Clarifying Family-Practice Hospitalists’ Value, Focused-Practice Opportunities
I am writing regarding the letter and your response in the January 2013 issue of The Hospitalist regarding hospitalists trained in family medicine and practice in critical-care units. I am the chair of the Family Medicine Committee for SHM, a practicing hospitalist, and an SHM member for over 10 years. There is an error in your reply, in that physicians who are board-certified through the American Board of Family Medicine (ABFM) are indeed eligible to take the examination for Recognition of Focused Practice in Hospital Medicine (RFPHM). This examination is administered by the American Board of Internal Medicine (ABIM), and is the same examination for all physicians, regardless of whether their residency was completed in family or internal medicine.
I am proud to be among the six family physicians who took and passed the first examination in October 2010. Through 2012, there have been 28 family physicians who have passed this exam, and attained RFPHM (verbal communication from ABFM). According to the ABIM website, there have been 267 total physicians who have taken the examination through 2011, which includes family-medicine-trained physicians. There are a number of Maintenance of Certification (MOC) modules offered through the ABIM that are available to hospitalists trained in family medicine.
A prior study showed that 66% of hospitalists trained in family medicine practice in critical-care units (McElrath et al). You are correct that there is no current pathway for HTFM to pursue a critical-care fellowship or attain board certification by the SCCM, as diplomats of the ABFM are excluded. However, there are many hospitalists trained in family medicine providing excellent care to patients in critical-care units. There are clearly not enough board certified intensivists to provide the care.
—Kevin Ahern, MD, SFHM, chief hospitalist, Sound Physicians, Urbana, Ohio
Dr. Hospitalist responds:
You are absolutely correct in your point of clarification regarding the Recognition of Focused Practice in Hospital Medicine from the ABFM. I was aware of this at the time of the article; however, in my efforts to outline the proposed path from RFPHM to ICU certification, I focused solely on the ABIM pathway without mentioning the additional recognition available to family-practice physicians. In no way was this meant to denigrate the efforts or contributions of family-practice physicians to HM and SHM, but I could have been much more clear on this point. Having hired and worked alongside family-practice hospitalists, I know just how valuable you are.
The overall picture is consistent with what you described in that there are “clearly not enough board-certified intensivists” to fully staff ICUs. However, it is evident that it will be an uphill battle to sanction an alternate pathway that lets any hospitalist gain certification as an ICU physician. Truth be told, there are fundamental differences in the amount of ICU exposure between internal-medicine and family-practice training programs. As a result, in the current proposal there is no overt discussion of the role for family-practice hospitalists in the ICU. I think that this will continue to remain a conscious omission for both political and practical reasons.