DALLAS — Board certification for hospitalists is coming—and most likely will initially take the form of a Recognition of Focused Practice granted by the American Board of Internal Medicine, according to speakers at the annual meeting of the Society of Hospital Medicine.
This Recognition of Focused Practice (RFP) in Hospital Medicine would be the first ABIM credentialing that doesn't require discrete formal training, relying instead on practice-based learning. The plan is for hospitalists to tap into the ABIM's existing maintenance of certification (MOC) mechanism, which every ABIM-certified physician already must go through periodically to demonstrate ongoing competence and a commitment to continuous lifelong learning, explained ABIM board of directors member and past SHM president Dr. Robert M. Wachter, professor and associate chairman of medicine at the University of California, San Francisco.
The ABIM, which had previously endorsed the concept of an RFP in Hospital Medicine, voted unanimously in early June to approve recommendations by a board subcommittee that Dr. Wachter chairs. The RFP plan goes next to the American Board of Medical Specialties, composed of 24 member boards, for final approval.
Although a handful of hospital medicine fellowships exist and some internal medicine residency programs offer a hospitalist track, such training isn't the norm and is unlikely to become so anytime soon. But the ABIM has established a template for recognition of new fields of internal medicine in the absence of discrete training. The criteria are contained in the ABIM's New and Emerging Disciplines in Internal Medicine II (NEDIM II) report. Hospital medicine is the first candidate for certification under its auspices. Others that may follow include HIV medicine and ambulatory internal medicine, according to Dr. Wachter.
In recent decades, boards have certified new specialties formed around novel procedures such as cardiac electrophysiology, or special populations such as geriatrics and palliative care medicine. Hospital medicine is an example of a site-specific medical specialty defined largely by the setting in which the work takes place. Emergency medicine and intensive care medicine fall within the same category.
Here's what hospitalist certification through the ABIM is likely to look like:
A candidate will have to be trained and board certified in internal medicine and must practice as a hospitalist for 3 years before applying to enter the MOC pathway seeking the RFP. The candidate must demonstrate a focus on hospital medicine by meeting a patient volume requirement and providing leadership of quality improvement projects.
Having met that threshold, the physician then enters into the self-evaluation programs and practice improvement modules that make up the MOC, which will be tailored for hospitalists. Unlike general internists, who have to go through the MOC process every 10 years, it's likely that hospitalists will be on a 3-year cycle, according to Dr. Wachter.
After completing the MOC, the candidate becomes eligible to take a secure exam. The test will cover core content in internal medicine—including ambulatory care—that every internist should know, but the emphasis will be on hospital medicine. “More sepsis, less osteoporosis,” Dr. Wachter said.
Upon passing, the physician will earn the RFP in Hospital Medicine sheepskin.
Down the line—perhaps in a decade—hospital medicine might very well evolve into a separate field within internal medicine, with its own residency tracks or fellowship training, but that's an issue for another day, he added.
Society of Hospital Medicine president Dr. Mary Jo Gorman said the SHM began investigating certification in 2004. Milestones along the way included the discipline's continued eye-catching growth—it is the fastest-growing field in the history of medicine, having rocketed from several hundred members a decade ago to 20,000 today—along with publication of a document defining the core competencies in hospital medicine and the launch of the society's official peer-reviewed Journal of Hospital Medicine, noted Dr. Gorman, CEO of Advanced ICU Care, St. Louis.
She said the SHM has met for “vigorous discussions” with other stakeholders in certification, including the American College of Physicians (ACP), the Society of Critical Care Medicine, the American College of Chest Physicians, and the American Thoracic Society. Despite concerns expressed within the ACP about the potential effects of the plan to develop the RFP in Hospital Medicine, ABIM and ACP leaders have expressed support for the process, in conjunction with development of a parallel RFP in Comprehensive Internal Medicine. The focused practice proposal still awaits approval by the American Board of Medical Specialties, Dr. Christine K. Cassel, president and CEO of the ABIM, and Dr. John Tooker, Executive Vice President and Chief Executive Officer of the ACP, said in a joint statement.