As internists further refined their skills and narrowed their professional focus, their expectations of their certification and especially their maintenance of certification (MOC) by the ABIM became an issue. Is the MOC process relevant to what they feel they do and should know?
In addition, many subspecialty societies have concerns about how maintaining a basis in internal medicine fits in with MOC in their subspecialties. At this meeting it became clear that many subspecialists feel there is a core of internal medicine they should continue to know and be evaluated on without being expected to know everything a practicing hospitalist or ambulatory internist knows. For example, a cardiologist may be expected to know when their diabetic patients are getting into trouble and need consultation but may not need to know the intricacies of managing extremes in glycemic control.
Many at this meeting felt that the time is now here for using the MOC process to offer those initially credentialed in general internal medicine to have their MOC evaluation tailored to their real-life practice as a hospitalist or an internist with an ambulatory practice and to allow for them to be identified as having expertise in hospital or ambulatory medicine. This was a recognition that these aspects of what have traditionally been lumped together as general internal medicine have key defined skills and knowledge and needs to be recognized as more than just an internist who is not a subspecialist.
Once again there is still much work to be done. SHM, ACP, SGIM, and others will need to work with ABIM and RUC and others to define the skills and the competencies that would form the basis for the training and evaluation of new and improved internists in the 21st century.
The good news from the Dec. 2, 2005, meeting in Dallas is that the national leadership in internal medicine recognizes the need to change internal medicine residency training and to have an MOC process that is relevant to all internists—general internists, subspecialists, and hospitalists. There was also a sense that this process needs to move forward with reasoned speed. We don’t need to write another white paper and declare victory. Today’s and tomorrow’s internists and our patients need us to provide the leadership to produce the best trained and motivated internists and subspecialists to meet the increasing needs of a sophisticated and aging population.
As always SHM will be there, playing an active role. Whatever we come up with for internal medicine I hope can be applicable to family practice and pediatrics as well. Because this is the professional world you will live in, we will continue to invite your input and ideas. TH
Dr. Wellikson has been CEO of SHM since 2000.