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Tell ABNM Board Members to support an alternative to the ABR Task Force proposal

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The American Board of Nuclear Medicine (ABNM) has recognized the need to ensure appropriately trained and credentialed physicians are available for the future of the specialty, and for the provision of high quality, safe, Nuclear Medicine clinical care in the United States. In April of 2015 a Task Force comprised of members from the American Board of Radiology (ABR) and ABNM unveiled a proposal that would streamline training pathways to a single acceptable experience requirement for certification, and bring that certifying function under the ABR. The primary driver to this approach is said to be a focus upon current and upcoming hybrid imaging technology, as well as historical economic trends related to the job market. The Task Force proposal has fueled extensive discussion and debate amongst stakeholders. There is widely recognized need for the field to adapt to disruptive technologies and innovation, as well as adapt to a changing healthcare climate within the United States. There are also a significant proportion of stakeholders opposed to the proposed dissolution of ABNM. In an effort towards harmonization, members of the Society of Nuclear Medicine & Molecular Imaging (SNMMI) have developed the below plan for consideration either as an alternative to the Task Force proposal, or as contingency should a motion for approving the Task Force recommendations as a standalone unaltered initiative fail.

The below Alternative Plan is intended to be inclusive of those dedicated to the field of Nuclear Medicine, Molecular Imaging & Therapeutics and prioritizes high quality safe patient care across practice settings within the United States. We invite all specialty and regulatory stakeholders to consider the following proposal:

1. The ABNM will remain the primary certifying organization for Nuclear Medicine in the United States

2. ABNM will assume responsibility for ensuring quality Nuclear Medicine practice across all settings by assessing and certifying a) basic Nuclear Medicine competence, b) continuing to certify those able to perform all aspects of Nuclear Medicine, Nuclear Cardiology, PET/CT, and therapeutics with recognition of training and experience adequate to serve as an Authorized User, and c) providing advanced certification to those who complete additional training in Molecular Imaging:

a. Basic Nuclear Medicine competence: At this time, the majority of Nuclear Medicine practice in the United States is performed by Board Certified Radiologists who have completed Nuclear Medicine training during Radiology residency or Nuclear Cardiologists who have completed level II certification in accordance with the American Society of Nuclear Cardiology (ASNC)/Certification Board of Nuclear Cardiology (CBNC). This training is typically 4-6 months in duration.

In general, most Nuclear Medicine procedures are performed in the outpatient setting, at centers required to be accredited by the Center for Medicare and Medicaid Services (CMS). Accrediting agencies, such as the Intersocietal Accreditation Commission (IAC) have requirements that a Nuclear Medicine or Nuclear Cardiology Imaging Center Medical Director have a minimum 4 months of training in Nuclear Medicine, or Nuclear Cardiology, respectively with further stipulation of a minimum supervised 800 case experience for Nuclear Medicine or

300 Stress Myocardial Perfusion procedures for Nuclear Cardiology. Aligning ABNM Basic Certification with accrediting agency requirements will streamline operations and add clarity to Nuclear Medicine practice in the United States. Requiring 6 months of foundational level experience, or a minimum case load as above, by the ABNM will ensure minimum requirements for safe practice and patient handling at the most frequent points of care, thus improving quality for all. The ABNM – Nuclear Medicine (NM) and ABNM – Nuclear Cardiology (NC) foundational exams can be administered during the last year of Radiology Residency or Non-invasive Imaging Cardiology Fellowship. The SNMMI will support training programs through the development of foundational educational materials that support a standardized minimum curriculum.

b. Full certification of those able to perform all aspects of Nuclear Medicine, Nuclear Cardiology, PET/CT, and therapeutics with recognition of training and experience adequate to serve as an Authorized User: The ABNM will continue to certify those who have completed Nuclear Medicine residency/fellowship requirements and are able to perform all aspects of Nuclear Medicine, Nuclear Cardiology, PET, and therapeutics with recognition of training and experience adequate to serve as an Authorized User. This full certification includes all existing pathways to ABNM certificate and recognizes the evolving nature of training that now includes hybrid imaging into routine clinical practice. SNMMI will support training programs through the development of educational content and/or programs designed to address any gaps in curriculum that may exist in training centers so that all consensus guidelines for minimum experience are able to be met prior to Board Examination. Existing robust maintenance of certification (MOC) will continue with opportunities for existing diplomates to continually further their skills and develop their careers.

c. Advanced certification to those who complete additional training in Molecular Imaging: The ABNM will develop an advanced certification in Molecular Imaging (ABNM – MI). This is intended to promote minimum competency and experience to further, and eventually practice, newer clinical imaging technologies. The Molecular Imager will have existing full certification by an ABMS member board and have completed two years additional training that ensures an aggregate 30 months Nuclear Medicine experience, as well as a minimum 12 months advanced anatomic imaging with no less than 6 months, or documented 300 cases, specific to Magnetic Resonance Imaging. This advanced certification will also be supported through SNMMI educational programs that will facilitate completion of core requirements, which may initially be challenging for some institutions.

3. ABNM will recognize practicing Nuclear Radiologists and Nuclear Cardiologists. As part of the process of transitioning to this new global paradigm, upon application, ABNM will issue the appropriate certificate to current practitioners commensurate with their experience/certification, and will partner with SNMMI and/or other stakeholders, as appropriate, to offer additional experience or educational content to those who need it for recertification in the period shortly following proposal adoption.

This proposal will align Nuclear Medicine practice within the United States and help to clearly delineate provider competency. We recommend this inclusive approach to foster collaborative relationships in Imaging Departments in support of training and validation of all levels of Nuclear Medicine practice. By embracing all who have a sincere interest in practicing high quality Nuclear Medicine we hope to improve access, quality, and safety for patients and dependent providers, such as Nuclear Medicine Technologists. It is our belief that this proposal will serve to advance the field and is intended to benefit all stakeholders.

The process to transition to proposal adoption will require acceptance by ABNM and SNMMI Leadership. Associated logistics and educational content development will likely necessitate a minimum 18 month period of transition. It is anticipated this new system can be in place by the year 2017. We understand the fluid and evolving nature of the field and are open to modifications that will enhance the underlying tenants stated herein.



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