Directors of the American Board of Internal Medicine have decided to assess the competencies described in its draft comprehensive internist proposal before formalizing any maintenance of certification pathway.
The ABIM board of directors met in February to discuss comments on its proposed Recognition of Focused Practice in comprehensive internal medicine. If ABIM had proceeded, office-based internists who completed a maintenance of certification module could have said their practice was focused in “comprehensive care.”
During a public comment period, ABIM received more than 280 formal responses—from physicians, insurers, patients, and groups including the American College of Physicians, according to Dr. Richard Baron, chair-elect of the ABIM board of directors.
“The board has never sought this kind of feedback before,” he said. It is important for the public to know that “the actions we did take and didn't take were very much informed by what we heard from a variety of stakeholders,” said Dr. Baron, a practicing internist in Philadelphia.
The feedback prompted the board to rethink its proposal. At its meeting, it elected “to commit to develop the tools to assess the competencies” articulated in the proposal, Dr. Baron said.
The board also voted to test those tools in the real world with partners such as the ACP and others who have been developing the patient-centered medical home, he said.
There's no set time line for developing the assessment tools and piloting them, but work has begun, he said. The ABIM's statement about the proposal is available at www.ccimreport.org
The ACP believes the ABIM's process worked. The ABIM board “seemed to listen,” said Dr. Joel Levine, chairman of the American College of Physicians board of regents, in an interview.
Comments on the proposal varied widely, Dr. Baron said. He added, “Responses were quite blunt and candid in many ways, and quite thoughtful and constructive in many ways.” Those in favor of the proposal said they thought the comprehensive designation would, correctly, recognize core competencies, that it would provide a new model for primary care, that it could improve patient care, and that it could encourage educators to teach these skills to future internists.
Critics said that most internists already were demonstrating the competencies, and that acknowledging only some would lead to more fragmentation of the specialty. Others criticized ABIM for seemingly acting alone or for creating more hurdles for internists. Many suggested that adding new expectations without adding compensation would be unwise and might even discourage trainees from going into internal medicine.
ABIM still would like to find a way to recognize those competencies, Dr. Baron said. But no matter the pathway, it would always be voluntary.
“We are looking for opportunities to assist a future of internal medicine that's sustainable and professionally gratifying,” he said. “There's a lot of pain out there right now in the practice world. It is no one on the board's desire to make that worse.”