Focused Practice in Hospital Medicine

The Focused Practice in Hospital Medicine (FPHM) Maintenance of Certification (MOC) program assesses, recognizes and sets standards for the specific knowledge, skills and attitudes of general internists who focus their practice in the care of patients in an inpatient setting.

While the FPHM MOC program is not a subspecialty, it is a variation of Internal Medicine certification. Physicians cannot participate in both the FPHM and Internal Medicine MOC programs simultaneously.

Completion of the program identifies physicians as ABIM Board Certified in Internal Medicine with a Focused Practice in Hospital Medicine. The certificate will remain valid as long as you continue to meet the requirements of the Maintenance of Certification (MOC) Program.

Please note: ABIM is retiring the Focused Practice in Hospital Medicine program at the end of 2023. Fall 2023 will be the last administration of Hospital Medicine MOC Exam.

Two new inpatient-focused Internal Medicine MOC assessments will be available in 2024. Enrollment for these assessments will open on 12/1/23. Read more about this transition and the new assessment options.

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Eligibility

To be eligible for entry into ABIM's Focused Practice in Hospital Medicine MOC program, you must:

Have completed your residency training at least three years ago and have been certified in Internal Medicine, and
Hold a valid, unrestricted medical license and confirmation of good standing in the local practice community.

The FPHM MOC program is not intended for subspecialists practicing in an inpatient setting. If you are a subspecialist who also practices as a general internal medicine hospitalist, you may apply to enter the FPHM program but you must be able to meet the patient encounter thresholds outlined below. Subspecialty encounters cannot count toward the patient encounter requirement.

If you are eligible to apply to enter the program, a feature will appear on your ABIM home page to guide you through the entry process. Sign in to your Physician Portal to see if you are eligible.

Program Entry

Entry into the FPHM MOC program requires two attestations stating that you meet the practice requirements to be a hospitalist:

The self-attestation confirms that you:

Have at least three years of unsupervised inpatient care practice experience at the time of entry (formal fellowship training in a hospital medicine fellowship program can be counted toward the three-year practice experience criteria), and
Meet patient encounter thresholds in an inpatient setting (see chart below).

Once you submit your self-attestation, the system will automatically trigger a secondary attestation for the Senior Hospital Officer (SHO) to complete. Attestation by a SHO confirms the information you submit in your self-attestation is accurate. You will need to provide contact information for the SHO during the self-attestation process. Acceptable SHO titles include:

Division Director
Section Chief
Chief Medical Officer
Chair of Medicine
Service Line Chief
Medical Director
Chief Executive Officer
President
Chair of the Board of Directors

Patient Encounter Thresholds

There are two pathways - Direct Patient Care or Clinical/Systems:

Direct Patient Care (i.e., full-time hospital practice)	Clinical/Systems (i.e., full-time hospital medicine professional activity with part-time hospital practice)
Requires a minimum of 1,000 inpatient encounters (limited to one encounter per patient day) per year for three years, or 3,000 over three years.	Requires a minimum of 250 inpatient encounters (limited to one encounter per patient day) per year for three years, or 750 over three years; these encounters must comprise at least 75% of total clinical activity, and at least 50% of the remaining non-clinical professional time must be directed toward improving inpatient care.

The inpatient encounter volume thresholds must be fulfilled in the three years immediately prior to application for entry into the program.
Inpatient encounters include patients seen in hospitals, skilled nursing facilities, rehabilitation facilities or other facilities to which a patient is admitted for care.
ABIM reserves the right to conduct a random audit of all applications to ensure the program's patient encounter requirements are being adequately fulfilled.
If you do not currently meet these inpatient encounter thresholds, you must accumulate them before you can enter the FPHM program.
Subspecialists are not permitted to count subspecialty patient encounters toward the patient encounter volume requirements.

Earning Your Certificate

Once you have been admitted into the Focused Practice in Hospital Medicine MOC program, you can begin working on the requirements to earn your MOC certificate in Internal Medicine with a Focused Practice in Hospital Medicine.

To earn the certificate, you must:

Continue to hold a valid, unrestricted medical license.
Earn 100 MOC points in the past five years or be participating in the MOC reciprocity program.
Pass the traditional, 10-year MOC exam in Hospital Medicine after having been approved to enter the program.
Self-attest to meeting patient encounters within the past three years (senior attestation also required).

You do not need to complete requirements in any particular order. However, if you do not complete the requirements within three years of entering the program, you will be prompted to resubmit the initial attestation to update your practice information. Your Physician Portal will show your outstanding requirements for earning the certificate.

The FPHM certificate issued is contingent upon participating in MOC. Once earned, the certificate will remain valid as long as you continue to meet the MOC program requirements.

Exam Information

You are eligible to take a Hospital Medicine MOC assessment upon being approved to enter the program.

The traditional, 10-year MOC exam in Hospital Medicine satisfies the assessment requirement for the FPHM MOC program.
If you withdraw from the FPHM program after successfully passing the Hospital Medicine MOC Exam, your FPHM certification status and assessment due date may be assigned to your Internal Medicine certification upon request. This means you will not need to pass an internal medicine assessment any earlier than is currently required for your FPHM designation.
While you are in the FPHM MOC program, you can also take the Internal Medicine MOC Exam
If you take the Internal Medicine MOC exam while in the FPHM MOC program, these assessments and any valid MOC points may be applied to the Internal Medicine certification upon withdrawal from the FPHM program at your request.

MOC Points

In order to achieve the designation of board certified in Internal Medicine with a Focused Practice in Hospital Medicine, in addition to passing the Hospital Medicine MOC exam and maintaining an unrestricted medical license, participants must earn 100 MOC points in the past five years or be participating in the MOC reciprocity program.

If you have previously participated in MOC, your MOC points will automatically be applied toward the requirements for the FPHM MOC program.

Your Physician Portal will track points earned toward the new FPHM MOC program requirements.

View your options for earning MOC points .

Maintaining Your Certification

Once you have earned your certificate in Internal Medicine with a Focused Practice in Hospital Medicine, to maintain it you need to:

Earn some MOC points every two years to be reported as "Participating in MOC"
Earn a total of 100 MOC points every five years or be participating in the MOC reciprocity program
Meet your assessment requirement by passing the traditional, 10-year MOC exam in Hospital Medicine
Attest every five years that you continue to meet inpatient encounter thresholds (senior attestation also required):
Full-time hospital practice inpatient encounters must be at least 2,000 in the past two years
Part-time hospital practice inpatient encounters must be at least 500 in the past two years

Transition from FPHM to Internal Medicine Certificate

You can send a request to have ABIM re-instate your Internal Medicine certificate with the assessment due date currently assigned to your Hospital Medicine exam. You will be withdrawn from the FPHM program. The display under My Assessments and Certifications will be updated. You will not need to pass an Internal Medicine MOC exam any earlier than the date currently required to maintain your FPHM designation.

Points earned toward maintaining your Hospital Medicine certificate may be applied to other certificates you choose to maintain.

Program Withdrawal

You can send a request to have ABIM withdraw you from the Focused Practice in Hospital Medicine (FPHM) MOC program and re-instate your Internal Medicine certification with the assessment due date currently assigned to Hospital Medicine. You will be withdrawn from the FPHM program and the display under My Assessments and Certifications will be updated. You will not need to pass an Internal Medicine MOC assessment any earlier than the date currently required to maintain your FPHM designation. Learn how to reinstate a lapsed Internal Medicine certification.

FPHM Retirement FAQs

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Why is ABIM retiring the FPHM program?

Even as more physicians practice in a hospital setting*, few have chosen to participate in the Focused Practice in Hospital Medicine (FPHM) program to maintain their Internal Medicine Certification since it became available in 2010. Physicians asked us to explore the creation of assessment options that more closely align with what they see in practice.

This decision was made after an analysis of those participating in the underutilized FPHM program, a survey of hospitalist diplomates who hold and do not hold the FPHM designation about their needs, and in close consultation with society partners and the Society of Hospital Medicine, which collaborated on the survey. The new inpatient-focused assessment options launching in 2024 will provide additional flexibility for hospitalists and subspecialists working in an inpatient setting.

*Gray BM, Vandergrift JL, Stevens JP, Landon BE. Evolving practice choices by newly certified and more senior General Internists: A cross-sectional and panel comparison. Annals of Internal Medicine. 2022; 175(7):1022-1027

What will happen to my FPHM designation?

Beginning 12/1/2023, you will be publicly reported as certified in Internal Medicine if you are up to date on your Maintenance of Certification (MOC) program requirements and not in a grace period.

Following the 12/1/2023 transition, when will I need to meet my Internal Medicine assessment requirement?

Your Internal Medicine certificate will be reinstated with the assessment due date currently assigned to your certificate with the FPHM designation. You will not need to meet your Internal Medicine MOC assessment requirement any earlier than the date currently required to maintain your FPHM designation. The information under “My Assessments and Certifications” in your Physician Portal will be updated accordingly beginning 12/1/2023.

I’m currently in the FPHM program and my assessment is due in 2024. What are my MOC assessment options?

You have four options:

The Internal Medicine Longitudinal Knowledge Assessment (LKA^®): Inpatient
The Internal Medicine traditional, 10-year MOC Exam: Inpatient
The Internal Medicine LKA
The Internal Medicine traditional, 10-year MOC Exam

You may choose any of these options to meet your Internal Medicine assessment requirement. Registration for 2024 assessments opens on 12/1/2023.

If I am currently participating in FPHM, how do I enroll in a new Inpatient assessment?

If you are currently maintaining your FPHM certification, your certificate will automatically be transitioned to Internal Medicine beginning 12/1/2023. After that, if you are due for an assessment, you will have the option of enrolling in one of the inpatient-focused assessments, or one of the general internal medicine assessment options.

You can enroll through your Physician Portal.

My FPHM assessment is due in 2023. Can I take the traditional, 10-year MOC exam in Hospital Medicine in the fall of 2023?

Yes. If you’re successful, please know your certificate will be transitioned to Internal Medicine beginning 12/1/2023. Your next assessment will then be due in 2033.

If you're unsuccessful you will have an additional year (called the grace period) to pass the traditional, 10-year MOC exam in Internal Medicine*. You can choose to take either the general or the inpatient-focused traditional 10-year Internal Medicine MOC exam. You will continue to be reported as Certified in Internal Medicine through 2024 as long as you are meeting all other MOC requirements.

*If your Internal Medicine assessment due date is after 2023, you will be given the benefit of the later assessment due date when your FPHM certificate is transitioned.

How is the new Internal Medicine: Inpatient MOC assessment different from the Internal Medicine general MOC assessment?

The Internal Medicine general assessments feature questions from across the range of Internal Medicine practice venues, including both inpatient and outpatient settings. The Internal Medicine Inpatient assessments also feature questions from the breadth of Internal Medicine, but are geared towards hospitalists, with a focus on the inpatient setting.

Is there any additional cost involved in this change?

No, the new inpatient LKA is included in your annual MOC fees. Any payments you have made toward current and future FPHM program years will automatically be applied to your Internal Medicine certification.

Who is eligible to participate in the new inpatient MOC assessment options?

The inpatient-focused MOC assessments are available to anyone who has ever been certified in Internal Medicine as long as they are not in the grace period. This includes diplomates transitioning from the FPHM program beginning 12/1/2023. Diplomates are eligible to enroll in the LKA beginning in their assessment due year and it can be used as a pathway to reinstate a lapsed Internal Medicine certificate.

If I am enrolled in the general Internal Medicine LKA and want to try the new inpatient option, can I switch back to general Internal Medicine if I decide the inpatient version is not working for me?

If you choose to switch from the general Internal Medicine LKA to the Internal Medicine LKA: Inpatient, your 5-year cycle resets. You can choose a different LKA assessment focus after completion of the 5-year Internal Medicine LKA: Inpatient cycle. You will be reported as certified as long as you are meeting all program requirements. If you are unsuccessful, you will go into the grace period and will need to take a 10-year MOC exam.

Alternatively, you can choose to take the general traditional, 10-year Internal Medicine MOC Exam.

If I take a traditional, 10-year MOC exam and pass, can I enroll in an LKA?

Not immediately. If you take and pass the traditional, 10-year MOC Exam your next assessment will be due 10 years from when you pass. You will not be able to participate in an LKA until that time.

What if I passed the spring 2023 FPHM MOC exam?

Your next assessment will be due in 2033 and will be applied to your Internal Medicine certification on 12/1/2023.

If you have not previously earned the FPHM designation, you will receive a new certificate in Internal Medicine with a Focused Practice in Hospital Medicine in the fall of 2023. However, your FPHM certification will be transitioned to an Internal Medicine certificate beginning 12/1/2023 and you may be eligible to receive a new printed certificate in Internal Medicine in spring 2024.

Will I receive a new printed certificate in Internal Medicine?

You may, depending on when you earned your most recent Internal Medicine certificate:

Prior to 1990, you will not receive a new printed certificate. Your original, lifetime certificate in Internal Medicine will be reactivated.
Between 1990 and 2013, you will receive a new must-be-maintained certificate in Internal Medicine to replace your expired certificate.
Since 2013 (initial certification) or 2014 (recertification), you will not receive a new printed certificate. Your original must-be-maintained certificate will be reactivated and will remain valid as long as you continue to meet the requirements of the MOC program. If you would like to request a copy of your certificate, please contact ABIM at request@abim.org.

Do I need to complete my FPHM attestation for 2023?

If your attestation is due by 12/31/2023 or later, you do not need to submit an attestation. You will no longer have an attestation requirement when you certificate is transitioned to internal medicine beginning in December 2023.

If you have an overdue FPHM attestation that was due 12/31/2022 or earlier, that requirement will be waived when your status is evaluated for the transition to Internal Medicine in December 2023.