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ORLANDO – The American Board of Internal Medicine is taking a potentially controversial step into the future by adding nonphysicians to both its main board and its subspecialty boards, a move that would give them a say in what defines being a good doctor.
The ABIM began the change in its governance process about 3 years ago, and took the first steps last July when it broke up its 29-member board of directors into two smaller panels: the board of directors and the ABIM council. The board will focus on governance issues, and the council will hone in on the assessment process itself. A few weeks ago, the board approved the addition of two new "public" members, including a health care executive and an official with a consumer organization.
*The subspecialty boards will remain the same, but add non-physician members. The boards will create exam committees, but those will be made up entirely of physicians.
Why the new structure?
One of the ABIM’s core roles is "to offer a professionally sanctioned definition of what a good doctor is," said Dr. Richard J. Baron, president and chief executive officer of the ABIM, in an interview. Physicians have always defined what that means, he said. But the world has changed, and "the definition doesn’t just belong to doctors," said Dr. Baron, who is also a past chair of the ABIM board.
Physicians now have to answer to payers that want to reward performance and measure quality. They also have to answer to patients. "I think there’s an increasingly clear recognition that medicine is a service profession," said Dr. Baron.
"It’s hard for us to say whether we are meeting the needs of our patients if we don’t find ways to ask them if we are. That’s a pretty important evolutionary transformation in assessing how well we do what we do," he said. "Having patients around the table as we think about the standards that we generate will help us have some assurance that we’re actually doing that."
By the same token, as physicians start working more with health care teams, having a team member help define what makes a good doctor also makes sense, said Dr. Baron.
The ABIM will soon announce the names of the nonphysicians who were confirmed in April by the ABIM Board. One is a health care executive who has experience heading a Medicaid managed care company and has also been a senior official with the Department of Health & Human Services. The second is the leader of a widely respected consumer organization, said Dr. Baron.
The main board now has 12 directors, with a maximum of 15. Up to 20% of the board’s membership can be made up of noninternists.
The council has up to 18 members, and will:
• Determine the requirements for certification and maintenance of certification across all the internal medicine disciplines.
• Harmonize ABIM standards with those of other recognized physician education and assessment initiatives.
• Set and integrate operational policies and procedures across the specialty boards.
• Evaluate proposals for new specialties/focused practice areas.
Some subspecialty board members migrated to the council. And the council has some at-large members who have expertise in performance improvement, quality measures, or health information technology. The council also will add members who can offer the patient and caregiver perspective and the health care team perspective.
Overhaul of subspecialty boards
The ABIM also decided it was time to reorganize the subspecialty boards, in part so they could more effectively design quality improvement and performance assessment modules for the MOC (maintenance of certification) process.
The role of the subspecialty boards is to define, refine, and set standards in certification and MOC in the discipline; perform oversight/review of performance assessments in the discipline; and build partnerships with societies and other organizational stakeholders in support of ABIM work.
In the past, the subspecialty boards were mainly charged with developing the exam for each specialty. But as the certification and MOC processes have evolved, the subspecialty board members have not been equipped to flesh out the exam, said Dr. Baron.
Each new exam committee will have from six to eight members, with physicians from the particular specialty. But the committees also will have at least one community physician in nonacademic practice and two public, nonphysician members. This will include, for example, a nurse practitioner who’s part of a patient-centered medical home, or a diabetes educator. And it also will include someone who can give the patient or caregiver perspective, said Dr. Baron.
The ABIM has selected exam committee members for internal medicine, critical care medicine, endocrinology, diabetes and metabolism, gastroenterology, geriatric medicine, hematology, infectious disease, medical oncology, nephrology, pulmonary disease, and rheumatology. Members of the committees will be announced in July.
The cardiology committee will contain a handful of tertiary specialties, including adult congenital heart disease, advanced heart failure and transplant cardiology, cardiovascular disease, clinical cardiac electrophysiology, and interventional cardiology.
Other specialties will be addressed in the near future.
Acceptance slow
So far, the ABIM’s governance and structural shifts seem to have largely gone unnoticed by internists, said Dr. Baron. In part, it’s because governance is a bit of sausage making that may not be of interest to outsiders. But it’s also because of the understandable focus on the changes to the MOC process, he observed.
And, the changes to the ABIM board and its subspecialty boards aren’t likely to have an impact on certification or recertification exams in the near future, Dr. Baron said.
But it will have an impact. And the addition of nonphysicians may not be wholly embraced.
Dr. Baron recalled that while giving a talk about the governance changes at the American College of Cardiology’s annual meeting in March, an ACC physician member stood up and said that he could not imagine why the ABIM thought it made sense to have a patient on the board.
"[He] congratulated me with great sarcasm on my political correctness," Dr. Baron said. " ‘What do [patients] know about being a cardiologist?’ " the physician asked.
This is "a view that many members of our physician community have," Dr. Baron noted, but he believes others will see the merits of bringing in other stakeholders.
On Twitter @aliciaault
*Correction 4/24/14: A previous version of this story misstated that the ABIM would rename the subspecialty boards. The story has been updated.
Thirty years ago, passing a board examination in internal medicine or one of its subspecialties was a rite of passage. The successful examinee had proven that they had mastered the complexities of their chosen medical discipline. One understood that there was more to clinical practice than medical knowledge, but the public demonstration of sufficient medical knowledge was a core requisite of that practice.
As a profession, we grudgingly accepted first recertification, and then the mysterious Maintenance of Certification process, as proof of our continued intellectual competency. We assented without much complaint to the increased costs and the constantly changing specifics of the certification process.
Now we learn that others, such as community physicians, health care executives, and consumer advocates, will have a place on the ABIM to pass judgment on the professional, knowledge-based, assessment of experts in internal medicine and its subspecialties. Instead of just "taking our boards," it may well be time to speak up and take them back!
Thirty years ago, passing a board examination in internal medicine or one of its subspecialties was a rite of passage. The successful examinee had proven that they had mastered the complexities of their chosen medical discipline. One understood that there was more to clinical practice than medical knowledge, but the public demonstration of sufficient medical knowledge was a core requisite of that practice.
As a profession, we grudgingly accepted first recertification, and then the mysterious Maintenance of Certification process, as proof of our continued intellectual competency. We assented without much complaint to the increased costs and the constantly changing specifics of the certification process.
Now we learn that others, such as community physicians, health care executives, and consumer advocates, will have a place on the ABIM to pass judgment on the professional, knowledge-based, assessment of experts in internal medicine and its subspecialties. Instead of just "taking our boards," it may well be time to speak up and take them back!
Thirty years ago, passing a board examination in internal medicine or one of its subspecialties was a rite of passage. The successful examinee had proven that they had mastered the complexities of their chosen medical discipline. One understood that there was more to clinical practice than medical knowledge, but the public demonstration of sufficient medical knowledge was a core requisite of that practice.
As a profession, we grudgingly accepted first recertification, and then the mysterious Maintenance of Certification process, as proof of our continued intellectual competency. We assented without much complaint to the increased costs and the constantly changing specifics of the certification process.
Now we learn that others, such as community physicians, health care executives, and consumer advocates, will have a place on the ABIM to pass judgment on the professional, knowledge-based, assessment of experts in internal medicine and its subspecialties. Instead of just "taking our boards," it may well be time to speak up and take them back!
ORLANDO – The American Board of Internal Medicine is taking a potentially controversial step into the future by adding nonphysicians to both its main board and its subspecialty boards, a move that would give them a say in what defines being a good doctor.
The ABIM began the change in its governance process about 3 years ago, and took the first steps last July when it broke up its 29-member board of directors into two smaller panels: the board of directors and the ABIM council. The board will focus on governance issues, and the council will hone in on the assessment process itself. A few weeks ago, the board approved the addition of two new "public" members, including a health care executive and an official with a consumer organization.
*The subspecialty boards will remain the same, but add non-physician members. The boards will create exam committees, but those will be made up entirely of physicians.
Why the new structure?
One of the ABIM’s core roles is "to offer a professionally sanctioned definition of what a good doctor is," said Dr. Richard J. Baron, president and chief executive officer of the ABIM, in an interview. Physicians have always defined what that means, he said. But the world has changed, and "the definition doesn’t just belong to doctors," said Dr. Baron, who is also a past chair of the ABIM board.
Physicians now have to answer to payers that want to reward performance and measure quality. They also have to answer to patients. "I think there’s an increasingly clear recognition that medicine is a service profession," said Dr. Baron.
"It’s hard for us to say whether we are meeting the needs of our patients if we don’t find ways to ask them if we are. That’s a pretty important evolutionary transformation in assessing how well we do what we do," he said. "Having patients around the table as we think about the standards that we generate will help us have some assurance that we’re actually doing that."
By the same token, as physicians start working more with health care teams, having a team member help define what makes a good doctor also makes sense, said Dr. Baron.
The ABIM will soon announce the names of the nonphysicians who were confirmed in April by the ABIM Board. One is a health care executive who has experience heading a Medicaid managed care company and has also been a senior official with the Department of Health & Human Services. The second is the leader of a widely respected consumer organization, said Dr. Baron.
The main board now has 12 directors, with a maximum of 15. Up to 20% of the board’s membership can be made up of noninternists.
The council has up to 18 members, and will:
• Determine the requirements for certification and maintenance of certification across all the internal medicine disciplines.
• Harmonize ABIM standards with those of other recognized physician education and assessment initiatives.
• Set and integrate operational policies and procedures across the specialty boards.
• Evaluate proposals for new specialties/focused practice areas.
Some subspecialty board members migrated to the council. And the council has some at-large members who have expertise in performance improvement, quality measures, or health information technology. The council also will add members who can offer the patient and caregiver perspective and the health care team perspective.
Overhaul of subspecialty boards
The ABIM also decided it was time to reorganize the subspecialty boards, in part so they could more effectively design quality improvement and performance assessment modules for the MOC (maintenance of certification) process.
The role of the subspecialty boards is to define, refine, and set standards in certification and MOC in the discipline; perform oversight/review of performance assessments in the discipline; and build partnerships with societies and other organizational stakeholders in support of ABIM work.
In the past, the subspecialty boards were mainly charged with developing the exam for each specialty. But as the certification and MOC processes have evolved, the subspecialty board members have not been equipped to flesh out the exam, said Dr. Baron.
Each new exam committee will have from six to eight members, with physicians from the particular specialty. But the committees also will have at least one community physician in nonacademic practice and two public, nonphysician members. This will include, for example, a nurse practitioner who’s part of a patient-centered medical home, or a diabetes educator. And it also will include someone who can give the patient or caregiver perspective, said Dr. Baron.
The ABIM has selected exam committee members for internal medicine, critical care medicine, endocrinology, diabetes and metabolism, gastroenterology, geriatric medicine, hematology, infectious disease, medical oncology, nephrology, pulmonary disease, and rheumatology. Members of the committees will be announced in July.
The cardiology committee will contain a handful of tertiary specialties, including adult congenital heart disease, advanced heart failure and transplant cardiology, cardiovascular disease, clinical cardiac electrophysiology, and interventional cardiology.
Other specialties will be addressed in the near future.
Acceptance slow
So far, the ABIM’s governance and structural shifts seem to have largely gone unnoticed by internists, said Dr. Baron. In part, it’s because governance is a bit of sausage making that may not be of interest to outsiders. But it’s also because of the understandable focus on the changes to the MOC process, he observed.
And, the changes to the ABIM board and its subspecialty boards aren’t likely to have an impact on certification or recertification exams in the near future, Dr. Baron said.
But it will have an impact. And the addition of nonphysicians may not be wholly embraced.
Dr. Baron recalled that while giving a talk about the governance changes at the American College of Cardiology’s annual meeting in March, an ACC physician member stood up and said that he could not imagine why the ABIM thought it made sense to have a patient on the board.
"[He] congratulated me with great sarcasm on my political correctness," Dr. Baron said. " ‘What do [patients] know about being a cardiologist?’ " the physician asked.
This is "a view that many members of our physician community have," Dr. Baron noted, but he believes others will see the merits of bringing in other stakeholders.
On Twitter @aliciaault
*Correction 4/24/14: A previous version of this story misstated that the ABIM would rename the subspecialty boards. The story has been updated.
ORLANDO – The American Board of Internal Medicine is taking a potentially controversial step into the future by adding nonphysicians to both its main board and its subspecialty boards, a move that would give them a say in what defines being a good doctor.
The ABIM began the change in its governance process about 3 years ago, and took the first steps last July when it broke up its 29-member board of directors into two smaller panels: the board of directors and the ABIM council. The board will focus on governance issues, and the council will hone in on the assessment process itself. A few weeks ago, the board approved the addition of two new "public" members, including a health care executive and an official with a consumer organization.
*The subspecialty boards will remain the same, but add non-physician members. The boards will create exam committees, but those will be made up entirely of physicians.
Why the new structure?
One of the ABIM’s core roles is "to offer a professionally sanctioned definition of what a good doctor is," said Dr. Richard J. Baron, president and chief executive officer of the ABIM, in an interview. Physicians have always defined what that means, he said. But the world has changed, and "the definition doesn’t just belong to doctors," said Dr. Baron, who is also a past chair of the ABIM board.
Physicians now have to answer to payers that want to reward performance and measure quality. They also have to answer to patients. "I think there’s an increasingly clear recognition that medicine is a service profession," said Dr. Baron.
"It’s hard for us to say whether we are meeting the needs of our patients if we don’t find ways to ask them if we are. That’s a pretty important evolutionary transformation in assessing how well we do what we do," he said. "Having patients around the table as we think about the standards that we generate will help us have some assurance that we’re actually doing that."
By the same token, as physicians start working more with health care teams, having a team member help define what makes a good doctor also makes sense, said Dr. Baron.
The ABIM will soon announce the names of the nonphysicians who were confirmed in April by the ABIM Board. One is a health care executive who has experience heading a Medicaid managed care company and has also been a senior official with the Department of Health & Human Services. The second is the leader of a widely respected consumer organization, said Dr. Baron.
The main board now has 12 directors, with a maximum of 15. Up to 20% of the board’s membership can be made up of noninternists.
The council has up to 18 members, and will:
• Determine the requirements for certification and maintenance of certification across all the internal medicine disciplines.
• Harmonize ABIM standards with those of other recognized physician education and assessment initiatives.
• Set and integrate operational policies and procedures across the specialty boards.
• Evaluate proposals for new specialties/focused practice areas.
Some subspecialty board members migrated to the council. And the council has some at-large members who have expertise in performance improvement, quality measures, or health information technology. The council also will add members who can offer the patient and caregiver perspective and the health care team perspective.
Overhaul of subspecialty boards
The ABIM also decided it was time to reorganize the subspecialty boards, in part so they could more effectively design quality improvement and performance assessment modules for the MOC (maintenance of certification) process.
The role of the subspecialty boards is to define, refine, and set standards in certification and MOC in the discipline; perform oversight/review of performance assessments in the discipline; and build partnerships with societies and other organizational stakeholders in support of ABIM work.
In the past, the subspecialty boards were mainly charged with developing the exam for each specialty. But as the certification and MOC processes have evolved, the subspecialty board members have not been equipped to flesh out the exam, said Dr. Baron.
Each new exam committee will have from six to eight members, with physicians from the particular specialty. But the committees also will have at least one community physician in nonacademic practice and two public, nonphysician members. This will include, for example, a nurse practitioner who’s part of a patient-centered medical home, or a diabetes educator. And it also will include someone who can give the patient or caregiver perspective, said Dr. Baron.
The ABIM has selected exam committee members for internal medicine, critical care medicine, endocrinology, diabetes and metabolism, gastroenterology, geriatric medicine, hematology, infectious disease, medical oncology, nephrology, pulmonary disease, and rheumatology. Members of the committees will be announced in July.
The cardiology committee will contain a handful of tertiary specialties, including adult congenital heart disease, advanced heart failure and transplant cardiology, cardiovascular disease, clinical cardiac electrophysiology, and interventional cardiology.
Other specialties will be addressed in the near future.
Acceptance slow
So far, the ABIM’s governance and structural shifts seem to have largely gone unnoticed by internists, said Dr. Baron. In part, it’s because governance is a bit of sausage making that may not be of interest to outsiders. But it’s also because of the understandable focus on the changes to the MOC process, he observed.
And, the changes to the ABIM board and its subspecialty boards aren’t likely to have an impact on certification or recertification exams in the near future, Dr. Baron said.
But it will have an impact. And the addition of nonphysicians may not be wholly embraced.
Dr. Baron recalled that while giving a talk about the governance changes at the American College of Cardiology’s annual meeting in March, an ACC physician member stood up and said that he could not imagine why the ABIM thought it made sense to have a patient on the board.
"[He] congratulated me with great sarcasm on my political correctness," Dr. Baron said. " ‘What do [patients] know about being a cardiologist?’ " the physician asked.
This is "a view that many members of our physician community have," Dr. Baron noted, but he believes others will see the merits of bringing in other stakeholders.
On Twitter @aliciaault
*Correction 4/24/14: A previous version of this story misstated that the ABIM would rename the subspecialty boards. The story has been updated.
FROM ACP 2014
