A-Plus Achievement

The Hospitalist. 2009 November;2009(11):

November 1, 2009 | The Hospitalist

Dr. Wachter agrees the RFP in HM is an “attractive” option to hospitalists, especially those whose recertification is looming in the next two or three years. This MOC, he explains, “offers a pathway that is more in sync with the medicine [they are practicing] day in and day out.”

ABIM plans to have comprehensive information about the process available on its Web site (www.abim.org) this month and online registration available in May 2010 (see “FAQs,” left). While the test-writing committee finishes its tasks, Dr. Holmbloe says, ABIM’s systems department is working to build the online infrastructure. The first RFP in HM tests should go live in fall 2010.

“For those individuals [whose certificates] expire in 2010 or 2011, this is a viable pathway for recertification. If HM is their passion, this is for them,” Dr. Holmbloe says. “The major change, from ABIM’s perspective, is the ability to implement the concept of a focused practice. It’s the first time, a new paradigm. This does recognize that the world has changed.”

Crash Course

Every physician, sometime in his or her career, has crammed for a test. ABIM, however, recommends physicians start this process two or three years before their certificate expires. That timetable might work for some hospitalists, not so much for others. In any event, Dr. Flanders says hospitalists can count on SHM to help them prepare for the HM-specific examination.

“SHM has to help develop the tools and resources hospitalists will need to successfully prepare for and pass this test,” he says. He expects educational resources and self-assessment modules will be available on SHM’s Web site (www.hospitalmedicine.org) and at HM10, April 8-11 in Washington, D.C.

Dr. Wellikson says MOC preparedness “should match [SHM’s] educational projects,” and his staff “will continue to develop” tools and resources to assist hospitalists. He also recognizes the moment: the notch on HM’s evolutionary timeline where a once-fledgling group of inpatient physicians helped chart a new course for American medicine.

“Obviously, 10 years ago was too early. Now there are 30,000 hospitalists. Many of them are making HM a career. It’s evolving as a discipline,” Dr. Wellikson says. “We’ve moved beyond the idea of HM to the reality of HM.” TH

Jason Carris is editor of The Hospitalist.

Reference

Wachter RM, Goldman L. The emerging role of “hospitalists” in the American health care system. N Engl J Med. 1996;335(7):514-517.

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FAQs

The following are excerpts from www.abim.org. For the complete transcript, visit www.abim.org/news/news/hospital-medicine-qa.aspx.

Question: Why is ABIM recognizing focused practice in HM?

Answer: HM has reached a state of maturity within the discipline of IM, as demonstrated by the large and growing numbers of physicians who have concentrated their practice in the hospital setting. The board’s decision to recognize HM acknowledges the value that hospital-based internists can bring to improving patient care in this practice setting. The characteristics of focused hospital practice are described in the field’s published core curriculum (J Hosp Med. 2006;1(Suppl 1):2-95).

Q: Will diplomates be eligible for recognition of focused practice in HM at the completion of IM training?

A: No. Developing a practice focus requires a period of experience in unsupervised practice and demonstration of proficiency beyond that expected in residency before it can be recognized by ABIM. The MOC program can recognize such practice differentiation through demonstration of proficiency acquired through practice and modification of the initial IM certification to reflect the practice focus. So a typical internist seeking ABIM recognition of focused practice in HM must complete training in IM, be certified in IM, and engage in a practice that focuses primarily on HM for several years.

Q: How will ABIM implement the MOC for focused practice in HM?

A: ABIM is one of 24 member boards of the American Board of Medical Specialties (ABMS), which sets the policies and processes governing certification of medical specialists in the United States. ABIM is working with ABMS to develop the process for recognizing focused practice through MOC. ABMS must determine how ABIM’s MOC program for recognizing focused practice in HM will affect the certification and MOC programs of the other member boards. The time frame for this ABMS process is uncertain. While the deliberations are ongoing, ABIM is further refining the focused practice concept, as well as defining the competencies and developing the assessment tools needed for its application to HM.

Q: I’m a hospitalist with an IM certificate expiring in 2009. Should I wait for the HM program before beginning MOC?

A: The board recommends that you not allow your IM certification to lapse. However, as you complete the requirements to maintain your IM certification, you can choose self-assessment options that are relevant to hospital practice, such as the Hospital-Based Internal Medicine medical knowledge modules and the Hospital-Based Patient Care PIM. In this way you will have completed MOC evaluations that will count toward requirements for the HM focused practice program should you later choose to pursue this recognition.

Q: I’m a hospital-based internist and executive director for a hospitalist program, with overall responsibility for quality assurance. I serve as a hospitalist for two to three months a year. Could I qualify for the HM focused practice program?

A: Yes. The HM program is designed for internists who have focused their practice in HM. ABIM will provide a pathway within the program for part-time hospitalists who devote the majority of their professional activity to HM, including both clinical and nonclinical work. However, if you were to withdraw entirely from your clinical work to focus on leadership and systems work full time, you would not be eligible for recognition of focused practice in HM because practice is a key requirement of the program.

Q: I’m a full-time, hospital-based subspecialist and also serve as a ward attending for one month a year. Could I qualify for the focused practice program for HM?

A: No. Because HM is a subset of the broad discipline of IM, the ABIM program is designed to recognize the proficiency of general internists who have focused their practice in the hospital setting.