going from an independent practitioner to being employed, hospital-owned. But I’ve done it three years,” he says, and “[I think this is] how I will finish my career. After three years, I’m kind of liking this road I’m on, so I’ve started looking into more about it.”
That level of personal accountability is a next step for hospitalists nationwide, according to new SHM president Shaun Frost, MD, SFHM, FACP, chief medical officer for the Northeast region of Brentwood, Tenn.-based Cogent HMG. Dr. Frost says that personal and professional accountability will be the drivers for HM’s continued growth and success, and that without individual physicians pushing their career development goals to new heights, the fastest-growing medical specialty in history could stall.
“We must all strive to consistently hold each other and hold ourselves personally accountable for embracing the work that is necessary to realize the potential of hospital medicine to be a true healthcare reform effector,” Dr. Frost says. “It’s time, I think, for each of us to put our money where our mouths have been.”