American Board of Internal Medicine

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The American Board of Internal Medicine (ABIM) is a non-profit, self-appointed physician evaluation organization which certifies physicians who practice internal medicine and its subspecialties. It is not a membership society, educational institution or licensing body, but an organization that attempts to assess physicians through proprietary testing and completion of required modules. ABIM has issued more than 425,000 initial certificates in internal medicine and its subspecialties in the United States and its territories since its founding.[1] From 2001 until 2013, ABIM certified 91,024 physicians in general internal medicine.[2] From 2001-2013 ABIM certified more than 10,000 cardiologists and more than 6,400 medical oncologists.[3] More than 140,000 physicians – including more than 8,000 physicians holding certifications that hold certifications which are valid indefinitely — are currently enrolled in ABIM’s Maintenance of Certification program.

The current president and CEO of ABIM is Richard J. Baron. The ABIM recently adopted a new governance structure that now consists of three entities:

  • Board of Directors
  • ABIM Council
  • Specialty Boards

History

ABIM, the largest of 24 member certifying boards of the American Board of Medical Specialties, was established in 1936 by the American Medical Association and the American College of Physicians to issue certification to physicians. Since that time, ABIM has categorized physicians into one or more of its 20 subspecialties based on training and the passing of a standardized exam:

Certification

ABIM Board Certification demonstrates that physicians have completed a residency in a specified medical specialty and have passed a rigorous knowledge assessment exam. Additionally, certification encompasses the six general competencies[citation needed] established by the Accreditation Council on Graduate Medical Education (ACGME). Following regulations established by the ABMS, in order to be certified, a physician must:

  • Complete the requisite predoctoral medical education
  • Meet the training requirements
  • Meet the licensure requirements and procedural requirements
  • Pass a secure board certification examination

Physicians may become board certified when they have successfully completed residency or fellowship training and by passing a secure examination. Unlike licensure, board certification is not a requirement to practice medicine. Many hospitals require internists to be board certified in order to have admitting privileges, and many health plans require certification for contracting or eligibility for select networks.

The ABIM asserts that there is a growing body of research that suggests:

  • A physician’s ability to independently and accurately self-assess is in dispute, with research showing no consensus [4][5][6] and more clinical experience does not necessarily lead to better outcomes of care.[7]
  • Fewer than 30% of physicians examine their own performance data and try to improve.[8] The MOC program structure tries to address these concerns with a sound theoretical rationale via the six ACGME competencies framework and a respectable body of scientific evidence, and to address its relationship to patient outcomes, physician performance, validity of the assessment or educational methods utilized and learning or improvement potential.[9][10]

The validity of the studies that ABIM cite to support these arguments has been questioned, because the authors of these studies are individuals who are employed by, or have previously been employed by, the American Board of Medical Specialties or its related bodies (see Hawkins, Richard E.) [11] In addition, there appears to be a tightly-knit, self-credentialed "patient safety/medical quality" industry developing in the United States, from which the authors of many of the studies supporting maintenance of certification have emerged.[12]

Maintenance of Certification (MOC)

The ABIM asserts that research shows that physician knowledge deteriorates and practice habits and patterns fail to change, over time, in response to medical advances[citation needed]. Every 10 years, some internists and subspecialists certified in or after 1990 renew their certifications through ABIM's Maintenance of Certification program

ABIM's Maintenance of Certification program changed in January 2014. The program now requires physicians to:

  • Possess a valid medical license
  • Earn MOC points (points count toward all certificates you are maintaining)
  • Some MOC activity every two years
  • 100 MOC points every five years
  • Pass MOC exam in your specialty every 10 years

Controversy

Despite the ABIM's assertions, there has been much controversy regarding the Maintenance of Certification Program. It has been criticized for taking time away from patient care, not being proven to improve patient care, and costing more in time and expense than it can justify [13][14][15]

On February 3, 2015, the ABIM announced more changes to the Maintenance of Certification program. In a press release, they apologized that they "clearly got it wrong" and admitted that the program changes in January 2014 were instituted prematurely.[16] They have suspended the Patient Survey and Patient Safety components for at least 2 years and will make changes to the secure exam to make it more reflective of medical practice among others. The final form of Maintenance of Certification remains to be seen.

On March 10, 2015, an article written by Kurt Eichenwald for Newsweek raised skepticism of the ABIM Foundation and its merit.[17]

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And there is another organization called the ABIM Foundation that does...well, it’s not quite clear what it does. Its website reads like a lot of mumbo-jumbo. The Foundation conducts surveys on how “organizational leaders have advanced professionalism among practicing physicians.” And it is very proud of its “Choosing Wisely” program, an initiative “to help providers and patients engage in conversations to reduce overuse of tests and procedures,” with pamphlets, videos and other means.

Doesn’t sound like much, until you crack open the 990s. This organization is loaded. In the tax year ended 2013, it brought in $20 million—not from contributions, not from selling a product, not for providing a service. No, the foundation earned $20 million on the $74 million in assets it holds.

The foundation racked up $5.2 million in expenses, which—other than $245,000 it gave to the ABIM—was divided into two categories: compensation and “other.” Who is getting all this compensation? The very same people who are top earners at the ABIM. Deep in the filings, it says the foundation spends $1.9 million in “program and project expenses,” with no explanation what the programs and projects are.

There are some expenditures, though, that are easy to understand: The foundation spends $153,439 a year on at least one condominium. And it picks up the tab so the spouse of the top-officer can fly along on business trips for free.
— Kurt Eichenwald

In July 2015, the Annals of Internal Medicine published an independent cost-analysis of the ABIM's maintenance-of-certification (MOC) program.[18] Using simulation modeling of the entire ABIM-certified workforce of US physicians, researchers from the University of California San Francisco and Stanford University estimated that the Feb 2015 version of ABIM MOC would cost $5.7 billion over ten years, including $561 million in ABIM fees and $5.1 billion in time costs (arising from 32.7 million physician hours spent completing MOC requirements). Internists will incur an average of $23 607 (95% CI, $5380 to $66 383) in MOC costs over 10 years, ranging from $16 725 for general internists to $40 495 for hematologists-oncologists. The authors concluded that "A rigorous evaluation of its effect on clinical and economic outcomes is warranted to balance potential gains in health care quality and efficiency against the high costs identified in this study."[19]

For the first time, the ABIM faces competition in the certification business from another entity, the National Board of Physicians and Surgeons (nbpas.org). Much of the controversy about the recent behavior of the ABIM is detailed on their new competitor's website, including a debate between the rival parties. In a survey on Sermo (a physician-only website), 97% of physicians favored the elimination of MOC.

See also

References

  1. ↑ ABIM. Number of candidates certified. Feb. 11, 2014. http://www.abim.org/pdf/data-candidates-certified/Number-Certified-Annually.pdf
  2. ↑ ABIM. Number of candidates certified. Feb. 11, 2014. http://www.abim.org/pdf/data-candidates-certified/Number-Certified-Annually.pdf
  3. ↑ ABIM. Number of candidates certified. Feb. 11, 2014. http://www.abim.org/pdf/data-candidates-certified/Number-Certified-Annually.pdf
  4. ↑ Meyer AD, Payne VL, Meeks DW, Rao R, Singh H. Physicians’ Diagnostic Accuracy, Confidence, and Resource Requests: A Vignette Study. JAMA Intern Med. 2013;173(21):1952-58. http://archinte.jamanetwork.com/article.aspx?articleid=1731967
  5. ↑ Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L. Accuracy of physician self-assessment compared with observed measures of competence: A systematic review. JAMA. 2006;296(9):1094-1102.
  6. ↑ Zevin B. Self Versus External Assessment for Technical Tasks in Surgery: A Narrative Review. Journal of Graduate Medical Education 2012;4(4):417-424. doi:10.4300/JGME-D-11-00277.1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3546569/pdf/i1949-8357-4-4-417.pdf
  7. ↑ Eva KW, Regehr G. "I'll never play professional football" and other fallacies of self-assessment. J Contin Educ Health Prof. 2008;28(1):14-19.
  8. ↑ Choudhry NK, Fletcher RH, Soumerai SB. Systematic review: The relationship between clinical experience and quality of health care. Ann Intern Med. 2005;142(4):260-273.
  9. ↑ Audet AM, Doty MM, Shamasdin J, Schoenbaum SC. Measure, learn, and improve: Physicians' involvement in quality improvement. Health Aff (Millwood). 2005;24(3):843-853.
  10. ↑ Hawkins RE, Lipner RS, Ham HP, Wagner R, Holmboe ES. American Board of Medical Specialties maintenance of certification: Theory and evidence regarding the current framework. J Contin Educ Health Prof. 2013; 33(S1): S7-S19,
  11. ↑ http://www.ama-assn.org/sub/accelerating-change/pdf/ama-medical-education-staff-leadership.pdf
  12. ↑ http://www.holbrookswordsmithing.com/blog-1/2015/2/10/ngo-pushes-for-centralized-power-control-over-physician-licensure
  13. ↑ http://www.nejm.org/doi/full/10.1056/NEJMp1407422
  14. ↑ http://www.nytimes.com/2014/12/16/opinion/board-certification-has-gone-too-far.html
  15. ↑ http://www.jpands.org/vol18no3/christman.pdf
  16. ↑ http://www.abim.org/news/abim-announces-immediate-changes-to-moc-program.aspx
  17. ↑ Lua error in package.lua at line 80: module 'strict' not found.
  18. ↑ http://annals.org/article.aspx?articleid=2398911
  19. ↑ http://annals.org/article.aspx?articleid=2398911

External links

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