Curbside Consult with Dr. Jayne 2/14/22

I started the HIMSS22 vaccine verification process today, and we’ll have to see if it works this time. Last year, when I still planned to attend the event in person, I started the process and never received conformation that my vaccine submission had been validated. The current process includes uploads of both a government-issued ID and the vaccine card. I tried using my passport this time to see if it works any better than my driver’s license did last year.

The emails I’m receiving from HIMSS22 vendors have started to increase in frequency, but I have yet to see a marketing campaign that really stands out. I’m trying to do a little planning every day so I can stay ahead of the game and avoid a flurry of organizing at the end.

This weekend’s hot topic in the virtual clinical informatics physician lounge is a petition to extend the so-called “practice pathway” for board certification in clinical informatics. The practice pathway, which is scheduled to expire in 2022, allows a certification mechanism for those of us who didn’t complete formal fellowships in clinical informatics. To be eligible for certification, physicians must demonstrate three years of practice in the field, with at least 25% of professional time in informatics. Physicians can also be eligible if they complete a 24-month master’s or PhD program in biomedical informatics, health sciences informatics, clinical informatics, or a related subject.

A number of clinical informaticists are supportive of extending the practice pathway, particularly due to the disruption caused by the COVID-19 pandemic. They note issues with the availability of residency and fellowship rotations that disrupted the ability of participants to complete their programs. Proponents cite a shortage of certified informaticists and the expected need for roles in thousands of hospitals and clinics. They also note the large number of physicians who have been practicing clinical informatics but who might not have the time or financial resources to pursue a fellowship. Others are concerned about the ability of fellowship programs to ramp up enough to be able to train the numbers of informaticists required to staff the workforce.

Others are opposed to leaving the practice pathway open. Some feel that the option hurts fellowships, leading to decreased applications and filled positions. Personally, I think the low salaries paid to fellows are at least partially responsible for decreased applications, not to mention the disruption to your career if you’re already practicing in the field. There is also concern that the practice pathway creates a lower standard. In my experience employing clinical informaticists, I’m not sure the board certification really makes a difference. It’s more of a check-the-box formality for some, but I’m perfectly happy hiring a seasoned informaticist who can do the job that needs to be done regardless of their certification status.

I obtained my certification through the practice pathway, having practiced clinical informatics exclusively in the seven years prior to certification. At that point in my career, there was no chance that I would consider leaving an EHR implementation at a major health system to complete academic pursuits. I used the Board’s content outline to craft a study plan and spent nearly six months reading more than a dozen college-level textbooks to prepare for the exam. Other than some specific and highly technical questions, the majority of the board examination involved topics that I dealt with on a daily basis in my informatics practice. One physician commenting on the issue noted that as data experts, we should be looking for proof that there are differences in outcomes when clinical informaticists are certified through the practice pathway versus through the fellowship pathway.

Board certification is a hot topic for physicians in general. Most boards require physicians to participation in a process called Maintenance of Certification. Depending on the board, physicians have to participate in continuing medical education, complete performance improvement projects, document evidence of professionalism, and complete a demonstration of knowledge. Those knowledge demonstrations vary. Some still require the traditional high-stakes examinations, and others allow longitudinal assessments. Most physicians aren’t interested in cramming for a high-stakes exam, especially when we’re tested over content that is no longer part of our daily practice. There is no immediate feedback on questions that are missed and it’s a generally miserable experience.

The last time I took one of those exams, I had a pat-down by the testing center employees and was treated like a criminal before even entering the testing room. There have been recent reports of physicians who were treated poorly at testing centers, including one lactating physician who was offered “accommodations” for pumping that failed to include a private area, a table or counter, or even an electrical outlet for the pump. She was forced to pump in a bathroom stall and the time spent counted against her limited exam breaks. I can’t imagine the mount of stress that added to the situation.

Specialty boards are trying to update their Maintenance of Certification processes to make them less onerous for physicians. However, there isn’t evidence that participating in the process makes physicians better at their jobs. I agree that for those of us participating in the longitudinal assessments, the process helps physicians become more proficient at finding information they don’t know.

Since I’ve been in urgent care for the last decade, I can handle most of the board questions that cover the musculoskeletal, digestive, and respiratory systems without blinking. Trauma is also a slam dunk and I’m solid with dermatology, infectious disease, and psychiatry. For maternity care, which I haven’t practiced in a very long time, I end up resorting to reference materials to handle those questions, just like I consult with practicing maternal care physicians in real life. Hopefully, the process is teaching physicians how to find information when they don’t know it off the tops of their heads, and to do so efficiently. However, it sometimes just feels like a game that we have to play.

Has there been any chatter about clinical informatics board certification in your organization? Are you for or against extending the practice pathway? Leave a comment or email me.

Email Dr. Jayne.