Eligibility for the Clinical Informatics Subspecialty, 2014 Update

One of the posts in this blog with the most page views ever is my January, 2013 description on eligibility for the clinical informatics subspecialty for physicians. No doubt part of the reason for its popularity was my using the post as a starting point for replying to those emailing or otherwise contacting me with questions about their own eligibility.

A year later, I still get such emails and inquiries. While the advice in the 2013 post is largely still correct, we have had the ensuing experience of the first year of the board exam, who qualified to sit for it, and what proportion of those taking the test passed. We can also put various educational offerings in context, not only for their content, but also for how the two boards qualifying physicians for the exam, the American Board of Preventive Medicine (ABPM) and the American Board of Pathology (ABP), viewed them in terms of eligibility to sit for the exam.

The official eligibility statement for the subspecialty is unchanged from last year and is documented in the same PDF file posted then from the ABPM (and summarized by the ABP). One must be a physician who has board certification in one of the primary 23 subspecialties. They must have an active and unrestricted medical license in one US state. For the first five years of the subspecialty (through 2018), the "practice pathway" or completing a "non-traditional fellowship" (i.e. one not accredited by the Accreditation Council for Graduate Medical Education, or ACGME) will allow physicians to "grandfather" the training requirements, i.e., take the exam without completing a formal fellowship accredited by the ACGME.

I have some observations about who was deemed eligible for the exam, although as always, let me give the standard disclaimer that ABPM and ABP are the ultimate arbiters of eligibility, and anyone who has questions should contact ABPM (for physicians in any specialty except pathology) and ABP (for physicians in pathology). I am only interpreting their rules.

One concern many had was the "nontraditional fellowship" for eligibility, in particular whether a master's degree in informatics would allow one to qualify. I argued that a master's degree alone should have qualified someone, since if nothing else, it (at least ours at OHSU) might meet the practice pathway time requirement, with educational time being "worth" one-half of the time of practice, and a master's degree being equivalent to at least 1-1/2 years of full-time study (i.e., 0.5 FTE over three years). (I also asserted last year that anyone education from OHSU would have the background to pass the exam. Experience bore me out, as at least 40 OHSU informatics alumni and current students - some qualifying by additional practice time in the practice pathway - passed the exam, and I am not aware of anyone from our program who did not pass it.)

We have also learned from the experience of having the first exam offered. It was exciting to see 456 diplomates newly certified in the subspecialty, including myself. However, I (and a number of others) were somewhat surprised at the pass rate of 91% for the exam being so high, given the vast body of knowledge covered by the exam and the lack of formal training, especially "book" training, of many who took the exam. It is not uncommon for pass rates for those grandfathering training requirements into a new subspecialty to be much lower. We do not know how the exam or its pass rate may change this year or beyond.

This challenges my statement in last year's posting that a single course, such as 10x10 ("ten by ten") or the American Medical Informatics Association (AMIA) Clinical Informatics Board Review Course, may not be enough. But perhaps with the experience brought to the table by qualifying via the practice pathway, a large amount of additional education is not necessary.

One bit of advice I can certainly give to any physician who meets the practice pathway qualifications (or can do so before 2018) is to sit for the exam before the end of grandfathering period. After that time, the only way to become certified in the subspecialty will be to complete a two-year, on-site, ACGME-accredited fellowship. While we are excited to be developing such a fellowship at OHSU, it will be a challenge for those who are mid-career, with jobs, family, and/or geographical roots, to up and move to become board-certified.

There are actually a number of categories of individuals for whom getting certified in the subspecialty after the grandfathering period will be a challenge:

• Those who are mid-career - I have written in the past that the age range of OHSU online informatics students, including physicians, is spread almost evenly across all ages up to 65.
• Those pursuing research training in informatics, such as an NLM fellowship or, in the case of some of our current students, in an MD/PhD program (and will not finish their residency until after the grandfathering period ends). Why must these individuals also need to pursue a clinical fellowship?
• Those who already have had long medical training experiences, such as subspecialists with six or more years of training - Would such individuals want to do two additional years of informatics when, as I recently pointed out, it might be an ideal experience for them to overlay informatics and their subspecialty training?

Fortunately one option for physicians who do want some sort of certification will be the Advanced Interprofessional Informatics Certification being developed by AMIA. These physicians can and will still apply informatics to make important contributions to healthcare. I am pleased to report that AMIA has revamped its efforts to create this certification, not only for these physicians but also other practitioners of informatics.