Medicine, Family Practice, and Pediatrics. The American Board of Internal Medicine (ABIM) has developed criteria regarding when to develop a certificate (exam) in a new field (Table 2), and if/when Hospital Medicine passes that step, it will be time to think about whether Hospital Medicine should move up the hierarchy of specialization to become a recognized subspecialty of Internal Medicine. But the process of “sanctioning” a new certificate (exam) or subspecialty is a complex one, and many fields initiate it on their own; which for Hospital Medicine might mean doing so without the distinct approval or input of the ABIM or American Board of Medical Specialties (ABMS) at the outset. Once a field’s own efforts gain legitimacy, then the ABIM and ABMS often recognize it as a distinct specialty or subspecialty. Such was the path taken by Emergency Medicine and many other fields.
I see a process of becoming eligible for the exam by completing residency training in IM, FP, or Pediatrics, and working as a hospitalist for a specified period of time (e.g., 3 years). Those who meet these (and other?) criteria, and pass the exam, could benefit from increased prestige and stature, and better differentiate themselves from doctors who might call themselves hospitalists but not have the delivery of inpatient care as their primary professional focus. Research studies of hospitalist systems of care could benefit from a more rigorous definition of who is really a hospitalist based on certification. And a practical consequence of a growing number of certified hospitalists might be an improved ability to lobby for adjustments and improvements in the professional fee reimbursement for inpatient care.
Patients indicate that board certification is very important when choosing a doctor (1), so being able to show them that I am a certified practitioner in a recognized specialty will have value. Of course, all hospitalists have the opportunity to show patients (e.g., on a business card or stationary) board certification in the specialty of their residency training, but the ability to demonstrate additional competence and dedication to Hospital Medicine will be valuable in the same way it is valuable for other fields with certificates of added qualification such as Sports Medicine, and Geriatrics.
Other features of a distinct specialty usually include things such as recognition in the AMA as a section; in the case of hospitalists a Section on Hospital Medicine. Such recognition would add legitimacy to the field and provide a stronger platform from which to lobby for the needs of our patients and our discipline. And with these credentials Hospital Medicine can relate to other specialties or subspecialties as peers rather than as a fledgling upstart.
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Costs of specialty recognition.
Some fear that developing an exam in Hospital Medicine will lead payers, which are usually enthusiastic supporters of the hospitalist movement, to discriminate between those who are and are not exam certified. In other words, if a payer has access to a group of certified (passed the exam) hospitalists, it might refuse to contract with non-certified PCPs to provide inpatient care. In this way the exam could be used as a way to restrict the practice of those who have not taken it, rather than simply enhancing the competence and stature of those who have passed it. I think there are many forces in medicine that would prevent this from happening to any significant degree. The history of many other specialties shows that an effort to restrict practice to certified doctors takes many years to gather steam (e.g., Emergency Medicine). And payers would only hurt themselves by restricting themselves to certified hospitalists early on, since it will likely be many years before the supply would be adequate to ensure enough doctors are available to do the work.