Philadelphia, PA, October 6, 2009 – The American Board of Internal Medicine (ABIM) has created a new program that provides general internists practicing in the hospital setting the opportunity to earn Maintenance of Certification in Internal Medicine with a Focused Practice in Hospital Medicine. This program*, has been developed in response to the growing number of ABIM certified general internists who have dedicated themselves to caring for patients in a hospital setting.
The program assesses, sets standards for, and recognizes the specific knowledge, skills and attitudes of general internists who focus their practice in the care of hospitalized patients. ABIM's decision to create this program is consistent with its primary role of certifying internal medicine physicians who meet the profession's standards for focused practice in internal medicine.
ABIM is posting the following Questions and Answers to help diplomates understand this evolving program. Updates for the program will be made to the Hospital Medicine section of our site.
Why is ABIM recognizing Focused Practice in Hospital Medicine?
The practice of hospital medicine has reached a state of maturity within the discipline of internal medicine, as demonstrated by the large and growing numbers of physicians who have concentrated their practice in the hospital setting (along with large numbers of general internists who no longer practice in the hospital setting). ABIM's decision to recognize hospital medicine acknowledges the value that hospital-based internists can bring to improving patient care in this practice setting. The characteristics of focused hospital practice are described in the field's published core curriculum [Journal of Hospital Medicine 2006 1(S1): 2-95]. The rapid growth and development of this field is evidenced by the fact that there are currently about 20,000 hospitalists in the United States; approximately 85% are internists.
Why isn't ABIM making hospital medicine a subspecialty of internal medicine?
According to American Board of Medical Specialties (ABMS) policy, a subspecialty constitutes a body of knowledge or technique that is beyond that of the broad discipline of internal medicine. Acquiring the subspecialty knowledge and skill requires additional training and directly supervised performance of procedures or application of specific practice methods by experts in the field. Subspecialty practice involves applying internal medicine as well as specialized knowledge and procedures to a subset of internal medicine patients. In contrast, hospital medicine is the practice of internal medicine for patients during hospitalization. The recognition of focused practice through MOC provides a method for assessing specific knowledge, skills and attitudes in hospital care.
Will diplomates be eligible for the Focused Practice in Hospital Medicine program at the completion of internal medicine training?
No. Developing a practice focus requires a period of experience in unsupervised practice and demonstration of knowledge, skills and attitudes beyond that expected in residency before it can be recognized by ABIM. The MOC program can recognize such practice differentiation through demonstration of knowledge, skills and attitudes acquired through practice and modification of the initial internal medicine certification to reflect the practice focus. So a typical internist pursuing ABIM Focused Practice in Hospital Medicine program must complete training in internal medicine, be certified in internal medicine, and engage in a practice that focuses primarily on hospital medicine for at least three years.
How will ABIM implement the ABIM Focused Practice in Hospital Medicine program?
Diplomates will be able to seek entry to the program in early 2010. Entry will require an attestation by the diplomate and a Senior Hospital Officer that the diplomate meets thresholds for internal medicine practice in the hospital setting and professional commitment to hospital medicine.
The date for the first ABIM Hospital Medicine examination, a requirement of Focused Practice in Hospital Medicine program, will be October 25, 2010. Registration for this examination will open May 1, 2010. In order to register for the exam, diplomates must first enter the Focused Practice in Hospital Medicine program. Before they can receive certification in focused practice in hospital medicine, diplomates will need to pass the hospital medicine exam AND have completed 100 points of self-assessment – including 20 points in Part 2 and 40 points in Part 4 within the last three years. To maintain the certification in this area of focused practice, diplomates will be expected to meet specific self-assessment requirements every three years.
I'm a hospitalist with an internal medicine certificate expiring in 2010, 2011 or 2012. Should I wait for the hospital medicine program before beginning Maintenance of Certification?
ABIM recommends that you not allow your internal medicine certification to lapse. However, as you complete the requirements to maintain your internal medicine certification, you can choose self-assessment options that are relevant to hospital practice, such as the Hospital-Based Internal Medicine medical knowledge modules and the Hospital-Based Patient Care Practice Improvement Module (PIMsm). Self-assessment MOC points earned in the preceding three years can count toward the ABIM Focused Practice in Hospital Medicine program requirements (see below).
How will the MOC program for Focused Practice in Hospital Medicine work?
Program requirements for ABIM Focused Practice in Hospital Medicine will include the following:
- ABIM certification in Internal Medicine
- Valid, unrestricted medical license and confirmation of good standing in the local practice community
- ACLS certification
- At least three years of unsupervised Hospital Medicine practice experience
- Attestation by the diplomate and a Senior Hospital Officer that the diplomate meets thresholds for internal medicine practice in the hospital setting and professional commitment to hospital medicine.
- 100 MOC points comprising self-assessment of medical knowledge and practice performance relevant to Hospital Medicine including 20 points in Part 2 and 40 points in Part 4 within the last three years. Followed by ongoing (e.g., every-three-year) self-assessment in Hospital Medicine to maintain the certification
- Passing an ABIM MOC examination in Hospital Medicine
- If you are already enrolled in MOC an additional fee of $380. Program fee for those not enrolled in MOC is $1,950.
- Completion of the program would identify diplomates as board certified in Internal Medicine with a Focused Practice in Hospital Medicine.
As a hospitalist-internist, would I be able to also maintain separate certification in internal medicine (that is, without focused practice) if I qualify for and choose to pursue Focused Practice in Hospital Medicine?
No. A separate certification in internal medicine will not be necessary, as the Focused Practice in Hospital Medicine recognition provides evidence of the type of general internal medicine you are practicing. Since you will have declared yourself as committed to Focused Practice in Hospital Medicine – a major component of internal medicine – meeting the standards for this program would indicate that your internal medicine certification remains active but has been focused. Of course, there is no obligation to pursue the Focused Practice in Hospital Medicine program. An internist who is practicing primarily as a hospitalist could maintain certification in internal medicine without the hospital medicine focus by completing the usual MOC requirements (including taking the secure examination in internal medicine rather than in hospital medicine).
I'm a hospital-based internist and executive director for a hospitalist program, with overall responsibility for quality assurance. I serve as a hospitalist for two to three months a year. Could I qualify for the Focused Practice in Hospital Medicine program?
Yes. The hospital medicine program is designed for internists who have focused their practice in hospital medicine. ABIM will provide a pathway within the program for part-time hospitalists who devote the majority of their professional activity to hospital medicine, including both clinical and non-clinical work. However, if you were to withdraw entirely from your clinical work to focus on leadership and systems work full-time, you would not be eligible for recognition of Focused Practice in Hospital Medicine because ongoing clinical practice as a hospitalist is a key requirement of the program.
I'm a full-time, hospital-based subspecialist and also serve as a ward attending for one month a year. Could I qualify for the Focused Practice in Hospital Medicine program?
Since hospital medicine is a subset of the broad discipline of internal medicine, the ABIM program is designed to recognize the knowledge, skills and attitudes of general internists who have focused their practice specifically on the hospital setting. Subspecialty consultative patient encounters are not sufficiently broad enough to reflect the spectrum of internal medicine practice. ABIM encourages diplomates to maintain certification in areas that are most relevant to their practice. For you, the most relevant area is your subspecialty. You do have the option to also maintain certification in internal medicine.
However, if you spend a percentage of your time practicing as a subspecialist and the other half practicing internal medicine as a hospitalist (for example, serving as physician-of-record for undifferentiated hospitalized patients for several months a year), you may meet the requirements for Maintenance of Certification in Internal Medicine with a Focused Practice in Hospital Medicine (as well as your subspecialty requirements).
I'm currently a full-time hospitalist. If I decide in the future to change my practice focus and join a primary care office-based practice, what would I need to do to reinstate my internal medicine certification?
The Focused Practice in Hospital Medicine will be flexible in order to be responsive to anticipated changes in diplomates’ practice focus over time. Should a diplomate’s practice focus change to an office-based setting or subspecialty, a diplomate can withdraw from the Focused Practice in Hospital Medicine program. Once withdrawn from the program the diplomate will automatically be enrolled in the standard Maintenance of Certification program.
Will there be a parallel ABIM process for recognizing general internists who focus their practice in office-based settings?
Possibly. Concurrent with the growth of hospital medicine, many general internists now focus their practice on ambulatory primary care in office-based settings. ABIM recognizes this practice differentiation within general internal medicine and appreciates that there are many efforts underway to support primary care practice. ABIM is also exploring ways to support and assess the competencies required for general internists who can provide comprehensive, longitudinal and coordinated care for patients with chronic or complex problems. To meet this need, ABIM has committed to developing tools to assess the competencies required for comprehensive care internal medicine practice' and to develop partnerships to establish such tools in the practice and educational domains. These efforts are not linked to or dependent on the time frame for developing the Focused Practice in Hospital Medicine program.
*The American Board of Medical Specialties approved a five-year pilot of the Focused Practice in Hospital Medicine program in September 2009. ABIM is committed to supporting this program for its diplomates.