ORLANDO – The American Board of Internal Medicine is taking a potentially controversial step into the future by adding nonphysicians to both its main board and its subspecialty boards, a move that would give them a say in what defines being a good doctor.
The ABIM began the change in its governance process about 3 years ago, and took the first steps last July when it broke up its 29-member board of directors into two smaller panels: the board of directors and the ABIM council. The board will focus on governance issues, and the council will hone in on the assessment process itself. A few weeks ago, the board approved the addition of two new "public" members, including a health care executive and an official with a consumer organization.
*The subspecialty boards will remain the same, but add non-physician members. The boards will create exam committees, but those will be made up entirely of physicians.
Why the new structure?
Alicia Ault/Frontline Medical News
ABIM President Richard Baron discusses board changes.
One of the ABIM’s core roles is "to offer a professionally sanctioned definition of what a good doctor is," said Dr. Richard J. Baron, president and chief executive officer of the ABIM, in an interview. Physicians have always defined what that means, he said. But the world has changed, and "the definition doesn’t just belong to doctors," said Dr. Baron, who is also a past chair of the ABIM board.
Physicians now have to answer to payers that want to reward performance and measure quality. They also have to answer to patients. "I think there’s an increasingly clear recognition that medicine is a service profession," said Dr. Baron.
"It’s hard for us to say whether we are meeting the needs of our patients if we don’t find ways to ask them if we are. That’s a pretty important evolutionary transformation in assessing how well we do what we do," he said. "Having patients around the table as we think about the standards that we generate will help us have some assurance that we’re actually doing that."
By the same token, as physicians start working more with health care teams, having a team member help define what makes a good doctor also makes sense, said Dr. Baron.
The ABIM will soon announce the names of the nonphysicians who were confirmed in April by the ABIM Board. One is a health care executive who has experience heading a Medicaid managed care company and has also been a senior official with the Department of Health & Human Services. The second is the leader of a widely respected consumer organization, said Dr. Baron.
The main board now has 12 directors, with a maximum of 15. Up to 20% of the board’s membership can be made up of noninternists.
The council has up to 18 members, and will:
• Determine the requirements for certification and maintenance of certification across all the internal medicine disciplines.
• Harmonize ABIM standards with those of other recognized physician education and assessment initiatives.
• Set and integrate operational policies and procedures across the specialty boards.
• Evaluate proposals for new specialties/focused practice areas.
Some subspecialty board members migrated to the council. And the council has some at-large members who have expertise in performance improvement, quality measures, or health information technology. The council also will add members who can offer the patient and caregiver perspective and the health care team perspective.
Overhaul of subspecialty boards
The ABIM also decided it was time to reorganize the subspecialty boards, in part so they could more effectively design quality improvement and performance assessment modules for the MOC (maintenance of certification) process.
The role of the subspecialty boards is to define, refine, and set standards in certification and MOC in the discipline; perform oversight/review of performance assessments in the discipline; and build partnerships with societies and other organizational stakeholders in support of ABIM work.
In the past, the subspecialty boards were mainly charged with developing the exam for each specialty. But as the certification and MOC processes have evolved, the subspecialty board members have not been equipped to flesh out the exam, said Dr. Baron.
Each new exam committee will have from six to eight members, with physicians from the particular specialty. But the committees also will have at least one community physician in nonacademic practice and two public, nonphysician members. This will include, for example, a nurse practitioner who’s part of a patient-centered medical home, or a diabetes educator. And it also will include someone who can give the patient or caregiver perspective, said Dr. Baron.