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The American Board of Addiction Medicine

Addic%on  Medicine:  Current  Status  Cer%fica%on,  MOC,  Training  and  Prac%ce  

 

Addic%on  Medicine  Academy  American  College  of  Medical  Toxicology    

March  26,  2015    

Kevin  Kunz,  M.D.,  M.P.H.  EVP,  ABAM  and  The  ABAM  Founda%on  

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Summary of this Talk

•  Why Addiction Medicine? •  History, Science,Epidemiology •  Medical, Public Health and Social impact •  American Board of Addiction Medicine •  ADM Certification, MOC, Fellowships •  Addiction Medicine & Medical Toxicology •  Recognition by ABMS

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Why are we all here today?

The limited involvement of the medical community in the prevention and treatment of risky drug use and addiction keeps advances in the science of addiction from being applied. Physician specialists in Medical Toxicology are uniquely positioned to contribute to the knowledge base and practice of addiction medicine, thus advancing the health of patients, families, communities and our nation.

History of Addiction Medicine

Med Tox &

ADM

Medical Toxicology

Addiction Medicine

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ADDICTION INVOLVES MULTIPLE FACTORS

Addiction

DRUG

Brain Mechanisms

Biology/Genes

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Environment

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The mu Opioid Receptor

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buprenorphine

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Medical Illness

•  Over 120 diseases caused or made worse by alcohol, nicotine and other drugs

•  Pulmonary •  Cardiovascular •  Infectious Diseases •  Mental Illness •  Cancer •  Trauma •  Unintentional Injuries •  Brain: hardware and software

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The Criminal Justice System is driven by Alcohol and Drugs

80 % of state inmates have been incarcerated for alcohol or drug offenses, intoxicated at the time of their offense, committed the offense to get $ to support their addiction, or had a history of alcohol abuse or dependence and/or illegal drug use

Alcohol and drug problems are common factors in 70% of child abuse and neglect cases.

Child Abuse and Neglect

Financial Loss to America ½ Trillion Annually

•  Illicit drugs: $181 billion/yr •  Tobacco: $168 billion/yr •  Alcohol: $185 billion/yr

•  $534 billion Annual for alcohol and drugs Compare to: •  Diabetes: $132 billion/yr •  Cancer: $210 billion/yr ONDCP (2004). (Publication No. 207303). 2004.; CDC. MMWR 54(25):

625–628, July 1, 2005; Harwood, H. Lewin Group for the NIAAA, 2000. 2000.

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Medical Specialty Boards

1910s 1920s 1930s 1940s 1950s 1960s 1970s 1980s 1990s 2000s 2010s

Oph ENT

IM Surg Peds P&N Path Rad ObG Derm CoRc Ortho Uro

NrSu Plsts Anes PMR PrvM FM

NuM EM A&I TSur

EM Rad MG

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ABMS Subspecialties

Addiction Psychiatry Adolescent Medicine Blood Banking/Transfsn Medi Cardiovascular Disease Chemical Pathology Child Abuse Pediatrics Child & Adolescent Psychiatry Clinical Cardiac Electrophysio Clinical & Laboratory

Dermmmunology Clinical Neurophysiology Critical Care Medicine Cytopathology Dermatopathology Dermatopathology Geriatric Developmental-Behavioral

Peds Endocrinology, Diabet & Metab Forensic Pathology Forensic Psychiatry Gastroenterology Geriatric Medicine Geriatric Psychiatry

Gynecologic Oncology Hematology Hospice and Palliative

Medicine (2007) Infectious Disease Interventional Cardiology Maternal & Fetal Medicine Medical Microbiology Medical Oncology Medical Toxicology Molecular Genetic

Pathology Neonatal-Perinatal

Medicine Nephrology Neurodevel Disabilities Neuromuscular Medicine Neuropathology Neuroradiology Neurotology Nuclear Radiology Orthopaedic Sports

Medicine Pain Medicine

Pediatric Cardiology Pediatric Critical Care

Medicine Pediatric Dermatology Pediatric Emergency

Medicine Pediatric Endocrinology Pediatric Gastroenterology Pediatric Hematology-

Oncology Pediatric Infectious Diseases Pediatric Nephrology Pediatric Otolaryngology Pediatric Pathology Pediatric Pulmonology Pediatric Radiology Pediatric Rehabilitation

Medicine Pediatric Rheumatology Pediatric Surgery Pediatric Transplant

Hepatology

Pediatric Urology Plastic Surgery Head and

Neck(Under Dev) Psychosomatic Medicine Pulmonary Disease Reproductive Endocrin/

Infertility Rheumatology Sleep Medicine (2006) Spinal Cord Injury Medicine Sports Medicine Surgery of the Hand Surgical Critical Care Transplant Hepatology Undersea and Hyperbaric

Medicine Vascular Neurology As of 2007, and many more

the last few years

Addiction Medicine Is…..

•  Prevention & Screening •  Diagnosis & Treatment •  Training & Education •  Basic Science & Epidemiology •  Administration & Advocacy •  Compassion, Patience,

Professionalism

ABAM Examination Details

•  250 questions, 5 hour time limit •  Question bank: 1,200 questions •  Prometric Testing Centers •  Exam tutorial •  Review courses, study references •  Pass Rates

•  October 17, 2015

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Criteria to take the ABAM exam.

•  Active unrestriced license •  Completed a primary residency, any field •  1,920 hours involving nicotine, alcohol or

other drug problems, or risk of such, over 5 years; clinical, research, teaching, or administration is OK.

•  50 CME credits over 2 years related to addiction

Scores on the 2014 ABAM Examination

N Mean Min Max %  PassingFellows 38 539 320 706 94.7%First  Time  Test  Takers 707 505 146 783 87.0%

1 2 3 4 5 6 7 8 9 10 11 12 13 14First  Time  Test  Takers 1 3 4 11 29 58 116 128 120 110 75 37 12 3Fellows 1 1 4 8 7 8 5 3 1

0

20

40

60

80

100

120

140

Num

ber  o

f  Exa

minee

s

150         200 250 300 350 400 450 500 550 600 650 700 750 800

Passing  =  396

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Exam  jointly  administered    by  ABAM,  NBME  

ABAM  incorporated  

Any  ACGME  residency  now  

required  

First  ADM  Cer@fica@on  

Exam,  ASAM,NBME  

Annual Number of New ABAM Diplomates 1986 - 2014

ABAM Diplomates by Primary Specialty ( N= 3,363 January, 2015)

Psychiatry and Neurology

34%

Internal Medicine14%

Family Medicine12%

Anesthesiology5%

Other4%

Emergency Medicine2%

Obstetrics and Gynecology

1%

Pediatrics1%

Physical Medicine and Rehabilitation

1%

Preventative Medicine

1%

No current ABMS certification

M.D.s18%

D.O.s7%

ABAM MOC

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MOC Participation Rates

77%#

91%#

61%#

85%#

0%#

20%#

40%#

60%#

80%#

100%#

Internal#Medicine*#

Family#Medicine**#

Preven=ve#Medicine***#

Addic=on#Medicine#

MOC$Par(cipa(on$Rates$

*http://www.abim.org/news/physicians-enroll-in-ABIM-MOC-program-in-record-numbers.aspx **Ann Fam Med. May 2011; 9(3):203-210. doi: 10.1370/afm.1251 ***2013 MOC Participation Rates

Addiction Medicine Fellowships

•  27 current, increasing by 4-7 per year •  1 year in length •  All within ACGME accredited settings •  Block Rotations & Longitudinal Learning •  56 slots available •  See handout on hallway exhibit table

Addiction Medicine Fellowships: Progress and the Future

•  Expansion plan –  Includes exploring MedTox-ADM opportunities

•  Goals for Growth –  65 fellowships by 2020 with 130 graduates annually –  125 fellowships by 2025 with 375 graduates annually

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As  of    March,  2014  

ADM Fellowships: Keys to Success

•  Local Champion •  Patients •  Clinical, research and administrative venues •  ACGME affiliated hospital, system or school •  Funding •  Assistance and encouragement •  Peer collaboration •  ADM Fellowship Program Directors Association

Scope of ADM Practice

•  Across all medical specialties

•  Across all venues where patients present

•  Clinical, Administrative, Faculty, Research •  An emerging field, ADM physicians are

pioneers

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Why a subspecialty in addiction medicine?

•  1 of 6 Americans has the disease •  Lives can be improved, and saved •  Families and communities are healthier •  Health care costs go down •  Many public health and social benefits •  The cure for addiction is prevention •  Medicine can address America’s

Number One disease

The Path to ABMS, ACGME Recognition of ADM

v Ten  year  plan,  began  in  2006  

v February,  2015:  ABPM  starts  final  path  with  ABMS  

v ABMS  COCERT  meets  October,  2015  

v ACGME  accredita%on  of  ADM  fellowships  in  2016-­‐17    v “Grandfathering”  and  a  mid-­‐career  pathway  

ABAM and The ABAM Foundation