The American Board of Internal Medicine is a 501 nonprofit, self-appointed physician-evaluation organization that certifies physicians practicing internal medicine and its subspecialties. The American Board of Internal Medicine is not a membership society, educational institution, or licensing body.
History
The American Board of Internal Medicine, 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, the American Board of Internal Medicine has categorized physicians into one or more of its 20 subspecialties based on training and the passing of a standardized exam, namely:
The current president and chief executive officer of the American Board of Internal Medicine is Richard J. Baron. The American Board of Internal Medicine adopted a governance structure that consists of three entities, namely a Board of Directors, ABIM Council, and Specialty Boards.
Certification
American Board of Internal Medicine 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 established by the Accreditation Council on Graduate Medical Education. Following regulations established by the American Board of Medical Specialties, 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
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 American Board of Internal Medicine 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 and more clinical experience does not necessarily lead to better outcomes of care.
Fewer than 30% of physicians examine their own performance data and try to improve. 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.
The validity of the studies that the American Board of Internal Medicine cites 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. 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. The American Board of Internal Medicine is an organization that attempts to assess physicians through proprietary testing and completion of required modules. The American Board of Internal Medicine has issued more than 425,000 initial certificates in internal medicine and its subspecialties in the United States and its territories since its founding. From 2001 to 2013, American Board of Internal Medicine certified 91,024 physicians in general internal medicine. From 2001 to 2013, the American Board of Internal Medicine certified more than 10,000 cardiologists and more than 6,400 medical oncologists. More than 140,000 physicians – including more than 8,000 physicians holding certifications that hold certifications which are valid indefinitely — are currently enrolled in the American Board of Internal Medicine's Maintenance of Certification program.
Maintenance of Certification (MOC)
The American Board of Internal Medicine asserts that research shows that physician knowledge deteriorates and practice habits and patterns fail to change, over time, in response to medical advances. Every 10 years, some internists and subspecialists certified in or after 1990 renew their certifications through the American Board of Internal Medicine's Maintenance of Certification program. The American Board of Internal Medicine's Maintenance of Certification program changed in January 2014. The program now requires physicians to:
Possess a valid medical license
Earn Maintenance of Certification points
Pass Maintenance of Certification exam in one's specialty every 10 years
Criticism of Maintenance of Certification Program
The Maintenance of Certification program 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. On February 3, 2015, the American Board of Internal Medicine announced more changes to the Maintenance of Certification program. In a press release, the American Board of Internal Medicine apologized that it had "clearly got it wrong", and it admitted that the program changes in January 2014 were instituted prematurely. The American Board of Internal Medicine has suspended the Patient Survey and Patient Safety components for at least two years, and it 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. In July 2015, the Annals of Internal Medicine published an independent cost-analysis of the American Board of Internal Medicine's Maintenance of Certification program. Using simulation modeling of the entire American Board of Internal Medicine-certified workforce of US physicians, researchers from the University of California San Francisco and Stanford University estimated that the Feb 2015 version of American Board of Internal Medicine Maintenance of Certification would cost $5.7 billion over ten years, including $561 million in American Board of Internal Medicine's fees and $5.1 billion in time costs. Internists will incur an average of $23,607 in Maintenance of Certification 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." For the first time, the American Board of Internal Medicine faces competition in the certification business from another entity, the National Board of Physicians and Surgeons. Much of the controversy about the recent behavior of the American Board of Internal Medicine 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 Maintenance of Certification.
