Saturday, November 12, 2016

ABPM Extends “Grandfathering” Period for Clinical Informatics Physician Subspecialty Through 2022

The single most-viewed entry in the history of this blog is a posting from 2013 describing eligibility for the clinical informatics subspecialty for physicians. This was partly due to my wanting to have a standard reply for the frequent emails I received at the time from individuals asking if they would be eligible to sit for the board exam during the "grandfathering" period. I would also mention to them my singular most important piece of advice, which was to try, if possible, to get certified before 2018, after which they would need to complete an Accreditation Council for Graduate Medical Education (ACGME)-accredited fellowship.

Earlier this month, however, the American Board of Preventive Medicine (ABPM) extended the period that allows physicians to be eligible for board certification in the clinical informatics subspecialty by five years, through 2022. This means that the grandfathering (and "grandmothering" for my female colleagues!) period can be used to achieve board eligibility through 2022.

One new issue is how this will impact the growing number of ACGME-accredited fellowships, such as the one we offer at Oregon Health & Science University (OHSU). I still believe those fellowships will be the gold standard for early-career physicians to receive the best training in clinical informatics. But other physicians wanting to enter the field who cannot relocate jobs or families will still be able to pursue other options, one of which is master's degree programs such as our program at OHSU.

The official eligibility statement for the subspecialty is otherwise unchanged from the beginning of the grandfathering period and is documented on the ABPM Web site. The first three eligibility requirements are:
  1. Primary certification by one of the 23 member boards of the American Board of Medical Specialties (ABMS)
  2. Graduate from a US, Canadian, or other medical school deemed acceptable by the ABPM
  3. Unrestricted license to practice medicine in the US or Canada
The fourth requirement is the "pathway" by which one is eligible during the grandfathering era. There are two pathways for eligibility, one of which must be completed to be eligible to take the certification exam under the grandfathering criteria.

The first of the two pathways is the "practice pathway." Those who have been working in informatics professionally for at least 25% time during any three of the previous five years, and can have a supervisory individual attest to it, are eligible for this pathway. "Working" in informatics not only includes "practice" (i.e., being a Chief Medical Information Officer or other clinical informatics professional or leader), but also teaching and research.

The second pathway is the "non-traditional fellowship," which is any informatics fellowship of 24 or more months duration deemed acceptable by ABPM. At a 2012 panel at the American Medical Informatics Association (AMIA) Annual Symposium, Dr. William Greaves of ABPM stated this would be composed of informatics educational programs that were listed in the proposal submitted to ABPM by AMIA in 2009. This list, which has never been made public by ABPM, included programs that were funded by training grants from the National Library of Medicine (NLM) or were members of the AMIA Academic Forum at the time the proposal was submitted by AMIA to ABMS in 2009. (I can say that OHSU was definitely on the list, since we were both NLM-funded and a member of the Academic Forum at that time and still are. both). Dr. Greaves also said that ABPM would review applicants trained in other fellowships for eligibility on a case-by-case basis.

The ABPM eligibility criteria also state that time spent in training in informatics can be applied to the practice pathway at one-half the value of practice time. In other words, someone in an educational program for at least 50% time during the previous five years would be eligible to take the certification exam. My interpretation of this is that someone in a master's degree program that involves the equivalent of one and a half years of full-time study would thus be eligible. This has indeed been the case, i.e., those completing the Master of Biomedical Informatics (MBI) Program at OHSU have been deemed eligible, presumably since it requires six academic quarters of full-time study. The OHSU Graduate Certificate Program, on the other hand, which is a subset of the MBI requiring about nine months of study if done full-time, has not on its own been enough. Some applicants have been able to mix and match to achieve eligibility, i.e., with some practice time combined with some education.

It should be noted that another option for physicians who are not eligible for board exam will be the Advanced Health Informatics Certification being developed by AMIA. This certification will be available to all clinician practitioners of informatics trained at the master's level and higher. It will also provide a pathway for physicians who are not eligible for the board certification pathway.

Overall, I am pleased with this development, although it still presents problems for physicians in the future who will want to transition their careers into informatics in the middle of their careers. But since that day of reckoning has now been put off another five years, I guess we can cross that proverbial bridge when we come to it in the early part of the next decade.

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