ATTC Messenger June 2017 Physician Certification in the New Sub-Specialty
Addiction Medicine:Physician Certification in the New Sub-Specialty
ATTC Network Coordinating Office
In 2016, the American Board of Medical Specialties (ABMS) formally recognized Addiction Medicine as a new subspecialty under the American Board of Preventive Medicine (ABPM). In a press release celebrating this news, the American Society of Addiction Medicine stated:
“This recognizes addiction as a preventable and treatable disease, helping to shed the stigma of misunderstanding that has long plagued it and provides a new career option for medical students, residents and physicians interested in specializing in the treatment of addiction.”
Currently, the U.S. has in practice:
- 3,500 Addiction Medicine Physicians (mostly part-time)
- About 2,000 Addiction Psychiatrists (mostly part-time)
America desperately needs more physicians who are trained and credentialed in Addiction Medicine (ADM)
- Need for ADM physicians by 2020: 7,500
Michael F. Weaver, M.D., FASAM, is a professor in the Department of Psychiatry and Behavioral Sciences at McGovern Medical School of the University of Health Science Center in Houston. He is the medical director at the Center for Neurobehavioral Research on Addiction. He serves as Chairman of the Addiction Medicine Sub-Board of the American Board of Preventive Medicine and oversees all aspects of the new certification examination.
Dr. Weaver is one of the featured presenters in the webinette, Addiction Medicine: Physician Certification in the New Sub-Specialty. This free 30-minute webinette is available for viewing on demand. It offers specific details on eligibility and other practical advice to guide viewers through the exam process, while also describing needs and opportunities in the sub-specialty of Addiction Medicine for those considering certification in the future.
Dr. Weaver answers a few questions about the new subspecialty in the following interview.
Q: From a physician’s perspective, what are the rewards of specializing in addiction medicine?
MW: What inspires me is seeing physicians from different backgrounds coming together to help patients with complex problems that cross a variety of fields and specialties. That, and seeing the profound change that patients experience when they are successful in substance use disorder (SUD) treatment and recovery. The change in a person’s life as a result of treatment can be dramatic. This is something you don’t see as much in other areas of medicine. So often we read about celebrities succumbing to an addiction, but it’s important to hear about how people can overcome substance misuse and return to their prior levels of success.
Q: Describe some ways that the new subspecialty will benefit addiction treatment and recovery services.
As a medical subspecialty with a defined body of research, the new addiction medicine certification will promote evidence-based practices in treating SUDs. For example, medication-assisted treatment, using the FDA-approved medications for SUD treatment, has been shown to be effective and life-saving. There are a variety of classes of medications that work in different ways, in combination with counseling and recovery support. Research validates these treatments, and the subspecialty will provide physicians with an understanding of multiple components of successful treatment plans, as well as the risks and benefits of different treatment approaches. Physicians who obtain the certification will be able to select the best treatment for an individual patient, considering the patient’s needs as well as restrictions that may apply, based on their circumstances.
This certification also legitimizes a SUD as a medical problem—not a bad habit—that can benefit from medical care. It will help more people get comfortable with the fact that having a SUD is not a weakness of character; it is a medical condition. And we hope that it will empower people to recognize that there is help available and they don’t have to struggle alone.
In addition, the addiction medicine subspecialty will help to accelerate the use of additional research-based treatments as they become available, giving us more arrows in the quiver for treating SUDs.
Ideally, this new subspecialty will help to close the treatment gap, so that more patients who need treatment will get the help that they need.
Q: How do you anticipate that the new medical subspecialty in addiction medicine will help build the capacity of the workforce that serves people with substance use disorders?
Physicians interested in taking the exam and becoming certified in Addiction Medicine need to complete the appication on the ABPM website.
The online application period ends on June 30, 2017.
MW: A rising tide floats all boats. Physicians and clinicians at all levels have been working together to make this certification a reality for helping patients who are struggling with the disease of addiction. As addiction medicine gains recognition and is seen as a bona fide subspecialty within medicine, it will legitimize the entire addiction prevention and treatment field.
Also, treating SUDs is a team approach. Physicians work as a part of a team of therapists, social workers, and behavioral health professionals—with different names in different states, providing one-on-one treatment. The subspecialty certification may also bring more patients into treatment. It will also make addiction treatment as a specialty more visible as a career option to medical students. It’s something more people might want to consider, with the understanding that helping people overcome addiction may be challenging, but at the same time extremely rewarding.
Q: What are the requirements for physicians who want to pursue the subspecialty?
MW: They will need to be certified in any of the 24 primary ABMS specialties. They would have supplemented care within their primary specialty with specific attention to addiction medicine competencies and practice, in the care of their own patients and patients in addiction prevention or treatment programs. Addiction medicine is a good companion to many specialties and subspecialties, including internal medicine, pediatric medicine, emergency medicine, obstetrics, family medicine, infectious disease, or pain medicine.
Physicians can sign up now to take the examination that will be offered in October 2017. Also, a fellowship is not required at this time, but starting in 2022 physicians will have to complete a one-year fellowship in Addiction Medicine to be eligible for the certification. Until then, any physician can sit for the exam, as long as they are already certified in any ABMS specialty and have met the Practice Pathway, which is the time-in-practice requirement for the ABPM.
For more information, visit the American Board of Preventive Medicine page, Addiction Medicine.
Q: From your perspective as a physician, how important is it for a person with a substance use disorder to work with an interprofessional care team?
MW: With the opioid epidemic and the increases in use and misuse of methamphetamine and cannabis, SUDs affect a very large number of Americans and people around the world. There’s a continuing need for effective treatment delivered by qualified professionals. Primary care physicians and specialists can work together to provide different aspects of care to patients as part of a comprehensive treatment plan.
Addiction medicine as a specialty is going to require core training that will include a behavioral health component. For some substance use disorders, it is the only treatment that we have available. Primary care physicians who have addiction training as part of their essential skills can help with one segment of the population in need of treatment or at risk of developing an SUD. Other people will require referral to specialty treatment.
Just as a surgeon should be aware of basics of psychiatry and recognize when a patient’s condition is serious and should be referred, physicians with the addiction medicine subspecialty will be able to determine if a patient needs specialty care. Training in the addiction medicine subspecialty will include education and experience in linking patients to community recovery support services such as Twelve Step and other groups.
Q: What can SUD treatment providers do to encourage physicians to consider pursuing the subspecialty in addiction medicine?
MW: The addiction treatment subspecialty doesn’t have to be full-time work. Physicians with the subspecialty could, for example, work part time with a treatment program, or they could do office-based opioid treatment in conjunction with another practice.
SUD treatment providers can also help promote the subspecialty by spreading the word to physicians that treatment is effective and people do recover, that addiction medicine is rewarding, and there are many ways to contribute.
Q: One final question, what role does the addiction medicine physician play in the prevention of substance use disorders?
MW: You have saved the most important question for last! We know that 95% of adults with addiction to any drug began their substance use before their brain was fully developed, which occurs in the mid-twenties. Epidemiology and neuroscience make clear that substance use disorders can be largely prevented if substances are avoided during the early critical period of brain maturation. Once the neurocircuitry is etched, if you will, the vulnerability to addiction has begun. America will never treat, incarcerate, or legislate its way out of widespread or endemic use–such as nicotine and alcohol—and epidemic opioid drug use. Addiction medicine physicians are leaders in promoting screening and early intervention for substance use. For example, SBIRT (Screening, Brief Intervention, Referral to Treatment) is taught in all addiction medicine fellowships, and all addiction medicine physicians have opportunities to promote prevention to their peers in other fields, and in community settings. Specialists in addiction medicine are clinical experts, yet also teachers and change agents. Prevention is the best intervention for substance use disorders and can be applied at many levels, from the new patient, to the adoption of screening and early interventions at a community or health system level.
- ATTC White Paper: Preparing Students to Work in Integrated Health Care Systems
- ATTC/NIATx Service Improvement Blog: What do med students and prescribers need to know about opioid use disorders?