ABFM, ABIM Collaborate to Launch Hospital Medicine Pilot

The American Board of Family Medicine, or ABFM, has announced that it is joining forces with the American Board of Internal Medicine, or ABIM, to establish a pilot program for Recognition of Focused Practice, or RFP, in Hospital Medicine.

The announcement is welcome news to AAFP President-elect Lori Heim, M.D., of Vass, N.C., a hospitalist who says she sees many benefits in such recognition. But she cautions that any RFP program that might result from the pilot should not be used to limit the scope of family physicians who practice the full scope of family medicine, including both inpatient and outpatient medicine.

"There are many family physicians who are doing hospitalist work, and this can be a plus for them," Heim told AAFP News Now. "But a focused practice recognition should not be construed to mean that one has to do additional training to maintain skills as a physician who continues to practice in a hospital."

In an Oct. 2 news release, the ABFM said the hospital medicine pilot program will use the current maintenance of certification, or MOC, framework and would be the first MOC pathway to draw on practice-based learning as its foundation.

The three-year pilot, which is expected to begin in fall 2010, would engage hospitalists in uniquely designed MOC Part II, Part III and Part IV tools that will be developed by the ABFM and the ABIM, the release said.

"Given the significant number of family physicians working exclusively in the hospital setting, our board of directors felt it important to participate fully in this pilot with the ABIM," said James Puffer, M.D., president and CEO of the ABFM. "We envision working together closely to develop the special tools used by our diplomates in this customized MOC pathway."

Puffer added that the ABFM also will participate in the evaluation that will be conducted near the end of the pilot. The American Board of Medical Specialties, or ABMS, which approved the pilot on Sept. 23, will then decide whether to extend, discontinue or approve the concept of focused practice recognition, he told AAFP News Now.

Heim said such recognition could help family physicians who want to enter practice areas that have been previously limited to internal medicine hospitalists. For example, when she was in private practice, said Heim, some hospitals wouldn't hire an FP hospitalist. They were only interested in candidates who were trained and certified in internal medicine, she noted.

If the currently proposed hospital medicine MOC pathway had been available to her, Heim said, she could have gone to the hospital board and made a better case for hiring a family physician. "I would have (had) special recognition of proficiency in hospitalist work" in that situation.

The criteria for the proposed RFP pilot program are elucidated in the ABIM's Final Report of the Committee on Recognizing New and Emerging Disciplines in Internal Medicine (NEDIM) - 2 (8-page PDF; About PDFs). One criterion is that "there must be an important social need for the discipline and evidence that focusing practice in the discipline improves patient care."

An article in the June 15, 2007, issue of Internal Medicine News described how the recognition process was initially envisioned for internal medicine hospitalists. According to that article, candidates would have to be trained and board-certified in internal medicine and practice as hospitalists for three years before applying to enter the MOC pathway seeking the RFP. They would be required to demonstrate a focus on hospital medicine by meeting a patient volume requirement and providing leadership on quality improvement projects.

After meeting those requirements, they would then enter the self-evaluation programs and practice improvement modules that make up the MOC pathway, said the article.

According to a question-and-answer document developed recently by the ABIM, hospital medicine has reached a "state of maturity" within internal medicine, and the recognition of focused practice through the MOC pathway provides a way to assess proficiency in providing hospital care.

Heim said that the RFP "recognizes that we've all been trained in inpatient medicine. After residency, some people wish to focus their practice on certain areas. (The RFP) allows them to tailor their education and (demonstrate) they have focused their education on hospital medicine."