“HM is borne of internal medicine … and has evolved to something unique. Therefore, your credentials should reflect that uniqueness,” says Larry Wellikson, MD, FHM, CEO of SHM. “This [process] is going to make the whole maintenance of certification process more relevant to hospitalists. This is recognition that hospitalists should be accountable for learning new things after they complete their formal training—things not emphasized in training like patient safety, quality, and care transitions.”
The language used on ABIM’s Web site to announce the new testing program furthers the message: “ABIM is developing a program to assess, set standards for, and recognize the proficiency of general internists who focus their practice in the care of hospitalized patients. The board’s decision to advance 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.”
In addition to quality, patient safety, and transitions, “accountability to the patient” is a popular catchphrase used by members of the committee dedicated to writing the new certification test. Licensure and certification provide public accountability to patients, colleagues, and stakeholders, says Dr. Wiese. What differentiates career hospitalists from those making a pit stop during an alternate career path is increased accessibility to patients, expertise in patient safety and quality initiatives, and knowledge of clinical care transitions, he explains.
“Everything is driving at those issues,” he says. “From the beginning, there has been no agenda to change residency training. Any information contrary is a complete myth. Principle No. 1 is that you have to be competent internist. This new [MOC process] is much closer to an MBA.”
How hospitalists who are recertifying through the RFP in HM will refer to themselves remains up for debate. Although some physicians might say they are “board-certified in hospital medicine,” Dr. Wachter hopes hospitalists will use the phrase “board-certified in internal medicine with a recognized focused practice in hospital medicine.” “I hope to think our physicians will still say ‘IM,’ ” he says. “The goal here is not to sever ties with IM. That is a concern.”
Dr. Wiese, who, along with Dr. Wachter and other members of the test-writing committee, was required to complete the IM maintenance of certification (MOC), envisions a four-part process (see “Board Certification, With a Healthy Dose of HM,” p. 31) that challenges hospitalists in the core competencies of hospital-based practice.
“The [IM] recertification was the one test in my career that made me a better physician. I think this HM examination is going to be the same way,” Dr. Wiese says. “I want hospitalists to say, ‘When I go back to take care of my patients, they’ll be better off for it.’ ”
Target Audience
Dr. Flanders has about 40 hospitalists in his HM group at the University of Michigan. Although he recertified in IM in 2006, he knows many of his hospitalists are itching to take ABIM’s new HM-focused test. “They will be thrilled. They have all said to me that we can’t get this done fast enough,” he says, noting three or four of his hospitalists probably will recertify through the new test in fall 2010. “Our field is young; I suspect there are a lot of hospitalists out there who are within the 10-year window for recertification. I plan to do it at my next MOC … and that date could be moved up the way things are going.”