College to expand recertification negotiations
By Phyllis Maguire
PHILADELPHIA—The Board of Regents decided at its April 9 meeting that the College will expand the scope of its recertification negotiations with the American Board of Internal Medicine (ABIM).
The Regents approved a package of recertification resolutions sent by the Board of Governors. Those recommendations call for the College to endorse multiple pathways for recertification and to advocate for less onerous requirements for dual recertification in internal medicine and its subspecialties. At the same time, both the Regents and the Governors reaffirmed their commitment to the concept of periodic recertification.
In unanimously approving the Governors' resolutions on recertification, the Regents sent a clear signal that negotiations with the ABIM need to continue. The ABIM has already modified its proposed recertification process, saying it may allow internists to substitute MKSAP and other educational materials from subspecialty organizations for certain self-evaluation modules. College officials said that the approved recommendations will continue to build on those changes.
Regent Barbara L. Schuster, MACP, voices support for multiple pathways to recertification.
"This is a new direction for the negotiating team," explained Bernard M. Rosof, FACP, Immediate Past Chair of the Regents. "With these recommendations, College leadership will be able to further the progress we've already made."
Walter J. McDonald, FACP, the College's Executive Vice President and Chief Executive Officer, noted that College leadership has been concerned about the ABIM's proposed Continuous Professional Development (CPD) program for several years. "The ABIM has been willing to negotiate many of the points included in the CPD proposals," Dr. McDonald said. "Using these new recommendations as a blueprint, we look forward to resolving more differences."
The approved recommendations now go directly to the negotiating team as guidance in negotiations with the ABIM.
Among other provisions, the Regents approved the following recommendations:
The College will work with the ABIM to establish multiple pathways to recertification, one of which would include a secure exam.
ACP-ASIM will encourage subspecialists to recertify in both their subspecialty and general internal medicine, and it will work to remove cost and time barriers to multiple recertification.
The College will advocate for allowing internists to substitute other educational resources—MKSAP or materials prepared by subspecialty societies—for some ABIM self-evaluation modules. ACP-ASIM will also work to keep the ABIM's patient and peer assessment module optional.
The College will work to ensure that the process of recertification is relevant to physicians in a variety of professional settings.
To ensure member representation, the College's negotiating team with the ABIM will include the Chair of the Board of Governors, as well as a Governor who serves on the Education Committee.
The College will work to ensure that all recertification components are validated.
The Regents also approved a recommendation stating that, if the College and the ABIM cannot reach consensus on a final recertification format, ACP-ASIM will consider supporting the development of an alternative recertification process.
Furthermore, the Regents approved a separate recommendation that endorses developing accountable, literature-based CME that could be presented as a possible recertification pathway. That recommendation will be forwarded to the Education Committee for further study.
In their deliberations, both the Regents and Governors commented that the ABIM has recently shown a willingness to work to modify its recertification program. "The Governors were encouraged by indications that the ABIM is ready to be more flexible in designing the preparation for the exam," said the new Chair of the Board of Governors, David C. Dale, FACP.
At their meeting, several Governors who have recertified complained that the self-evaluation modules continue to offer practicing internists little value. Many Governors also warned that many subspecialists, facing onerous cost and time burdens of having to recertify in more than one specialty, are opting not to recertify in more than one area of internal medicine—a trend that could impact the future of internal medicine and the College.
Several Governors pointed out that third-party payers are paying close attention to recertification. And Julie Ake, ACP-ASIM Medical Student Member, Chair of the College's Council of Student Members, told the Governors that the recertification issue is hurting internal medicine's ability to recruit medical students to the specialty.
Recertification in internal medicine became mandatory for all internists and subspecialists who originally certified in 1990 or after. ACP-ASIM members began voicing strong concerns about the program in 2000, when the College began negotiating with the ABIM for changes.
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