The internal medicine community is concerned about the number of subspecialists in internal medicine who are choosing to recertify in their specific fields rather than in core internal medicine.
Data from the ABIM show that 87% of subspecialists are keeping their subspecialty certificate, but only 71% have renewed their certification in general or core internal medicine. Many of those in the latter group may be renewing in both core internal medicine and in their subspecialty, ABIM spokesman Leslie Goode said in an interview.
Interest in the general internal medicine certificate tends to vary by subspecialty, noted William E. Golden, M.D., an American College of Physicians regent, and professor of medicine and public health at the University of Arkansas, Little Rock, said in an interview. For example, “60% of nephrologists recertify in core medicine, but the vast majority of cardiologists don't, if they recertify in cardiology,” he said.
Subspecialists may be shying away from core internal medicine because they don't find it relevant or think they won't be able to pass the general recertification exam without intensive work. Technically, these subspecialists are internists and should be recertifying in the core discipline, said Dr. Golden, a member of the Liaison Committee on Recertification, which was formed several years ago to advise the board about new pathways for recertification.
“Most members of the committee believe that good physicians are better diagnosticians if they understand key issues beyond their area of interest,” he said. The committee and ABIM “are actively trying to look at how recertification in core internal medicine reflects information that all internists should know, or is relevant to a subspecialty internist.”
Most internists, no matter what their discipline, choose to recertify. Since 1990, the year that the ABIM began issuing 10-year certificates, nearly 80% of general internists with a time-limited certificate have recertified in core internal medicine.
The new “maintenance of certification” program that the ABIM plans to roll out in January 2006 may further test the staying power of general internal medicine, which has been hit hard by declining match rates. The ABIM reports that 20% of physicians who certified in internal medicine after 1990 no longer practice in the field, Ms. Goode said.
Early estimates are encouraging: Nearly two-thirds of ABIM diplomates with 10-year certificates have enrolled in the new program. In April, the board announced more flexible options for maintenance of certification, hoping to encourage internists without time-limited certificates to participate.
The steps required for maintenance of certification “are useful and important,” but the process runs the risk of exacerbating the hassle factor, said Robert Hopkins, M.D., associate director of the medicine/pediatrics residency program at the University of Arkansas, Little Rock.
“Several of my colleagues in private practice—general internists and subspecialists—are concerned that the number of steps required for maintenance of certification [will] pose a major barrier to carrying out day-to-day patient care,” Dr. Hopkins said. The ABIM faces challenges in getting the message out to private practices about the value of recertification, he said.
Still, Dr. Golden expressed confidence. “In the past, people have been anxious and uncertain about what it would mean,” he said, but they have become more comfortable as the process has become clearer.
Dr. Golden said that in his recent presentations at American College of Physicians regional meetings, he never gets a “single question or complaint” when he explains the maintenance of certification program. “It sounds complicated, but when you look at it, it's pretty straightforward.”
As part of its revision of the certification process, the ABIM plans to make it simpler to renew certificates in internal medicine and the subspecialties of internal medicine. Also, more options will be available to meet the ABIM's new standard for practice performance, which entails practice improvement modules.
This Month's Talk Back Question
Should subspecialists be required to recertify in core internal medicine, and not just in their own subspecialty?