The newly formed American Board of Addiction Medicine has certified more than 1,600 physicians as specialists in addiction medicine so far this year, including more than 200 internists. Physicians from multiple disciplines who meet expertise criteria are taking advantage of the opportunity to be “grandfathered in” to the nascent specialty by taking a special 6-hour certifying examination.
Dr. Kevin B. Kunz, president of the American Board of Addiction Medicine (ABAM), said in an interview that the 15 physicians on the ABAM board of directors will create a new examination to certify physicians after the grandfathering option ends in December. Previously, only psychiatrists could claim addiction-related board certification.
Official recognition of addiction expertise is being expanded to include internists, family physicians, emergency physicians, ob.gyns., surgeons, pediatricians, preventive medicine physicians, and neurologists.
“There are already folks out there toiling in relative obscurity in addiction medicine,” internist Peter D. Friedmann said in an interview. “Creation of the ABAM was driven by the need for better recognition within medicine.” The American Society of Addiction Medicine provided a certification exam for years, “but it was not accorded the same respect and gravitas as fields that have their own subspecialty boards.” Dr. Friedmann of Brown University in Providence, R.I., is one of the internists who took advantage of the grandfathering option.
Criteria for certification grandfathering include at least 1,950 hours over the past decade providing addiction-related care, research, and/or education; 50 hours of CME related to addiction medicine in the past 2 years; letters of recommendation supporting proficiency in this area; and successful completion of the examination.
Primary care physicians will continue to play a large role in addiction care because “there will never be enough ABAM-certified specialists to treat everyone,” Dr. Friedmann said. “It would be like expecting everyone with hypertension to be treated by a cardiologist.”
“So many of the more than 120 million emergency department visits each year are due to substance abuse,” said Dr. Gail D'Onofrio of the ABAM board of directors and section chief of emergency medicine at Yale University in New Haven, Conn. Dr. D'Onofrio cited a statewide survey of seven Tennessee EDs showing that 31% of screened patients tested positive for substance abuse and 27% were assessed as needing substance abuse treatment.
Unfortunately, emergency physicians identified only 1% as having a diagnosis or problem related to substance abuse (Ann. Emerg. Med. 2003;41:802-13). ABAM plans to establish addiction medicine residency programs and get them recognized by the Accreditation Council for Graduate Medical Education (ACGME). “We expect these programs to be in place by 2011, after which time we will add a residency requirement to ABAM certification, as well as a maintenance-of-certification program,” Dr. Kunz said.
There is a core content shared among all specialties treating addiction, and therefore one examination, but individual specialties could add their own content to fellowship programs, Dr. D'Onofrio noted.
Once these requirements are in place, ABAM will seek recognition from the American Board of Medical Specialties (ABMS), which may take another 4-6 years. “We want addiction prevention, screening, intervention, and treatment to become routine aspects of medical care, available virtually any place health care is provided,” noted Dr. Jeffrey H. Samet, ABAM president-elect and professor of medicine at Boston University.
Reimbursement for addiction-related services remains a challenge. “These are difficult patients who take time and for whom there has been little reimbursement,” Dr. Kunz said. Although reimbursement codes for addiction screening and brief intervention in addiction are recognized by Medicare, some states, and some private insurers, “reimbursement for doing this work is still quite low,” Dr. Friedmann said. Better financial incentives are needed to encourage physicians to get into this field and make it a career, he added.
The codes for screening and intervention “are very important. You can't get doctors to do something they won't get paid to do,” Dr. Sokol said.
The next ABAM examination is scheduled for Dec. 11, 2010. Application deadlines are Oct. 31, 2009; Jan. 31, 2010; and April 30, 2010. More information is available at www.asam.org/ABAM.html