Designation of Focused Practice

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    FAQ: Designation of Focused Practice in Hospital Medicine

    1. Why is the ABFM offering a Designation of Focused Practice in Hospital Medicine?
      The ABFM Board of Directors realizes that many board-certified family physicians practice in a hospital setting and that recognition of their efforts in maintaining certification with an emphasis on this practice setting could be important to the Diplomate, the patients, and the credentialing body of the hospital. While all family physicians must participate in the Family Medicine Certification process in order to maintain certification, physicians who choose to practice in a hospital setting may want to tailor their certification activities to this area. This is not a new certificate; instead, it is a process by which family physicians will be designated as focusing their practice in the hospital through successful participation in the process.
    2. Are any other certifying boards offering a Designation of Focused Practice in Hospital Medicine?
      The ABMS approved an application from the American Board of Internal Medicine (ABIM) in September 2009 allowing general internists practicing in the hospital setting the opportunity to maintain their certification with Recognition of Focused Practice in Hospital Medicine. The term "Recognition" was replaced with "Designation" in 2018. ABIM is the only other board participating at this time.
    3. Why is this designation not a Certificate of Added Qualifications (CAQ)?
      ABMS policy limits the designation of a subspecialty to those areas where the subspecialty constitutes a body of knowledge or a technique that is beyond the scope of the specialty practice. Acquiring such subspecialty knowledge and skill requires additional training and directly supervised performance of procedures or application of specific practice methods by experts in the field. Subspecialty practice involves applying the knowledge and principles of family medicine, as well as specialized knowledge and procedures in the CAQ discipline, to a subset of family medicine patients. In contrast, hospital medicine is the practice of family medicine during a patient's hospitalization. The ABFM has designated subspecialty practice with CAQs in the areas of Sports Medicine, Adolescent Medicine, Hospice and Palliative Medicine, Geriatrics, Pain Medicine and Sleep Medicine. Accredited specialized training and a body of knowledge exist for the CAQs. ABMS recognizes our family medicine Diplomates who hold a CAQ in the same way they recognize physicians from other medical specialty boards who hold subspecialty certificates. This Designation of Focused Practice in Hospital Medicine (DFPHM) is by definition not a subspecialty or a CAQ.
    4. Am I required to hold and maintain my primary certificate in family medicine in order to achieve Designation of Focused Practice in Hospital Medicine?
      Yes. Among other requirements, discussed below and in more detail here, a primary certificate in family medicine must be held at the time you apply for DFPHM and through the duration of holding such recognition.
    5. How will successful participants in the Designation of Focused Practice in Hospital Medicine be identified?
      The Directory of Certified Family Physicians will recognize your primary certificate holding, as well as any CAQs that you hold, and will acknowledge your status as having successfully met the requirements for Designation of Focused Practice in Hospital Medicine. In addition, users of the website can look up the dates of your certification history for both your primary certificates and any CAQs that you hold. The Family Medicine Certification section of your directory listing will note that you have achieved DFPHM. This recognition will be displayed as long as you adhere to the ongoing requirements for this recognition and as long as you maintain your primary certificate.
    6. Will credentialing agencies and the public be able to verify my Designation of Focused Practice in Hospital Medicine status?
      Credentialing organizations that know your date of birth and the last four digits of your social security number are able to use our online verification to receive confirmation of your Diplomate status. This verification indicates the dates for your family medicine certification history, the dates of your CAQ certification history, your Family Medicine Certification status, and now, your DFPHM status.
    7. What are the prerequisites to indicate my practice in the hospital setting?
      • In order to participate in DFPHM, you and a senior officer of the hospital(s) at which you practice will need to attest that you meet one of the following thresholds for practice:
        • Direct Patient Care Pathway (i.e., full-time hospital practice):
          • a minimum of 1,000 hospital patient encounters (limited to one encounter per patient per day) per year in the last 3 years, or 3,000 encounters in the last 3 years. Formal fellowship training completed in the last 3 calendar years in a Hospital Medicine Fellowship program can be counted for a maximum of 1000 patient encounters.
          • Clinical/Systems Pathway (i.e., full-time hospital medicine professional activity with a part-time hospital practice): a minimum of 250 hospital patient encounters (limited to one encounter per patient per day) per year in the last 3 years, or 750 encounters in the last 3 years. These patient encounters must comprise at least 75% of total clinical activity, and at least 50% of the remaining non-clinical professional time must be directed toward improving the care of hospitalized patients.
        • This 3-year practice threshold requires that you have not been in a residency or fellowship training program, excluding Hospital Medicine Fellowship training, for the 3 calendar years prior to seeking designation of focused practice in hospital medicine. Formal fellowship training completed in the last 3 calendar years in Hospital Medicine Fellowship program can be counted for a maximum of 1000 patient encounters.
        • You will select the appropriate officer of the hospitals where you obtained your patient encounters to attest to your practice levels. Acceptable hospital officers would include the Division Director, Section Chief, Chief Medical Officer, Chair of Family Medicine, Service Line Chief, Medical Director, Chief Executive Officer, President, or Chair of the Board of Directors.
        • We will randomly audit the attestation process via communication with the selected officer of the hospital, and your enrollment in the process is your agreement to this audit process.
    8. Must I be participating in Family Medicine Certification activities in order to receive DFPHM?
      Yes. To enroll in DFPHM you must have successfully completed six (6) Knowledge Self-Assessment Activities (KSA) and/or Performance Improvement (PI) Activities. Four of the activities must have been completed in the 3 years prior to receiving designation, and at least one module must have been a Performance Improvement activity. All six of the modules required must have been completed within the last 10 years.
    9. Do all Knowledge Self-Assessment (KSA) and Performance Improvement (PI) activities count toward the enrollment requirements of DFPHM?
      Most of the KSA and PI activities will satisfy the requirement for focused practice in hospital medicine; however, some of the activities do not cover topics that relate to practice in the hospital setting. The activities listed below meet the DFPHM requirements:
      • Knowledge Self-Assessment (KSA) Activities
        • Asthma KSA
        • Cerebrovascular KSA
        • Coronary Artery Disease KSA
        • Diabetes KSA
        • Heart Failure KSA
        • Hospital Medicine KSA
        • Hypertension KSA
        • Pain Management KSA
      • Performance Improvement Activities
        • Asthma PI Activity
        • Coronary Artery PI Activity
        • Diabetes PI Activity
        • Heart Failure PI Activity
        • Hypertension PI Activity
        • Information Management Methods in Medicine Module
        • AAFP METRIC—Diabetes
        • AAFP METRIC—Asthma
        • AAFP METRIC—Coronary Artery Disease
        • AAFP METRIC—Chronic Obstructive Pulmonary Disease
        • AAFP METRIC—Hypertension
        • ABMS Patient Safety Improvement Program
        • Cultural Competency Methods in Medicine Module
        • National Committee for Quality Assurance (NCQA) Physician Recognition Program—Diabetes
        • NCQA Heart Stroke Physician Recognition Program
        • Wisconsin Medical Society’s Improving Advance Care Planning
        • Illinois Academy of Family Physicians (IAFP) module—Managing Childhood Asthma in Primary Care
        • American College of Physicians (ACP) modules—ACOVEprime and Closing the Gap: Diabetes Care and Cardiovascular Risk
        • Novant Health module—Ambulatory Care Diabetes Performance Improvement CME
        • The Permanente Federation (TPF) Adult Medicine Continued Quality Improvement
    10. When is the exam offered?
      The examination will be offered twice a year (Spring and Fall). Once all requirements have been met, and the examination has been successfully completed, you will receive the DFPHM.
    11. How is the exam delivered?
      The American Board of Internal Medicine administers the Designation of Focused Practice in Hospital Medicine Exam for all participating boards and their respective physicians. The exam is administered on computer by their testing vendor, Pearson VUE in the U.S. and internationally.
    12. What are the continuing requirements for designation?
      In order to maintain DFPHM, your Family Medicine Certification requirements must be current for your primary family medicine certificate. Additionally, you must continue to meet the practice thresholds and successfully complete the hospital medicine examination once every 10 years.
    13. What are the fee requirements for DFPHM?
      The fee will be the current fee charged for all of our examinations. No fees will be collected beyond your Family Medicine Certification fees unless you complete activities for DFPHM that do not also meet Family Medicine Certification requirements and, thus, require you to complete additional activities. There are no other specific fees due to maintain your designation until you take the next DFPHM examination.
    14. What impact is there on my primary certificate or CAQ certificate if I cease practice in the hospital setting or allow my focused designation to expire?
      The DFPHM is separate from all requirements associated with your primary certificate and CAQ. You will not lose your primary or CAQ certificates simply due to your decision not to practice in the hospital setting or because you allow your focused designation to lapse. You can re-enter the DFPHM program at a later date if you meet the requirements to do so at that time.
    15. Does DFPHM replace my need to maintain my primary certificate in family medicine or relieve me of the requirements of Family Medicine Certification?
      No. DFPHM does not replace your primary certificate in family medicine. In fact, you must maintain your primary certificate to be designated as having a focused practice in hospital medicine. Maintaining your primary certificate requires that you adhere to the requirements of Family Medicine Certification in order to maintain that primary certificate and be eligible to sit for the continuing certification examination. Remember, your Family Medicine Certification cycle and the time limit for your primary certificate or CAQ most likely will be on a different timeline than the DFPHM.

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