American Board of Internal Medicine
|This article needs additional citations for verification. (September 2012)|
The American Board of Internal Medicine (ABIM) is a non-profit, independent physician evaluation organization committed to continuously improving the profession for the public good by certifying physicians who practice internal medicine and its sub-specialties. It is not a membership society, educational institution or licensing body but an organization that assess the clinical judgment, skills and attitudes essential for the delivery of quality patient care. More than 200,000 physicians are ABIM Board certified – about one out of every four physicians practicing in the United States. Richard J. Baron, MD, MACP, is ABIM's current President and CEO.
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 be an independent evaluator of physicians. Since that time, ABIM has worked to ensure a high level of competence in the American health system by certifying physicians who practice internal medicine in one or more of its 20 subspecialties.
- Adolescent Medicine
- Adult Congenital Heart Disease
- Advanced Heart Failure & Transplant Cardiology
- Cardiovascular Disease
- Clinical Cardiac Electrophysiology
- Critical Care Medicine
- Endocrinology, Diabetes & Metabolism
- Geriatric Medicine
- Hospice & Palliative Care
- Hospital Medicine
- Infectious Disease
- Interventional Cardiology
- Medical Oncology
- Pulmonary Disease
- Sleep Medicine
- Transplant Hepatology
ABIM Board Certification demonstrates that physicians have met rigorous standards through intensive study, self-assessment and evaluation. Additionally, certification encompasses the six general competencies established by the Accreditation Council on Graduate Medical Education (ACGME) and sets the stage for continual professional development through values centered on lifelong learning. 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 have passed a secure examination. Unlike licensure, board certification is not a requirement to practice medicine. However, board certification is widely accepted as a marker of excellence. Most 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.
A growing body of research (produced above all by the employees and subcontractors of the ABIM and affiliates) suggests (by association but not with outcome based scientific proof) that physicians who are board certified deliver higher quality of care than their non-certified colleagues and that board certification is correlated with:
- Better outcomes and more reliable care(N.B. reference is authored by ABIM) The ABIM and affiliates have gross cumulative income reaching $325 Million in 2011 and pay CEO salaries as non-profit organizations six and seven figure salaries. They are a non-validated non-government service and have lobbied congress to impose financial penalties on any physician who does NOT subscribe to their programs under the Physician Quality Reporting System (PQRS-MOC) incentives. The concept of Board Certification was conceived as a testing validation of medical training documenting "attainment of consultant status" and has now been expanded as a financial juggernaut under the Continuous Maintenance of Certification (C-MOC) to conscript all physicians into yearly payments to sustain what was once a lifelong certification as now becoming dependent upon continual payments to these board organizations.
"The lack of compelling evidence favoring recertification may be one reason why many " grandfathered" American Board of Internal Medicine (ABIM) physicians have not taken the recertification examination. In fact, a review of the ABIM's physician executives and board of directors manually entered into the ABIM certification verification window indicates that few of these leaders (5 of 27) who are grandfathered in internal medicine have taken the internal medicine recertification examination that the ABIM encourages."
- Lower mortality rates
- Higher rates of preventive services
Maintenance of Certification (MOC)
Research shows that in general, over time, knowledge deteriorates and practice habits and patterns fail to change in response to medical advances. Maintenance of Certification (recertification) promotes lifelong learning and enhancement of the clinical judgment and skills essential for high quality patient care. Every 10 years, some internists and subspecialists certified in or after 1990 renew their certifications through ABIM's Maintenance of Certification program, even though no data exists to suggest the program accomplishes its goals.
Fewer than 30 percent of physicians examine their own performance data, and physicians' ability to independently self-assess and self-evaluate is poor. Physicians value a framework that provides them with both guidance and trusted data to conduct self-evaluations so they can see what changes they need to make to improve the quality of care they deliver, and MOC may provides a framework. Additionally, board certification is an important factor when patients choose a physician and a some patients expect their physicians to participate in Maintenance of Certification.
There are four elements to ABIM's Maintenance of Certification program:
- Verification of Credentials: Physicians must have a valid, unrestricted license to practice medicine. An action against a license compromises the most basic professional credential.
- Self-Evaluation of Medical Knowledge: Physicians use open-book, Web-based modules developed by ABIM or others to self-assess their own clinical area. These stimulate learning but also require that learning be documented. Medical knowledge and the technology essential to care are evolving at an incredible rate, and these modules provide physicians another way to keep current.
- Self-Evaluation of Practice Performance: ABIM requires that physicians engage in a quality improvement activity. A variety of quality improvement pathways are available, including ABIM PIMs Practice Improvement Modules and Approved Quality Improvement (AQI) programs. These are lso options available for those with access to quality data from external sources, for those who practice in academic settings and those who are clinically inactive.
- Physicians use PIMs and AQI programs to assess their performance in a clinical area relevant to their practice, compare their performance to clinical guidelines, develop a plan to improve important aspects of their practice, and assess the impact of that improvement plan. Self-assessment of performance in practice helps physicians see that the quality of care they provide is not always what they expected, and establishes measurement and improvement as valuable parts of practice (rather than externally imposed requirements).
- Secure Examination: Physicians are required to pass a closed-book, proctored, computer-based exam. The exam includes questions that are pre-tested for relevance, and create a simulated environment in which critical aspects of clinical knowledge and judgment can be evaluated. It is not just what physicians know—but how they use what they know to diagnose and treat illness effectively and efficiently—that matters.
- Holmboe ES, Wang Y, Meehan TP, Tate JP, Ho SY, Starkey KS, Lipner RS (2008). "Association between maintenance of certification examination scores and quality of care for medicare beneficiaries". Arch Intern Med. 168 (13). pp. 1396–1403.
- Wenghofer E, Klass D, Abrahamowicz M, Dauphinee D, Jacques A, Smee S, et al. (2009). "Doctor scores on national qualifying examinations predict quality of care in future practice". Med Educ. 43. pp. 1166–1173. "Association between maintenance of certification examination scores and quality of care for medicare beneficiaries."
- Mayo Clin Proc. Sept 2013:88(9):1035 http://dx.doi.org/10.1016/j.mayocp.2013.07.005
- American Board of Internal Medicine (ABIM)
- The ABIM Foundation
- American Board of Medical Specialties (ABMS)
- American Board of Physician Specialties (ABPS)