Tuesday, December 3, 2019

Eligibility for the Clinical Informatics Subspecialty - 2019 Update

I have been posting periodic updates of the eligibility for the physician clinical informatics subspecialty since the early days of the subspecialty, motivated by regular receipt of emails from physicians asking me questions about their individual eligibility. Rather than reply from the beginning each time, I replied with a link to the latest posting on eligibility in this blog and then instruct them to read the posting and write back to me with any questions specific to their situation. I also pointed out that my recommendations were just my interpretation of the rules, which were officially set by the American Board of Preventive Medicine (ABPM) for physicians of all specialties other than pathology, which were set by the American Board of Pathology (ABPath).

The very first posting was in 2013, which was then superseded by several minor updates. The overall eligibility rules have not changed much: As a subspecialty of all medical specialties, one must have a primary board certification in one of the 23 physician specialties that are recognized by the American Board of Medical Specialties (ABMS). Unfortunately, this excludes physicians who never achieved primary specialty certification or whose primary certification had lapsed. (Most board certifications now must be renewed every 10 years, although some of us trained in the era when boards such as the American Board of Internal Medicine [ABIM] granted lifetime certification.)

Perhaps the most significant update to my periodic postings came after 2016, when ABPM and ABPath extended the "grandfathering period" for an additional five years from 2017 to 2022. As with most new specialties and subspecialties, the clinical informatics subspecialty has a grandfathering period allowing one to become eligible to sit for the board exam and get certified through a certain level of practice or educational ("non-traditional" fellowship or master's degree) attainment.

With less than three years to go before the end of the grandfathering period, the window of opportunity for the practice or educational pathways is closing, especially for those who do not yet have any formal work or training in the field. It is unlikely that ABPM and ABPath will extend the grandfathering period beyond 2022. After that time, the only way to achieve board eligibility will be through a fellowship accredited by the Accreditation Council for Graduate Medical Education (ACGME).

For physicians who might be able to achieve eligibility via the Practice Pathway, my same advice from 2013 still holds: It will be more difficult, especially for mid-career physicians, to achieve board eligibility in or after 2023, when the only pathway to board certification will be to complete an ACGME-accredited fellowship. One other option for physicians will be the Advanced Health Informatics Certification being developed by AMIA. This will be a certification open to all who work in informatics but will be a pathway to certification for physicians who are not eligible for the ABMS clinical informatics subspecialty.

One fortunate happening since 2013 has been the marked improvement of the ABPM Web site, including its page describing eligibility for the clinical informatics subspecialty. (It was always somewhat ironic that the original Web site for the clinical informatics subspecialty was so poorly designed.) Another improvement of this page is the simplification of the explanation for becoming board-eligible, with all "grandfathering" now folded into the Practice Pathway. The site notes two options are available in the Practice Pathway (from which I quote):
  • Time in Practice: Three years of practice in Clinical Informatics is required. Practice time must be at least 25% of a Full-Time Equivalent (FTE) to be considered. Practice time need not be continuous, however, all practice time must have occurred in the five-year period preceding June 30 of the application year. Practice must consist of broad-based professional activity with significant Clinical Informatics responsibility. Fellowship activity that is less than 24 months in duration or non-ACGME accredited may be applied toward the practice activity requirement. The actual training must be described for any fellowship activity. Documentation of Clinical Informatics research and teaching activities may also be submitted for review.
  • Masters or PhD in Biomedical Informatics: Credit for completion of a 24 month Masters or PhD program in Biomedical Informatics, Health Sciences Informatics, Clinical Informatics, or a related subject from a university/college in the US and Canada, deemed acceptable by the Board (e.g. NLM university-based Biomedical Informatics Training) may be substituted for the Time in Practice option above.
So what are the options for clinical informatics board subspecialty eligibility in late 2019? Since the 2022 exam is now less than three years away, the Time in Practice pathway is closed unless one has already been in a qualifying position since mid-2019 or earlier. Fortunately, the Masters pathway is still open, and our online Masters program at Oregon Health & Science University (OHSU) fits the criteria of the second bullet above, namely our being part of a program that is a National Library of Medicine (NLM) university-based training program. Indeed, we have a number of physicians who have enrolled in the program with the intent of graduating by June 2022 and becoming board-eligible for the 2022 exam. Several of them have formed a cohort to work together toward that goal.