American College of Physicians: Internal Medicine — Doctors for Adults ®

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Subspecialty societies meet to discuss recertification, socioeconomic issues

From the July 2001 ACP-ASIM Observer, copyright 2001 by the American College of Physicians-American Society of Internal Medicine.

By Phyllis Maguire

The Council of Subspecialty Societies (CSS), an advisory council made up of representatives of more than 20 internal medicine subspecialty organizations, met at College headquarters in May to discuss recertification and ways in which the College and the subspecialty societies can work together on payment and regulatory issues.

The agenda item that generated the most discussion was recertification. Ronald P. Fogel, FACP, the group's representative from the American Gastroenterological Association, was one of several physicians who talked about the "unintended consequences" of mandatory recertification that are coming to light in the program's second year.

Dr. Fogel said that many members of his subspecialty, as well as the others represented at the meeting, are finding the process too time-consuming to recertify in both internal medicine and their subspecialty. As a result, many subspecialists are choosing not to recertify in internal medicine and may lose general internal medicine privileges at local hospitals or with managed care organizations. In addition, hospital call schedules and emergency room coverage may be significantly affected, as there may be fewer board-certified internists to help shoulder the patient load.

Recertification is also affecting subspecialists at academic institutions, Dr. Fogel said, as colleagues postpone research projects to make time to recertify.

Herbert S. Waxman, FACP, the College's Senior Vice President for Education, briefed the group about ongoing discussions between the College and the American Board of Internal Medicine (ABIM). The two organizations have been communicating via the Joint Committee on Recertification, a task force that includes College and ABIM representatives.

Dr. Waxman also outlined the College's misgivings about the ABIM's proposed Continuing Professional Development (CPD) program, the redesigned self-assessment component of recertification that may include patient-peer and practice performance reviews. (More information on CPD.)

The College is concerned that several elements of the CPD process may be redundant and intrusive, Dr. Waxman said. He pointed out that during a telephone survey of College members conducted this spring, half of the respondents said they were already engaged in some form of practice performance measures. (See "Internists see little value in recertification," page 1.)

Dr. Waxman also said that the College is concerned that the ABIM is competing unfairly with other providers of medical education material, and that the CPD process does not recognize other valid processes of lifelong learning.

In a straw vote taken by CSS chair Harris R. Clearfield, FACP, most of the representatives claimed that their subspecialty societies support the idea of a sit-down examination as part of the recertification process. But in a show of hands, no one indicated support for the current CPD process. At press time, the group's member societies were submitting letters to Dr. Clearfield outlining their positions on CPD. Dr. Clearfield will present those opinions to the College's Board of Regents at their meeting this month.

CSS representatives also discussed the Subspecialty Advisory Group on Socioeconomic Affairs (SAGSA), a new group formed to help the College work with subspecialty societies on socioeconomic issues. The organization will concentrate on payment and regulatory issues and give input to the College's Medical Services Committee.

The group, which will hold its first meeting later this year, was formed in part to respond to conflicts between the College and certain subspecialties-most notably gastroenterology and cardiology-over Medicare practice expense payments. The College supported HCFA's decision to begin in 2000 to use a resource-based system to calculate reimbursements. The new system increased reimbursements for general internists, but reduced payments for some subspecialists.

The CSS consists of 22 internal medicine subspecialty organizations that have training programs, as well as separate board certification. The council gives input to the College on issues of concern to subspecialties and on problems that arise between referring physicians and subspecialists. The group meets twice a year, and its chair is a voting member of the College's Board of Regents. Subspecialists account for roughly 40% of College membership.

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