Today’s Wound Clinic recently asked key opinion leaders to comment on the potential of wound care to become a recognized medical specialty. This article is authored by officials with the American Board of Wound Medicine and Surgery.
In 2011, a group of respected wound care physicians established the American Board of Wound Medicine and Surgery (ABWMS) with the goal of enhancing the quality of available care by offering board certification in wound medicine and surgery to physicians (in the United States and Canada) who demonstrated required qualifications. The certification is also based upon receiving a specific course of quality education and by proving, through successful written examination, one’s commitment to and understanding of appropriate care and management of patients living with chronic wounds. The mission of the ABWMS has been for the American Board of Medical Specialties (ABMS) to recognize the practice of wound care as a medical or surgical subspecialty and officially grant the clinical field of wound medicine and surgery this important status. This article will discuss the ABWMS’ work to date in attempting to achieve this recognition.
Specialties & Subspecialties
Since the late 1990s, ABMS officials have emphatically stated that they will not create any new medical or surgical specialties. However, the ABMS has acknowledged that there are many pathways available to achieve subspecialty status through existing specialty boards. The ABWMS has held several productive meetings with the ABMS and is actively working toward this goal, but the path has been a long one. To become a subspecialty recognized by the ABMS, a special area of clinical practice such as wound care must be “adopted” by an established medical or surgical specialty board that is already recognized by the ABMS. In most cases, the adoption is based upon the “relatedness” of this special area of practice to the body of knowledge tested by the ABMS-recognized board. ABWMS officials have participated in multiple encouraging discussions with several boards, including general surgery, internal medicine, infectious disease, geriatrics, emergency medicine, family medicine, vascular surgery, and physical medicine and rehabilitation. However, it is premature to discuss which board(s) might agree to adopt wound medicine as a subspecialty.
As a condition of recognition, members of the established medical specialty board will expect to see an interest in the new field by physicians who are currently in practice or in training. One of the principal indicators of interest in the subspecialty field is the existence of fellowships that are conducted by qualified physicians. Another is the number of diplomates in the new field. The ABWMS has been diligently working in both areas and has developed a certification examination that has led to more than 400 physicians being certified in wound medicine and surgery since 2012. Six fellowships in wound medicine have also been created across the country that parallel with the certification, and the ABWMS has recently established a commission that’s charged with nurturing more fellowships. Yes, it is difficult to develop fellowships in the absence of public or federal funding, and it is difficult to expand interest in certification via testing of physicians long after their formal education is complete. However, these are challenges that the board members will seek to validate a burgeoning field of practice.
Seeing The Specialty Become Reality
There is another challenge with regard to the process of obtaining subspecialty recognition, and that is that wound care as an industry cannot determine exactly how close it is to achieving this recognition until the ABWMS finalizes a relationship with a sponsoring board. The ABMS specialty board that recognizes or adopts wound medicine would set the goals for subspecialty certification in terms of the number of fellowships expected and the number of physicians who must be certified by the examination. So, the ABWMS will continue its methodical work with the expectation that, when the time comes, and as its relationship with a given board continues to unfold, the ABMS will accept the progress this group will have made up to that point. ABWMS officials anticipate that within the next five years we will have achieved the expectations of a specialty board, although, naturally, that cannot be guaranteed due to many variables, a major one of which is funding. From the outset, the ABWMS has worked diligently to remain free from any and all relationships that might create even the appearance that the group could be influenced in its actions, especially with regard to the status of a candidate for certification. Consequently, the ABWMS has not sought any external funding for its work. Until now, funding for the work of the ABWMS has come exclusively from the fees generated through the testing process and annual certification, which may encourage physicians to take the certification examination if they know that the relatively nominal fee paid helps support the initiative for subspecialty recognition. However, it can’t be denied that additional funds would help accelerate the work of the board, particularly with regard to the establishment of fellowships, and that is the reasoning behind the ABWMS’ board of directors recent decision to create a 501(c)(3) nonprofit foundation to assist in achieving the goal of a recognized subspecialty. Funds received into the foundation will support fellowships in wound medicine. Of course, there are precedents for this process. Undersea and hyperbaric medicine (UHM) is a recognized subspecialty by both the preventive medicine and emergency medicine boards. After UHM became recognized by the ABMS as a subspecialty, there was a grandfathering period of several years, during which physicians with any ABMS-recognized medical specialty board certification and specifically defined clinical experience in UHM could sit for the UHM subspecialty board examination. Now that the grandfather period has closed for UHM, physicians wishing to be subspecialty board certified must complete a fellowship that is accredited by the American College of Graduate Medical Education in UHM. The ABWMS cannot provide definitive information about how subspecialty certification will work in terms of a grandfather period, however, because that will depend upon negotiations between the ABWMS and a sponsoring board. Still, it is likely to resemble historical precedents.
Is Subspecialty The Best Way?
Clinicians and key opinion leaders in this industry often talk about wanting wound care to become a specialty, but a subspecialty is the only option available through the ABMS. Nevertheless, physicians must understand that being an ABMS-recognized subspecialty does nothing to undervalue the importance of the wound care field. As an ABMS-recognized subspecialty, wound care would become a valid and formally accepted field of medicine, and, consequently, its legitimacy will be assured beyond those in the industry. In many ways, becoming a subspecialty is a meaningful advantage for patients as well. Wound care clinicians must remember that wounds are not so much a disease as they are a symptom of a disease (or many diseases). Patients who require chronic wound management are likely living with many complex conditions and benefit from having a diverse group of specialists involved in their treatment. One might compare it to palliative care — not that the goals of treatment are in any way the same — in that this field of care is another subspecialty that benefits richly from having clinicians who are trained in many different fields and who look at a complex medical problem from different perspectives. There is a richness to the diversity of backgrounds among practicing wound care professionals, such as infectious disease, dermatology, physical medicine, and vascular surgery (to name only a few), and the subspecialty pathway makes perfect sense for wound care as a field. A subspecialty recognition would surely serve as the valid appreciation across all healthcare arenas that this specialized area of care deserves.
Richard Simman is president and chair of the ABWMS and a professor at Wright State University’s Boonshoft School of Medicine. Anthony J. McNevin is executive director of the ABWMS.