A common reason given for the establishment of clinical informatics as a physician subspecialty is the recognition of the growing role of physicians who work in informatics professionally, particularly in operational clinical settings. Sometimes this is viewed almost synonymous with the Chief Medical Informatics Officer (CMIO) and related roles in healthcare provider organizations.
However, I prefer to think of the subspecialty more broadly. Even if the CMIO is the most common or aspired to position for clinical informatics subspecialists, we should still consider other career paths, especially for those who will increasingly be trained in formal fellowships. Just as physicians of other specialties may enter private practice, managed care settings, academia, and even industry, so should we view the breadth of options for those trained in clinical informatics. I certainly hope there will be pathways from clinical fellowships into academic careers for these physicians.
I was recently involved in a discussion on an email list where many CMIOs lamented that many of the questions on the clinical informatics subspecialty board exam did not seem pertinent to their day-to-role as CMIOs. That led me to raise the question, do we view this subspecialty as primarily focused on the CMIO role, or should it cover broader aspects of clinical informatics? Not being a CMIO, and being in academia, my sentiments are with the broader view. But on the other hand, as the CMIO is a prominent position for those working in this field, and perhaps the most common one, it does deserve important consideration.
This discussion is highly relevant to those of us standing up ACGME-accredited clinical informatics fellowships. We certainly want our fellows to gain substantial operational experience. But I would advocate that they also learn the fundamentals of the informatics field, and believe that although a little dated since its creation in 2009, the Core Content outline covers it pretty well.
Just as while most physicians in a specialty (e.g., internal medicine) do not use the entire spectrum of knowledge in their fields on a daily basis, I believe our clinical informatics fellowships should take the same approach and that the board exam should reflect comparable breadth. I do not believe there is anything in the Core Content outline that is completely superfluous to the practice of being a CMIO or other jobs applying clinical informatics.
The challenge, then, is how to create a fellowship program and board exam to reflect the broader field. Informatics has always had (and I am a product of) the research-oriented NLM fellowships. Even though focused on research, these fellowships have produced diverse outcomes, including some CMIOs. While the focus on clinical fellowships is somewhat different, there should be no reason why graduates of these fellowships should not be able to pursue careers in academia, research, industry, and other settings.