New England Journal of Medicine "Sounding Board" Discusses the Benefits and Risks of New Subspecialties in Internal Medicine

(Philadelphia, PA) - Existing criteria for determining subspecialties in internal medicine try to balance the needs of the public against a medical profession that has gained expertise within specific areas of practice, according to a new Sounding Board published in this week's New England Journal of Medicine. The American Board of Internal Medicine (ABIM) and its policies for establishing new areas of certification – or subspecialties – of internal medicine are detailed in the article.

Co-Authored by Christine K. Cassel, MD, President and CEO of ABIM and David B. Reuben, MD, the current Chair of the ABIM Board of Directors , the article discusses the challenges ABIM faces from an internal medicine community that on the one hand worries about fragmentation of the field and declining numbers of generalists and on the other wants information about specific expertise and knowledge made available to patients through certification.

Currently, ABIM offers specialty certification in internal medicine and 19 subspecialties: Adolescent Medicine, Advanced Heart Failure & Transplant Cardiology; Cardiovascular Disease; Clinical Cardiac Electrophysiology; Critical Care Medicine; Endocrinology, Diabetes and Metabolism; Gastroenterology; Geriatric Medicine; Hematology; Hospice and Palliative Medicine; Infectious Disease; Interventional Cardiology; Medical Oncology; Nephrology, Pulmonary Disease; Rheumatology; Sleep Medicine; Sports Medicine and Transplant Hepatology. Over the last five years there were about 15 requests for new internal medicine subspecialties, mostly from medical specialty societies, of these five were approved.

The criteria for recognizing a subspecialty for a new certification pathway, most recently reexamined by ABIM in 2006, include:
- The discipline must have a unique body of knowledge that cannot be fully incorporated into the "parent" discipline.
- The discipline must have clinical applicability to be practiced in a form that is distinct from the "parent" discipline.
- The discipline must contribute to the scholarly generation of new information and must advance research in the field.
- There must be an important social need for the discipline and evidence that practice of the discipline improves patient care.
- The positive value of certification in the new discipline must outweigh any negative impact on the practice of general internal medicine or an existing subspecialty or on the basic education in the core competencies of internal medicine.

ABIM has explored new types of recognition – including the focused practice designation, which serves to delineate not new areas of certification, but ways physicians within a specialty have focused their practice. ABIM launched a focused practice program in Hospital Medicine in 2010. More than 500 physicians have enrolled in the program.

The article's authors, who note that subspecialty designation only has value when it is rigorous and meaningful to the public, conclude: "New specialties can benefit both patients and physicians. However, a proliferation of specialties without adequate justification may simply confuse the public without creating a social good."

About ABIM
For 75 years, certification by the The American Board of Internal Medicine (ABIM) has stood for the highest standard in internal medicine and its 19 subspecialties and has meant that internists have demonstrated – to their peers and to the public – that they have the clinical judgment, skills and attitudes essential for the delivery of excellent patient care. ABIM is not a membership society, but a non-profit, independent evaluation organization. Our accountability is both to the profession of medicine and to the public. ABIM is a member of the American Board of Medical Specialties. For additional updates, follow ABIM on Facebook.