Alert: ABIM Research Pathway Policy Changes

[Doctor&Geek]

I was alerted to the following policy changes on the ABIM Website:

Internal Medicine Training
All trainees in the research pathway must satisfactorily complete 24 months of accredited categorical internal medicine training. A minimum of 20 months must involve direct patient care responsibility.

Clinical Subspecialty Training
The minimum full-time clinical training required for each subspecialty is also required for Certification through the research pathway. Specifically:

• 12 months in adolescent medicine; allergy and immunology; critical care medicine; endocrinology, diabetes, and metabolism; geriatric medicine; hematology; hospice and palliative medicine; infectious disease; nephrology; medical oncology; pulmonary disease; rheumatology; sleep medicine or sports medicine
• 18 months in gastroenterology, hematology/oncology, pulmonary/critical care medicine, or rheumatology/allergy and immunology
• 24 months in cardiology

Research Training
At least three years of research training at 80 percent commitment is required. ABIM defines research as scholarly activities intended to develop new scientific knowledge.

The research experience of trainees should be mentored and reviewed; training should include completion of work leading to a graduate degree (if not already acquired) or its equivalent. The last year of the research pathway may be undertaken in a full-time faculty position if the level of commitment to mentored research is maintained at 80 percent.

Much of this is not different than before. What is different is the three years of research training at 80% effort that is now required. In years past one might be able to single board in hematology or oncology, then do clinical research for two years, then go to industry (or *aghast* escape to private practice). Now, one cannot even go to a clinical research faculty position without protected time of 80% in this pathway.

This pathway now officially makes "short tracking" an entire misnomer; it is now 6-12 months longer for all specialties. Example: ABIM research pathway hematology/oncology fellows must do 4.5 years of total subspecialty training rather than the 4 previously required. This of course excepts the fine folks who are able to obtain research instructor positions or tenure track 80% protected time faculty positions.

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[Fencer]

The ABMS is changing all of the residencies to create research track residencies. This is in response to their participation in the NIH driven Physician-Scientist Workforce report. You can read what the ABMS task force came up with as a set of recommendations for further discussions for the individual ABMS boards (i.e.: ABIM, ABPN, etc.). Overall, I see this as a very positive development to improve the PSW pipeline.

Report: http://www.abms.org/media/119931/abms_physicianscientists_report.pdf

 

[OxToCA]

The ABMS is changing all of the residencies to create research track residencies. This is in response to their participation in the NIH driven Physician-Scientist Workforce report. You can read what the ABMS task force came up with as a set of recommendations for further discussions for the individual ABMS boards (i.e.: ABIM, ABPN, etc.). Overall, I see this as a very positive development to improve the PSW pipeline.

Report: http://www.abms.org/media/119931/abms_physicianscientists_report.pdf

MOC IV appears to be their main point per the conclusion that "The Committee agreed that the key to increased flexibility for physician-scientists lies in aligning MOC Part IV requirements for physician-scientists with quality improvement (QI) activities planned by NIH and other research funding agencies. For instance, the most recent NIH clinical and translational science award (CTSA) funding announcement explicitly requires improvement in research processes."

They are recommending the above since "... the total number of funded investigators has increased consist[ing] almost entirely of investigators with PhDs... [while] the absolute number of funded investigators with MDs and MD/PhDs has been relatively constant," and therefore, "... physician-scientists" should incorporate "... efforts to streamline the translational research process by improving Institutional Review Board operations, increasing subject recruitment to clinical trials, quality and efficiencies of laboratory-based research, study design, results reporting, and related QI activities" such as "Better reproducibility of scientific data; Improved dissemination of research results; More effective education of the lay public about research" into their publications and funding applications.

 

[dl2dp2]

I don't see the ABMS report as very relevant at first glance. It's just more about MOC, which a large fraction of people don't participate.

I suspect ABIM realized that 2 years is no longer enough to get enough data to get people Ks--especially when Ks no longer get funded in the first submission. So they extend "training" by another year so the institutions can come up "fellows-level" salary for another year. Otherwise to retain you they'd have to pay you something that resembles an attendings salary. Being #bornrich makes this game a lot easier to play... good job NIH...

 

[StatlerandWaldorf]

This pathway now officially makes "short tracking" an entire misnomer; it is now 6-12 months longer for all specialties. Example: ABIM research pathway hematology/oncology fellows must do 4.5 years of total subspecialty training rather than the 4 previously required. This of course excepts the fine folks who are able to obtain research instructor positions or tenure track 80% protected time faculty positions.

Can you explain the last sentence there?

I don't quite understand the exception you are pointing out. Just entering the ABIM pathway and would be grateful if you could spell it out further for a simpleton .

 

[NotAProgDirector]

I am confused because I don't think this is a change -- or I'm missing the point. As far as I know, this is the way the research pathway in IM has been for at least the last 5-7 years. I have told all of my residents that it's not short tracking at all -- it's one year longer, in all specialties. You trade your PGY-3 in IM for two research years.

So, if you wanted to do just Heme, the pathway would be:

PGY 1 and 2 - Internal Medicine (usually with limited/no research time)
PGY 3 and 4 - 80% research. Usually do 1 block of PGY-3 IM Consults (or some other PGY-3 rotation) in the PGY-3. 1/2 day continuity clinic either in IM or Heme (if they are willing).
PGY 5 - Hematology fellowship
PGY 6 - Heme Fellowship, 80% research. Can be faculty position.

Note that if you only wanted to do Heme the "usual" way, it would be 5 years -- 3 IM + 2 Heme (with theoretically 1 of those years being research).

It's also possible to do the pathway with the research more at the end. PGY 1 and 2 are IM. PGY 3 is research. PGY 4 is clinical fellowship. PGY 5 and 6 are research. This structure can be more useful if the research requires clinical work -- i.e. if you're going to be doing some sort of research with BMBx samples, it might be better to complete your clinical training first, so you can obtain samples for your research. But this leaves less time to apply for K awards at the end.

The only place it gets "slippery" are the 18 month programs -- H/O, GI, P/CCM, etc. But I point out to residents considering those pathways that they should look at the missing 6 months as "flexible", not "optional". So the GI research pathway is 7 years long - 2 IM, 2 Research, 1.5 clinical GI, 0.5 either clinical or research, and then 1 research at the end.

Not sure where the change is. This is the way it's been for at least 5-7 years, to my knowledge.