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Fellowship and certification: What’s in a name?

March 2009

I recently received two e-mail messages on the same day, and their content struck me as being somehow related in a Six Degrees of Kevin Bacon kind of way.

The first had this message: “Hello ACP Member, You have been identified as a member who potentially qualifies for advancement to Fellowship in the American College of Physicians.” In the second e-mail, a friend relayed this revised message: “Our [SHM] message dated January 14, 2009, concerning the availability of board certification in hospital medicine, contained inappropriate language regarding the American Board of Hospital Medicine that is affiliated with the American Association of Physician Specialists and requires correction.” (Technically, the name of the group that the ABHM is affiliated with is the American Board of Physician Specialties.)

In an effort to connect those dots, let me say first that I have never put much thought into becoming a fellow of ACP. Why? Because I never really think of myself as an internist.

From day one, I have been a hospitalist, albeit one trained in internal medicine. Here’s another reason: I’ve never been convinced that the “fellow” designation means all that much. That’s not directed specifically at ACP, which is no doubt an important organization, but at the “fellow” label in general. Being able to use a “fellow” title has always struck me as two parts marketing, one part significant.

After all, aside from having a paid membership in a professional medical organization, one generally qualifies for “fellow” status after finishing two years of practice, holding a valid medical license and board certification, and paying the prerequisite application fee. While ordaining medical society members with “fellow” status is certainly enough to solidify the membership ranks, it is hardly the rigor needed to distinguish the Dr. Oslers of the world from the Dr. Doolittles.

But I did take the bait when SHM offered its members the opportunity to become fellows for the first time. That’s less of a value determination and more of an identity decision, representing the career path I have taken.

And I give SHM kudos for making its “fellow” status perhaps more meaningful than many others. (Full disclosure: I am now an FHM.) Between needing five years of practice and some important leadership requirements, I believe hospitalists who have obtained this distinction should feel that they received it the old-fashioned way: “They earned it.”

While I’m sure we can debate whether an FHM is more substantial for a hospitalist than an FACP, no one would argue that board certification in hospitalist medicine would carry more weight than a fellow distinction from either society. That is why I am so curious about the information in that second e-mail that seems to indicate that SHM is now rethinking its previous comments about the ABPS’s American Board of Hospital Medicine. (The SHM also pulled the link to its earlier statement from its Web site). The new message was terse, stating, “…the Society of Hospital Medicine hereby retracts that message in its entirety,” and it left much to the imagination.

My first thought was that it sounded contrite but lacked heart, like when you’re a child and have to apologize for hitting your little brother. Yes, you said, “sorry,” but no, you really didn’t mean it; making nice was just much better than going without dessert. Of course, the adult version of this scenario is when one receives a “cease and desist” letter from an attorney.

I am no lawyer, nor do I play one on TV, but I certainly didn’t believe SHM’s original message sounded libelous. So I am left to wonder if SHM is considering giving the ABHM at least a tacit acknowledgement. To draw upon an analogy: You don’t have to like your mother-in-law, but you have to at least try to get along.

However, given SHM’s long commitment to working with the ABIM on focused recognition–and ABPS’s minority status in terms of the number of its diplomates–I find it very unlikely that any form of endorsement for a competitive certification process might really be in the cards.

Finally, perhaps all of this should be kept in context. Approximately 95% of doctors who take the medicine boards eventually pass. Thought of in those terms, board certification confers precious little more distinction upon physicians than the original accomplishment of completing a residency program.

What to conclude? Hospitalists were recently highlighted in Oprah magazine. And guess who was a guest on the Oprah show in 2005? You got it: Kevin Bacon. So even hospitalists have a Bacon Score of 2.

OK, that’s way off track, even though admittedly it may be a more logical connection than between my two aforementioned e-mails. So again, what to conclude? Only that our own, universally accepted form of professional recognition is both needed and inevitable, no matter how winding the road to that recognition will be. And the very existence of the ABHM alternative might make the folks at the American Board of Medical Specialties think a little harder about giving hospital medicine its own board and certification process.