Low budget, I agree with you, it is another assault on generalist medicine but I think that it was a necessary response on part of the ABFM to join ABIM in recognizing this hospitalist certification. I think just ignoring the problem and hopping that we can practice as hospitalists in the future when all of a sudden "HOSPITALIST" boarded is the new requirement for all the hospitalist jobs out there would be a grave mistake.
There is one interesting consequence. When you graduate from residency (IM or FM), your ability to obtain this RFP in Hospital Medicine depends on your ability to get a hospitalist position. This totally subverts the stronghold that academia has on board certifications. See, right now in order to be board certified in any specialty, you have to train in the residency/fellowship and take a test to get the certificate. That can only happen in academia, which means your (a candidate's) fate lies in the hands of program directors & admissions committees and standards. But with the RFP thing, it's your experience in the real world that opens the gateway to certification. So your fate now lies in the hands of a hiring employer or partnership... it's up to the free market. In a way, the RFP pathway codifies the "grandfathering" approach (where people can obtain certifications without structured training but instead through clinical experience). I think it undercuts the academic medical center and all the political bullsh*t that happens there. Huge gamble on the part of ABIM, who currently hold a stronghold in academic medical centers. I think FP's will stand to gain while IM's try to sort out who's qualified to work inside and outside the hospital.
Lastly, if RFP's become a trend (where you gain certifications through experience, self-study CME, test modules, and practice audits), we'll see a decline in people who choose "cognitive" fellowships (ID, endo) with people instead seeking fellowships in order to gain procedural expertise:
"Criteria for Focused Recognition through Maintenance of Certification (MOC):...
Proficiency or expertise can be gained through rigorous demonstration of self-directed,
continuous learning and self-evaluation of practice over time, and does not require direct
observation of technical procedures or skills that can only be achieved through formal
residency or fellowship training. "
http://www.ccimreport.org/pdf/nedim-2-report.pdf
I hate seeing a proliferation of over-certifying (it's like the nurses list 5 bagillion degrees after their names)... but if it is inevitable of the trend is going to go this way, and the ABIM is trying to jump start that movement, I hope the ABFM is wise enough to jump on board rather than get shut out.
