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Remembering an Active Year in Hospital Medicine

Karen M. Cheung, December 24, 2009

The most notable year in hospital medicine used to be 1996, when the phrase "hospitalist" was first coined in the New England Journal of Medicine. That is the year typically associated with the official birthday of hospital medicine.

Now, another landmark year has dawned. The year 2009 was a milestone for hospital medicine.

Hospitalists now have certification in hospital medicine from the American Board of Internal Medicine, as well as their own designation (Fellow of Hospital Medicine, or FHM, for short) from the Society of Hospital Medicine (SHM).

As the fastest growing medical specialty, hospital medicine includes a field of 30,000 practicing hospitalists in the country, according to SHM. With the newfound certification and designation, hospitalists are increasingly gaining professional recognition in the healthcare world.

Certification in hospital medicine

After years of whispers and held breaths, the American Board of Internal Medicine (ABIM) and the American Board of Family Medicine (ABFM), under the American Board of Medical Specialties (ABMS), in October officially announced a five-year pilot program for focused practice in hospital medicine (FPHM) for general internists.

"This is not only a new kind of credential in hospital medicine, but it is a new kind of credential for the certifying board in that we are credentialing you not based on additional training, but rather based on what you have been doing for a living," said Robert M. Wachter, MD, professor and associate chair of the Department of Medicine at the University of California, San Francisco, and a member of the ABIM board of directors.

FPHM is considered maintenance of certification, rather than a separate certification. In the typical internal medicine maintenance of certification, which most hospitalists go through, physicians must complete a practice improvement module every 10 years. However, those pursuing the new FPHM must complete the more frequent standard of one in every three years. The FPHM criteria include ABFM- and ABIM-developed tools that are specifically targeted at hospitalist practice-based learning.

Just as airline pilots and teachers must recertify every couple of years, physicians might consider more frequent certification, according to Wachter. The new FPHM shows a continued competency and dedication in hospital medicine, he said.

ABIM vs. ABPS: Who's on first?

There's debate, however, on which organization was the first hospitalist certifying board. The American Board of Physician Specialties (ABPS) announced the newly established American Board of Hospital Medicine (ABHM) in January. The new ABHM generated debate among the hospitalist community about its validity as a certifying board, with e-mails and blogs filled with chats about what to expect.

A study in September concluded that the three major board certifying organizations—The ABMS, ABPS, and the American Osteopathic Association's Bureau of Osteopathic Specialists—require the same amount of certification and recertification requirements. The study, which was conducted by The Associated Industries of Florida Service Corporation, compared the three organizations' requirements by medical specialty, including years of required training, exams, documentation, and CME hours; it concluded the boards were essentially equal in the rigor of standards.

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