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

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ACP develops guiding principles for customized maintenance of certification

From the September ACP Observer, copyright © 2007 by the American College of Physicians.

An article entitled "Hospital Medicine Certification Ahead," which reported on a presentation at the Society of Hospital Medicine's (SHM) annual meeting, appeared in the June 15, 2007 issue of Internal Medicine News. Because the article contained some factual errors, the College and The American Board of Internal Medicine (ABIM) sent a joint letter to Internal Medicine News to correct the facts and outline our positions. The importance of maintenance of certification (MOC) is important to all of us, so I would like to provide some background on this issue and clarify the College's positions and actions.

ABIM is currently developing ways in which the focus of a physician's practice is evaluated and acknowledged through ABIM's MOC process. According to ABIM, enhanced patient care is the primary rationale for linking MOC with areas of focused practice. Hospital Medicine is the first area of focused practice to be considered by the ABIM Board of Directors. The ABIM is also developing a parallel process for Comprehensive Internal Medicine. The general concept is to provide an opportunity (not a requirement) for specialists in general internal medicine to have the MOC pathway match the focus of their practice. This would come through a customization of the MOC process, emphasizing knowledge, skills and competences required for the physician's site and type of practice. Implementation of ABIM's focused practice proposals requires the approval of the American Board of Medical Specialties, a process that has just begun.

In 2006, in response to the SHM's request that ABIM consider some form of separate evaluation and acknowledgement for hospitalists, ACP developed guiding principles for a customized MOC process that would allow internists to tailor the components of MOC (including the secure examination) to their particular scope of practice. The ACP goal in crafting these principles was to make the process more relevant and more valuable to internists.

ACP agreed that an ABIM process that would recognize focused practice through customization of MOC provided an opportunity to acknowledge both the expertise and experience of internists practicing in a particular setting. As such, the College supports pathways within ABIM's MOC program that allow internists to be evaluated based on their particular scope of practice. We want to ensure, however, that any process for practice-based evaluation strengthens internal medicine as a whole, including both office-based and hospital-based general internal medicine, and that the MOC process should accommodate internists practicing in both these and other settings.

ACP maintains that MOC with focused practice in hospital medicine should not be a requirement for internists to care for their patients in the hospital setting. Both ABIM and the SHM are in agreement with this position. Rather, the MOC process leading to focused practice in hospital medicine is meant in large measure to evaluate and recognize hospitalists for their responsibilities and activities to improve quality of care and systems of care delivery in the hospital setting.

Be assured that ACP and ABIM are continuing to work together to refine the MOC process and make it relevant to internists in all settings: ambulatory practice, hospital-based practice, academic practice or non-academic practice. We want to ensure that it provides added value to internists and to our patients and the communities we serve.

Furthermore, ACP greatly values the membership of hospitalists, who represent a very important and growing component of the internal medicine community. Our goal is to support all internists, whether they are general internists or subspecialists; whether their practice settings are inpatient, outpatient or both; and whether their activities include clinical practice, teaching, research or administration.

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