Hospitalists, a branch of internal medicine that has become one of healthcare's fastest growing and most in-demand specialties, will at last be getting the recognition they deserve. Sort of.
A five-year pilot program to test a plan for recertifying internists as practitioners of hospital medicine—rather than general internal medicine—will be launched next year. The program, called Recognition of Focused Practice, will be used by hospitalists who are completing their American Board of Internal Medicine 10-year maintenance of certification requirements.
While news of “board certification for hospitalists” had spread rapidly through the hospital medicine community, some officials are saying “not exactly.”
“This is unique in that it's not a new certification per se,” says Eric Holmboe, M.D., senior vice president and chief medical officer at the American Board of Internal Medicine. “It's some subtle terminology. It will say ‘maintenance of certification in internal medicine with a focused practice in hospital medicine.' ”
Robert Wachter, M.D., a professor and associate chairman of the department of medicine at the University of California at San Francisco and coiner of the term “hospitalist” in 1996, broke the news on his blog under the headline: “Board certification for hospitalists: It's heeeere!”
“It not your father's recertifcation—which meant taking a test every 10 years—and it includes practice-improvement modules with you measuring the quality of your care and acting on it,” Wachter says. “To me, it is one of the final steps of legitimizing a field for those of us who were there in the very beginning and who had hopes and dreams for this idea.”
According to the 9,000-member Society of Hospital Medicine, or SHM, (founded in January 1997 as the National Association of Inpatient Physicians), about 82.3% of practicing hospitalists are trained in general internal medicine, while 6.5% are trained in general pediatrics, 4% in an internal medicine subspecialty, 3.1% in internal medicine pediatrics, 3.7% in family practice and 0.4% in a pediatrics subspecialty.
According to Rusty Holman, M.D., who was the 2007-08 president of the SHM, there are about 30,000 practicing hospitalists in the U.S., and he also notes the significance of this board certification pathway.
“I think it's a linchpin for hospital medicine in terms of establishing credibility and recognition within the healthcare environment,” says Holman, chief operating officer for Brentwood, Tenn.-based Cogent Healthcare, whose roster of about 350 physicians provides hospitalist services for facilities in 20 states. He adds that Cogent will be “encouraging and facilitating their inclusion in the pilot program.”
Holman notes the unique factors that would be behind hospitalist certification. “Traditionally, established specialties in medicine are based on a specific training regimen and studies, which represent the acquisition of unique knowledge and skills,” he explains. “Hospital medicine represents a departure from that paradigm. The foundation of board certification in hospital medicine is predicated upon accomplishment, knowledge and skills gained through practice.”
The American Board of Medical Specialties includes 24 member boards that cover some 145 medical specialties and subspecialties. There is also some discussion about certifying specialties related to medical informatics or internists specializing in the treatment of patients with HIV/AIDS. Wachter says the idea that medicine may be becoming too splintered was considered.
“None of us want left toenail specialists,” Wachter says. He explains that hospital medicine deserves its own specialty because it has been determined that patients benefit from the specific care hospitalists provide, and that there are many doctors who only perform the work that hospitalists specifically do and many who never get near it.
Jeff Wiese, M.D., SHM president-elect, noted the significance of the ABMS recognition to the growing hospital medicine field.
“It says this is as important to the delivery of healthcare in this country as the care delivered by a physician with an organ specialty would be,” says Wiese, a professor of Medicine at Tulane University and chairman of the question-writing committee for the pilot program's exam.
In addition to the focus on inpatient care, Wiese says the program will also emphasize patient safety, the transition of care through different settings, and quality improvement.
“Hospitalists are the architects of a hospital's patient-safety program,” Wiese explains. “Somebody who is doing hospitalist work needs to be continuously involved in improving the hospital where he or she practices.”
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