We started with internal medicine because more than 85% of hospitalists are trained as internists. But our strategy is to soon follow on with discussions with the American Board of Family Practice (ABFP), the American Board of Pediatrics (ABP), osteopathic certification organizations, and others who oversee any part of credentialing hospitalists.
The ABIM with the support of the ACP, the AAIM, SHM, and others has embarked on a process to use the Maintenance of Certification (MOC) to create a unique recognition for hospital medicine without requiring additional formal training beyond current residencies. The plan for now is that all graduates of an internal medicine residency would take the same initial certification, but that after entering practice and sometime within the first 10 years of practice, hospitalists could use the elements of the MOC process (e.g., self assessment, a quality improvement process, and a secure test—all specific to hospital medicine practice) to create a recognition of them as hospitalists. Presently, the ABIM has formed a Hospital Medicine Task Force to develop the details that will make this rigorous and meaningful to the key stakeholders (e.g., hospitals, patients, hospitalist employers, referring physicians, and hospitalists).
Getting this far was not in any way a slam dunk or a rubber stamp. SHM didn’t just send in a postcard asking for a credential for hospitalists and ABIM said, “Fine.” This has taken several years of reasoned conversations, meetings to clarify our position, and opportunities to understand the broader aspects of the emergence of hospital medicine’s effect on the rest of medicine. More recently it has taken the courageous leadership and vision of the ABIM, the ACP, the AAIM, and others to meet their missions of promoting quality of care for our patients.
Work still needs to be done and the devil is always in the details. But the current direction is forward, and that is surely welcome.
Working to Improve Quality
There has been much heat and fury around quality—defining it, measuring it, even possibly paying for it, instead of just paying for units of work whether they are any good or not. For many years the role of the professional medical society in the quality arena was to pull together the smartest people in their specialty, latch on to the diseases they knew the most about, define quality, write guidelines, issue a white paper, and declare victory.
From its beginning SHM has taken a different tactic. We believe many smart people have already defined the best quality for DVT or diabetes or CHF, but the remaining gaps have been in implementation strategies to export all these great ideas to 5,000 hospitals and the millions of patients who occupy them.
With this in mind SHM has sought funding in the diseases defined in our Core Competencies such as DVT, diabetes, CHF, and others, and we have looked for ways to provide hospitalists with key tools as well as looking for implementation strategies (e.g., mentorship, training courses in leadership and the quality improvement process, demonstration projects) to make a measurable difference. And as hospitalists begin to become change agents at their hospitals, we hope to use our meetings and our publications to report your successes and the barriers to success.
Once again SHM will not be able to do much on our own. Therefore, our strategy has been to involve very early on the leaders in nursing, pharmacy, case management, and relevant specialties of medicine. In fashioning a strategy for glycemic control in the hospital, for example, SHM works with the American Association of Clinical Endocrinologists, the American Diabetic Association, and others. Once again as early vague ideas take shape and become real programs, it seems as if they have appeared fully formed in short order. But SHM has been working on many of these for years, and we expect that we will be in the quality improvement implementation realm for many years to come. We are just getting started.