President's Message: Internal Medicine and Subspecialty Knowledge... A Powerful Combination

by Christine K. Cassel, MD
ABIM President and CEO

The practice of internal medicine faces many new challenges in an increasingly complex world in which advancing biomedical science must be linked with coordinated care delivery. While being an “internist” may mean different things to different physicians, we share a common bond of general internal medicine as the foundation for applying our unique skills and knowledge. It is this common bond from which all of us benefit, regardless of where and how we may choose to specialize.

More than any other area of medicine, internal medicine is characterized by unique and varied disciplines that represent the broad scope of knowledge related to maintaining health, diagnosing and treating disease in adults.

ABIM’s certification statistics highlight the increasing prevalence of subspecialties on the internal medicine landscape. In 2007, ABIM issued over 13,000 initial certificates, of which more than 7,300 were in subspecialties. ABIM data also reveals that for 1997 through 2005 third-year residency cohorts the number entering fellowships after completion of residency training increased from 43 to 59 percent.

Throughout its history, ABIM has recognized the evolution of internal medicine by introducing and administering subspecialty examinations. Just five years after ABIM was established in 1936, the Board introduced the Cardiovascular Disease, Gastroenterology, and Pulmonary Disease Certification Examinations. The next wave of subspecialty certification took place in 1972 and 1973, with the introduction of the examinations in Endocrinology, Diabetes & Metabolism; Hematology; Infectious Disease; Nephrology; Rheumatology; and Medical Oncology. Recent years have been characterized by the growth of increasingly specialized disciplines, such as Geriatric Medicine, Clinical Cardiac Electrophysiology, Interventional Cardiology, Sports Medicine, and Adolescent Medicine.

In 2006, ABIM’s Committee on New and Emerging Disciplines in Internal Medicine (NEDIM-2) established the framework and criteria to guide the creation of new certification areas within internal medicine. Since then, ABIM has formally recognized all of these disciplines as “subspecialties of internal medicine,” emphasizing the common core of essential training that is required to certify in a subspecialty. The latest ABMS-approved subspecialties in Transplant Hepatology, Sleep Medicine, and Hospice and Palliative Medicine were all guided by NEDIM-2. It is important to note that increased specialization sometimes requires considerable collaboration with our colleagues at other certifying boards. For example, the new ABIM-administered Hospice and Palliative Medicine Certification Examination, to be offered for the first time this fall, has involved the collective input of 10 certifying boards.

Another contributing factor to our focus on subspecialties comes from ABIM’s subspecialty boards and test writing committees for each examination, composed of scores of internal medicine subspecialist experts both in academic medicine and in practice. Members of these boards and committees apply their individual and collective internal medicine and subspecialty knowledge toward the development of each of the subspecialty exams.

The growth of subspecialty medicine has also influenced our Maintenance of Certification program. Significantly, more than 88 percent of subspecialists participate in Maintenance of Certification and 65 percent of subspecialists are choosing to retain their underlying internal medicine certification even though it is not required by ABIM. This might reflect the breadth of patient care provided by these subspecialists. For those recertifying in multiple areas, points earned in the self-assessment component of the Maintenance of Certification program can be applied to renewal of more than one certificate.

Whether you are certified in general internal medicine, in a subspecialty, or both, your work as an internist continues to touch more and more patients; the collective impact of internal medicine is significant. ABIM’s commitment is to provide you with certification options that are relevant to your practice and support our profession’s ability to deliver higher quality care to the patients we serve.