This is the year I complete my second recertification for the American Board of Internal Medicine (ABIM). Prior to 1990, the ABIM issued certificates that were good for life. Beginning in 1990 and through 2013, all certificates were issued for a 10-year duration. All those prior lifetime certificates were honored, so those holding them were deemed “grandfathered” and have not had to recertify. The rest of us are now on the recertification pathway, renewing every 10 years. Although the date has been set at 10 years, the recertification process has become more regimented since January 2014, when the ABIM moved to a continuous program requiring evidence of new learning and maintenance of quality in your practice every two years.
This ratcheting up of requirements and adding increased increments of progress hasn’t come without controversy. Last year a petition was started and signed by 19,000 physicians protesting the changes and arguing the ABIM should go back to the methodology of taking a test every 10 years. Even this was a moderate position; many were clamoring for the abolition of maintenance of certification (MOC) all together.
I represented the Society of Hospital Medicine (SHM) in July 2014 at a summit in Philadelphia called by the ABIM Foundation. Each of the medical subspecialties was given an opportunity to speak to the ABIM leadership and the audience of fellow representatives about the impact of MOC. As members of a relatively youthful field, hospitalists are less focused on how the “grandfathers” are being treated and more concerned about the confusing process and lack of opportunity to incorporate our daily hospitalist-focused work effort easily into the process.
As a result of that petition, many letters written to the board, and the outspoken representatives at the ABIM summit, the ABIM has responded with a plan to make elements of the process more friendly and open, as well as one to further plan and adapt.
Clearly, this is a process in evolution. Hospitalists are committed to lifelong learning. I think we can expect that with more transparency in all aspects of our lives, personal and professional, our patients, our hospitals, and payers…will all be expecting to see just exactly how committed we are to lifelong learning and self-improvement.
It’s our turn…
In 2009, some bold steps were taken with the announcement of the new Focused Practice in Hospital Medicine (FPHM) that, hopefully, will impact hospitalists for many years to come. SHM’s partnership with the ABIM began with work five years prior, creating a focused declaration of hospital medicine competence. Initially, this was set up as a pilot project to be evaluated for success along the way, to see if the concept would become permanent. The work was announced, and the inaugural class of 175 physicians entered the process. Since that time, 555 physicians have earned the FPHM certificate. What’s even more impressive is that we have seen a surge recently in the number of entrants. There are now 3,300 hospitalists enrolled in the pathway.
While this growth is great, we estimate that there are 44,000 hospitalists in the U.S. We know that many are newer hospitalists and not yet up for recertification. Our goal is to get every hospitalist entering the pathway when it is his or her time, just like I’m doing now. It is my time!
As we steadily progress in distinguishing and defining our field, we need as many hospitalists as possible to raise their hands and say that they proudly practice hospital medicine and have taken the steps to learn the special knowledge and gain the special skills needed to succeed in the hospital. The ABIM certification program is still in the pilot phase. One of the key markers of success to determine if it will be continued is the number of participants. I am writing this column as another way to encourage us all to stand up and be counted.