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Tuesday, January 29, 2008

The ABIM's certification in Comprehensive Internal Medicine -too silly even for the ACP?

The American College of Physicians (ACP) apparently has problems with the latest proposal from the American Board of Internal Medicine (ABIM) which involves the concept of the Comprehensive Care Internist (CCIM). I have written about this before when details were few but now the plan has been revealed-although some particulars remain to be worked out.

Here is the executive summary of the proposal and from that the interested reader can access all the details. When I read the details I concluded that ABIM is proposing certification for a type practice that really doesn't exist which will involve assessment of various skills and roles for which they have no assessment tools. ACP addresses that fact in more polite understatement;

"The lack of valid and reliable assessment tools for CCIM competencies is a substantial limitation."

Yes, not having the tools to assess the competencies on which the certification is based would be a limitation -actually it would be impossible.

Internists who earn this new certificate would be referred to a "Comprehensive Care Internists". The standard dictionary definition of the word comprehensive is including all or everything.
Since the comprehensive care internist would be basically an physician doing office work and not taking care of sick patients in the hospital ( an activity once associated with internists) the designation "comprehensive" seems off base. I suggest the term Non-comprehensive Care Internist would be more appropriate. Although the "comprehensive" internist would not take care of sick patients in the hospital she would be certified as a "change agent" and a "team leader" -that is once they figure out how to assess those skills. I feel confident that if my very elderly but still very savvy and sharp aunt were asked what she wants in her physician what she would not say is that she wanted someone who was a change agent and a team leader.

In summary, then we have a proposal for a board certification for a comprehensive internist whose practice is really not comprehensive that envisions a type of practice that really does quite exist yet and for which the set of tools to carry out the assessment do not exist. Sounds like a plan.


Anonymous said...

As I understand it ABIM's plan for the CCIM was a response to the crisis in primary care.Since all they do is "certify" internists their solution was to think up still another certification ladder to climb.If your only tool is a hammer...

Anonymous said...

Like any other business, some specialty boards like the ABIM and the ABFM have become big business with an established bureaucracy (think JCAHO too). In order for them to remain in business and justify their nice offices and big executive salaries, they need to come up with new products, those being new subspecialties and new certification exams and exercises. The CCIM certification seems to me to be directed toward the potential "concierge" physician who wants to distinguish himself and promote his own business. The ABIM sees more and more internists going this route. Very progressive thinking!

Anonymous said...

Interesting thought about the CCIM target.I think the target is more likely the internists who buy into the vague,benign sounding Medical Home rhetoric which so far seems to exist only in the super managed care version floated by United Health Group.