American Board of Internal Medicine, Philadelphia, PA.
JCO Oncol Pract. 2020 Aug;16(8):e641-e648. doi: 10.1200/JOP.19.00651. Epub 2020 Feb 18.
Critics argue that the American Board of Internal Medicine's medical oncology Maintenance of Certification examination requires medical oncologists with a narrow scope of practice to spend time studying material that is no longer relevant to their practice. However, no data are available describing the scope of practice for medical oncologists.
Using Medicare claims, we examined the scope of practice for 9,985 medical oncologists who saw 8.6 million oncology conditions in 2016, each of which was assigned to 1 of 23 different condition groups. Scope of practice was then measured as the percentage of oncology conditions within each of the 23 groups. We grouped physicians with similar scopes of practice by applying K-means clustering to the percentage of conditions seen. The scope of practice for each physician cluster was determined from the cancers that encompassed the majority of average oncology conditions seen among physicians composing the cluster.
We found 20 distinct scope-of-practice clusters. The largest (n = 6,479 [65.5%]) had a general oncology scope of practice. The remaining physicians focused on a narrow scope of cancers, including 22.6% focused on ≥ 1 solid tumors and 11.9% focused on hematologic malignancies. The largest focused cluster accounted for 7.7% of physicians focused on breast cancer.
A single American Board of Internal Medicine Maintenance of Certification assessment in medical oncology is most appropriate for approximately 65% of certified medical oncologists' practices. However, the addition of assessments focused on breast cancer and hematologic malignancies could increase this figure to upwards of 85% of certified medical oncologists.
批评者认为，美国内科医师学院的肿瘤内科维持认证考试要求实践范围狭窄的肿瘤内科医生花费时间学习与其实践不再相关的材料。然而，目前尚无数据描述肿瘤内科医生的实践范围。
我们使用医疗保险索赔数据，检查了 9985 名肿瘤内科医生在 2016 年治疗的 860 万例肿瘤疾病的实践范围，每位医生治疗的疾病被分配到 23 个不同疾病组中的 1 个。实践范围随后通过每个疾病组中肿瘤疾病的百分比来衡量。我们通过对所观察到的疾病的百分比应用 K-均值聚类将具有相似实践范围的医生进行分组。从构成聚类的医生中观察到的大多数平均肿瘤疾病所涵盖的癌症确定每个医生聚类的实践范围。
我们发现了 20 个不同的实践范围聚类。最大的聚类（n=6479[65.5%]）具有一般肿瘤学实践范围。其余医生专注于狭窄的癌症范围，包括 22.6%的医生专注于≥1 种实体肿瘤，11.9%的医生专注于血液恶性肿瘤。最大的聚焦聚类占专注于乳腺癌的医生的 7.7%。
单一的美国内科医师学院肿瘤内科维持认证评估最适合大约 65%的认证肿瘤内科医生的实践。然而，增加针对乳腺癌和血液恶性肿瘤的评估可以将这一数字提高到 85%以上的认证肿瘤内科医生。
