title: The role of internal medicine subspecialists in patient care management.
abstract: OBJECTIVE
  To understand the clinical roles in which internal medicine (IM) subspecialists engage, especially those involving ongoing patient management.
  
  
  METHODS
  Measures of physician clinical roles were based on survey responses collected from 8020 mid-career IM subspecialists who registered for the American Board of Internal Medicine maintenance of certification program (86% registration/response rate) between 2009 and 2013.
  
  
  METHODS
  Each subspecialist reported their percentage of clinical time in 5 clinical roles: primary, principal, longitudinal consultative, medical consultative, and procedural care. We characterized an IM subspecialist's clinical role focus as those roles that composed a majority of their clinical time.
  
  
  RESULTS
  Most IM subspecialists reported spending a majority of their time performing 1 (65%) or 2 (31%) clinical roles. Most (54%) reported a clinical role focused on ongoing patient care management roles, including principal care (eg, total responsibility for a specific condition, 23%), longitudinal consultative care (eg, shared care, 21%); or a mixed clinical role focus composed of both principal and longitudinal consultative care (8%). We also found that physicians focused on ongoing patient care management roles represent a significant percentage of physicians within most IM subspecialties (ranging from 19% to 88% across subspecialties).
  
  
  CONCLUSIONS
  A subspecialist's clinical role focus is an important practice characteristic, and many subspecialists perceive themselves as playing a significant role in care management. These findings suggest there are opportunities to incorporate subspecialists into newer payment and care delivery reforms; they also bring to light reasons that training and certification programs should consider the different clinical role foci subspecialists adopt.
authors.affiliation: American Board of Internal Medicine, 510 Walnut St, Ste 1700, Philadelphia, PA 19106-3699. E-mail: Jvandergrift78@gmail.com.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Vandergrift
authors.forename: Bradley M
authors.initials: BM
authors.lastname: Gray
authors.forename: James D
authors.initials: JD
authors.lastname: Reschovsky
authors.forename: Eric S
authors.initials: ES
authors.lastname: Holmboe
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Lipner
mesh_terms: D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D008297:Male; D017063:Outcome Assessment, Health Care; D010346:Patient Care Management / Q000458:organization & administration*; D010819:Physician's Role; D010818:Practice Patterns, Physicians'; D013038:Specialization; D014481:United States