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Jorge G. Ruiz, MD, Chair of the Geriatric Medicine Board

The Geriatric Medicine Board held its fall meeting on Wednesday, September 27, 2023. The agenda provided an opportunity to update the Geriatric Medicine Board on activity at ABIM and allowed for discussion of pressing issues in the field. The Specialty Board was joined for a portion of the meeting* by representatives of AMDA: The Society for Post-Acute and Long-Term Care Medicine (AMDA) and the American Geriatrics Society (AGS).

The following is a summary of the fall meeting.

Conversation with the President*

Prior to the meeting, members and guests of the Geriatric Medicine Board had the opportunity to review a video update from Richard J. Baron, MD, MACP, President and Chief Executive Officer of ABIM and ABIM Foundation, reflecting on current issues for ABIM and the internal medicine community. Dr. Baron invited the Specialty Board to discuss these topics, including:

  • Recent public conversations and press coverage around the value of ABIM’s Maintenance of Certification (MOC) program.
  • Engagement of early career physicians and trainees in ABIM’s work and how members of ABIM governance can facilitate conversations with colleagues and leaders in their disciplines to foster better understanding of ABIM’s mission and programs.
  • The ongoing and evolving challenges in addressing misinformation, and the historical roots of mistrust in science and medicine, as explored at the ABIM Foundation Forum in July.

Members of the Specialty Board continued exploring the topic of misinformation and how ABIM can advocate for thought leadership in the internal medicine community and work with specialty societies to define appropriate steps to take together toward promoting factual information. Dr. Baron pointed out how ABIM is working to ensure that actions to combat misinformation extend beyond ABIM, such as grants dedicated to addressing misinformation in 2022, funded by the ABIM Foundation. He noted that partnerships with medical specialty societies are beneficial as well.

In discussing the recent rise of criticisms of the MOC program, a member of the Specialty Board suggested that confusion around ABIM’s fee structure could be leading to criticism. Dr. Baron shared the public resources available on ABIM’s website about the fee structure and how fees are used, and explained ABIM’s goal to achieve transparency and clarity around the fee model.

Diversity, Equity and Inclusion (DEI)*

The Geriatric Medicine Board received an update on ABIM’s DEI work from Lorna Lynn, MD, Vice President of Medical Education Research; Kelly Rand, MA, CPH, Program Officer of Diversity and Health Equity; and Pamela Browner White, Senior Vice President of Communications and Chief DEI Officer.

Their central points included:

  • A September meeting in collaboration with 24 medical specialty societies around DEI and how ABIM can collaborate with and support societies in this work. This meeting highlighted work that societies and ABIM can do together in the areas of shared resources, developing pathway programs to diversify the health care workforce and providing support for mentorship programs.
  • Collaboration with the Accreditation Council for Continuing Medical Education (ACCME) to explore possibilities for offering continuing medical education credit and MOC points for mentoring activities based on feedback that identified the importance of mentorship for students, trainees and underrepresented groups who face barriers to success because of personal characteristics.
  • Fairness review pilots conducted in cardiovascular disease, gastroenterology, internal medicine and nephrology over the past year using statistical analysis and content review to identify bias in ABIM assessment questions (items) in those disciplines.

Some members of the group followed up with questions about the fairness review pilots, such as whether age differences were being evaluated as a factor for how participants score on items, how physicians with different levels of DEI training approached the work and whether non-physician health equity experts were involved. Dr. Lynn confirmed that non-physician experts had been involved in the cardiology cohort, and that this approach would be reviewed and expanded to other disciplines if found to be beneficial. She acknowledged the importance of training for participants and expressed her appreciation for the group’s suggestions that involving medical students in the future might be beneficial, and that assessing for age might be considered in future rounds as well.

The group also suggested creating increased awareness of ABIM’s accommodations for assessment takers, as many physicians with disabilities are not aware of the accommodations available. Information about accommodations can be found here on ABIM’s website.

Ms. Rand invited feedback from the Specialty Board about how ABIM can better support an age-friendly workforce and health care system. Niharika N. Suchak, MD, member of the Geriatric Medicine Longitudinal Knowledge Assessment (LKA®) Approval Committee, pointed out the need in the physician community to recognize aging as a diverse process in which not all individuals experience the same health difficulties associated with aging, or experience them in a similar manner.

Listening Session on the Longitudinal Knowledge Assessment (LKA®)*

Benjamin Chesluk, Ph.D., Senior Research, Ethnographic Research for ABIM, and Thor Odhner, Program Officer of Diplomate Experience, shared recent insights about diplomates’ engagement in the LKA and their experience and feedback.

Key points included:

  • The relatively small number of diplomates unenrolling from the LKA may be physicians who find they prefer the traditional, 10-year MOC exam, or who find that the commitment to 30 questions per quarter does not align with their availability.
  • Diplomates certified before 1990 can use the LKA to meet their assessment requirement to remain publicly reported as “Participating in MOC.”
  • Physicians continue to choose the LKA over the traditional, 10-year MOC exam at a rate of 4:1 on average across all 15 subspecialties in which it is offered.
  • On average, LKA participants are taking less than two minutes to answer each question, equating to less than one hour per quarter in total. ABIM also offers accommodations in compliance with Title III of the Americans with Disabilities Act, which can include time added to the standard four minutes that physicians have to answer each question as well as the 30-minute time bank, if approved.

In discussion, members of the Specialty Board touched on the importance of keeping the traditional, 10-year MOC exam an option for those who want it. ABIM has no plans to stop offering the MOC exam. Others offered varied feedback of the LKA from their own experience and communities, noting the option to share feedback on individual items’ relevance through the LKA itself.

Questions also arose on whether geriatricians who are not active in patient care are electing to take the LKA or the traditional, 10-year MOC exam, and how age and proximity to retirement influence that decision. Rebecca S. Lipner, Ph.D., Senior Vice President, Assessment and Research for ABIM, responded that, typically, physicians who leave practice do not maintain certification. Dr. Chesluk added that data show people making different choices based on a variety of factors, and some diplomates close to retirement still choose to participate in the LKA.

LKA enrollment for diplomates with an assessment due in 2024 opens on December 1, 2023. Diplomates are encouraged to check their Physician Portal for upcoming requirements and eligibility.

Annual Maintenance of Certification Status Review*

Florence Mickens, Program Operations Manager for ABIM, and Weifeng Weng, Ph.D., Director of Research and Data Intelligence, reviewed the annual process through which ABIM evaluates certificates to determine whether an individual diplomate is meeting MOC requirements. The requirements are to be current with the MOC assessment requirement and MOC points (some points every two years and 100 points every five years). Certificates that do not meet these requirements will either experience a status change in certification or participation, or enter a grace period. Diplomates are encouraged to sign in to their Physician Portal to check their status regularly.

Ms. Mickens and Dr. Weng explained that the 2023 cohort of “at-risk” certificates is comparatively large due to two primary contributing factors:

  • The number of physicians who earned initial certification prior to 2014 when the current MOC program requirements began are now due for their second five-year MOC point requirement. Physicians who earned certification in 2018 are also due for their first five-year point requirement in 2023.
  • The extension given to certificates in Critical Care Medicine, Infectious Disease and Pulmonary Disease as a result of the pandemic has ended.

ABIM engages in a robust and comprehensive communications strategy over several months to alert at-risk diplomates of upcoming deadlines in order to minimize the number of diplomates who miss the deadline and are subsequently reported as “Not Certified.” Tactics include email campaigns, postcards and e-newsletters.

Update on a Proposed Special Consideration Pilot Program for Exceptionally Qualified International Medical Graduates*

At its spring meeting, the Geriatric Medicine Board discussed the ABIM Council’s plan to explore the proposed new special consideration pathway for international medical graduates (IMGs) who have completed their internal medicine training in another country and then completed accredited fellowship training in the U.S. or Canada. Anamika Gavhane, Senior Director of Discipline-Specific Governance for ABIM, provided an update on this proposal, outlined as follows:

  1. Begin with a pilot program which results in the ability to answer key questions in order to build a data-informed decision about whether to create a formal pathway.
  2. Connect the pilot to principles of competency-based medical education.
  3. Connect eligibility for the pilot to IMGs who have met criteria of the Accreditation Council for Graduate Medical Education (ACGME) to be considered “exceptionally qualified” to enter accredited fellowship training. (See Section III.A.1.c) of ACGME Common Program Requirements for Fellowships.)

Before any decision is made, ABIM plans to conduct stakeholder outreach. Stakeholders would include the ACGME, ACGME International, medical specialty and professional societies, program directors, physician employers, state medical boards, patient advocacy groups, graduate medical education societies and state public health organizations. Data collected from these groups would inform the Council’s recommendation which, if positive, would lead to a public comment period prior to a final decision by the Council on whether to apply to the American Board of Medical Specialties Committee on Certification to formally implement the pilot program.

Lisa Walke, MD, mentioned that at the spring Geriatric Medicine Board meeting, the Specialty Board discussed how the pathway may not increase the number of diplomates in the discipline unless there were a requirement to take the Geriatric Medicine Initial Certification Exam as part of the pathway. Furman S. McDonald, MD, MPH, Senior Vice President for Academic and Medical Affairs at ABIM, explained that the pilot could answer questions like that as hypotheses to be tested.

Post-Match Performance in Geriatric Medicine Fellowships

The Geriatric Medicine Board continues to monitor the post-match performance of geriatric medicine fellowship programs. Dr. Walke shared varied data gathered from several institutions, including the ACGME and the Journal of the American Medical Association Graduate Medical Education Appendix. In 2022, only 70% of programs were filled through the match, and a decline has been shown over the past three years.

Discussion in the group focused on whether low match rates are unique to geriatric medicine and specific to certain programs or regions, such as the Midwest. Dr. Lynn pointed out that some disciplines have been affected by the pandemic, but the issue remains a constant in geriatric medicine. Dr. Walke highlighted competing forces represented by the creation of new programs and openings, adding that the Association of Directors of Geriatric Academic Programs is working with program directors to enhance their websites to attract more applicants.

Update on the Geriatric Medicine Approval Committees

Helen L. Chen, MD, University of California, San Francisco and the San Francisco Veterans Affairs Healthcare System; Chair of the Geriatric Medicine Traditional, 10-Year MOC Exam Approval Committee

Niharika N. Suchak, MD, Florida State University College of Medicine; member of the Geriatric Medicine LKA Approval Committee

ABIM Approval Committees are responsible for approving and editing all assessment content, and maintaining the blueprints for the Initial Certification Examination, the MOC Exam and the LKA. There are two ABIM Approval Committees working with the Geriatric Medicine Board: the Traditional, 10-year MOC Exam Approval Committee (which also develops the initial certification exam) and the LKA Approval Committee. Dr. Chen and Dr. Suchak (on behalf of the LKA Approval Committee Chair, Anne R. Fabiny, MD) provided a brief update for the Specialty Board on the composition of the Approval Committees, progress on item development in meetings this year and news about the Item-Writing Task Force. Dr. Chen added that her committee plans on reviewing the Geriatric Medicine Blueprint next year for bias in assessment items. Both committees will perform the blueprint review, and will include the opportunity for diplomate feedback, before forwarding their recommendations to the Geriatric Medicine Board.

Dr. Suchak also noted that her committee has been enthusiastic about mentoring work with the Item-Writing Task Force, and that Dr. Fabiny and other committee members have been attending meetings of the item-writers to share their expertise and advice.

Communications and Governance Engagement

John Held, Senior Director of Communications and Brand Management for ABIM, and Peter McConnell, Program Manager for Governance and Medical Society Communications, provided an update on ABIM’s communications work and current trends in the community. The presenters invited the Specialty Board to share their own perspectives and discuss how ABIM can foster better understanding and enhance the perceived value of the MOC program among diplomates.

The Specialty Board encouraged staff to validate the experiences of diplomates in communicating with them, reflecting on their own and others’ experiences of balancing numerous demands on their time and the importance of acknowledging that. ABIM is committed to continuing to listen to and engage with diplomates in order to evolve programs and products that better serve their interests and practices.

Opportunities for Engaging Early Career Physicians

ABIM is one of several organizations that nominate candidates for the ACGME Residency Review Committee for Internal Medicine (RC-IM). The RC-IM invited ABIM to nominate two physicians for the committee who will still be in training during their two-year term. Nominations were solicited from ACGME-accredited internal medicine residency and fellowship program directors.

Ms. Gavhane explained the candidate vetting process to the Specialty Board and also shared ABIM’s plans to explore a convening of early career physicians across the disciplines of internal medicine. The convening would offer an opportunity to learn more from young physicians by gathering trainees and/or newly certified diplomates, including prospective nominees not chosen to serve on the RC-IM.

In Closing

The Geriatric Medicine Board values the feedback and commentary of the entire medical community, including diplomates and society partners.

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*Indicates that Society guests were present for this topic.