Two landmark developments in medicine pave the way for quality medical care to address America's largest and most costly preventable health problem – unhealthy substance use and addiction involving all addictive substances. These changes are designed to increase the number of addiction medicine physician specialists who can provide direct patient care and consultation, teach other providers and thereby drive knowledge across health care, and help policymakers and the public understand and effectively respond to our current health crisis.
"These developments will change the landscape in substance use prevention and early intervention and in addiction treatment and management. Many more trained physicians will be available to address the opioid crisis and other addictions. They will also be able to help prevent and intervene early with unhealthy substance use in all its forms," said Lon R. Hays, MD, President of The Addiction Medicine Foundation and Director of the University of Kentucky Addiction Medicine Fellowship Program. "For the first time, when aspiring physicians consider a career path they will now have as an available choice an addiction medicine specialty that meets the highest standards of medicine."
The first development is the formal certification of 1,200 addiction medicine physicians by the American Board of Medical Specialties (ABMS) – the gold standard in physician certification. The administrative sponsoring board for the new field is the American Board of Preventive Medicine (ABPM). In 2015, addiction medicine was recognized by ABMS as a subspecialty available to physicians from all medical fields who were already certified by an ABMS member board. The first certification exam was administered in the fall of 2017 and this first cohort of physicians has just been certified; future exams will be offered annually.
The second key development is that the medical body that accredits physician specialty training programs in the U.S. — the Accreditation Council for Graduate Medical Education (ACGME) — has opened the pathway for accrediting subspecialty training programs in addiction medicine. These are one-year, full-time training programs that physicians may apply to after they have completed a residency in a primary specialty such as internal medicine, family medicine or pediatrics. In these fellowship programs, physicians are trained in a wide range of clinical venues in the care of people engaged in unhealthy substance use or who meet medical criteria for a substance use disorder — from hospital wards, to outpatient programs and community primary care clinics and practices. Upon completion, physicians will be able to work as expert clinicians in these environments as well as engage in teaching, research, advocacy and administrative positions that require in-depth expertise.
Medical schools and teaching hospitals can now seek formal accreditation for addiction medicine training in accordance with ACGME approved program requirements. The Addiction Medicine Foundation developed a set of core competencies and program requirements for its fellowship programs with anticipated ACGME program accreditation in mind. The new ACGME program requirements closely mirror those now in place. ACGME accreditation will also enable fellowship programs to apply for funding from the Centers for Medicare & Medicaid Services and the Veterans Health Administration.
To date, 55 addiction medicine fellowship (training) programs (52 in U.S.; three in Canada) have been established at leading North American medical schools and hospitals, with the assistance of The Addiction Medicine Foundation. It is expected that the 52 fellowship programs based in the U.S. – and many more – will apply to become accredited by the ACGME. The Addiction Medicine Foundation projects that at least 125 addiction medicine fellowship programs are needed and will receive accreditation by 2025.
"We have been waiting for this moment when addiction medicine specialists can join the mainstream of American medicine and expand the critically needed addiction prevention and treatment workforce," said Anna Lembke, MD, who serves as President of the independent Addiction Medicine Fellowship Directors Association, and directs the Stanford University Addiction Medicine Fellowship.
There is a profound need for knowledge in addressing this disease and its prevention and treatment across primary care and in many areas of specialty care practice. Risky substance use and addiction constitute America's largest and most costly preventable health problem. Approximately 40 million people in the U.S. have the disease of addiction, yet only about one in 10 receive any form of treatment. These landmark changes will help ensure that trained physicians are available to address the full range of medical conditions related to the use of addictive substances, including, including psychiatric disorders.
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To learn more about The Addiction Medicine Foundation, or to support their work in expanding physician training, go to http://www.AddictionMedicineFoundation.org, or call 301-656-3880. AGCME program requirements and applications can be found at http://www.ACGME.org (they are also available on the TAMF website at https://www.addictionmedicinefoundation.org/acgme-application-now-available-for-addiction-medicine-fellowship-accreditation/). Physician addiction medicine certification requirements are described on the http://www.TheABPM.org site.
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