Best Practices
American Board of Obesity Medicine (ABOM) information:
- Encourage fellows to sit for the ABOM exam AFTER fellowship is completed, or if in a multi-year program, after the year of clinical requirements is completed.
- Most programs do not pay the ABOM exam fees for fellows; however, most do provide some funding for CME activities/travel and registration to conferences.
- ABOM offers a discount for fellowship-trained candidates
- Program directors must fill out the ABOM attestation form after fellows complete training. Click here to download attestation letter.
- Encourage fellows who’ve completed an OM fellowship to brand themselves as “Fellowship-Trained” to distinguish themselves from CME-trained ABOM Diplomates
Fellow appointments:
Obesity Medicine is not accredited by the ACGME; therefore, programs have the flexibility to give trainees different appointments.
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- Fellow: the traditional title; does not enable trainees to bill for their time seeing patients; attending must sign off on all patients
- Jr. Attending/Instructor: allows the fellow to bill for their time seeing patients; however, programs must be sure to balance expectations for revenue generation with time for training
- Dual appointments: if allowed by your institution, may enable the fellow to receive benefits of a trainee while also allowing them to bill for their services and generate revenue for the program
Fellow Supervision:
1) Supervision + billing models (and how to keep programs financially viable)
- Common baseline approach: An attending physician “touches” every patient encounter (often going in briefly) so billing can occur under the attending when the fellow is not credentialed/eligible to bill independently. This preserves revenue and keeps precepting from being a financial loss.
- Key constraint noted: No primary care exception applies for obesity medicine the way it can in some primary care training settings—so to bill under the attending, the attending generally must meet payer documentation/face-to-face requirements.
- Volume and visit length tension: Some programs flagged that fellow visits are longer (e.g., 60-min new / 30-min follow-ups), which can make a pure precepting model financially “under water” unless the attending can double up (see their own patients or precept multiple learners).
- Multiple funding pathways:
- Start-up support via grants/foundation/philanthropy while volumes ramp.
- Pro formas showing eventual break-even through clinical growth.
- RVU-sharing or revenue-flow arrangements (e.g., allocating a portion of RVUs generated on the fellow schedule back to the fellowship).
- Hybrid roles (e.g., “instructor/fellow” or junior faculty-style appointments) allowing fellows to bill independently to cover salary—balanced against institutional rules and visa constraints.
2) Fellow autonomy is a “graduated” progression—and institutional HR/GME rules drive what’s possible
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- Many programs use a ramp-up model:
- Early period (1–3 months) = shadowing + didactics + supervised clinic. Program Directors and other core faculty schedule fewer patients or have parallel patient panels to allow for time to review patient presentation and management plan.
- Mid-year = increasing independence, but with structured check-ins.
- Later months = more independent visits, ideally with case review at the end of clinic rather than attending entering every room.
- Whether that later-stage autonomy can happen depends heavily on:
- Whether fellows are appointed as “fellows” vs “instructors” (billing/independence rules differ).
- Whether the program sits under GME (more structure/requirements, sometimes more protection) or outside it (more flexibility, but less institutional scaffolding).
- Many programs use a ramp-up model:
Administrative:
- Most programs have a shared program coordinator/administrator
- Funding is typically through clinical revenue generation along with institutional sponsorship, grant support, and some philanthropy and endowments.
- It is recommended that programs have a Clinical Competency Committee (A CCC synthesizes quantitative and qualitative assessments regarding an individual fellow's performance).
- It is recommended that programs have a Program Evaluation Committee (A PEC identifies outstanding features of the program and areas that could be improved).
Recruitment:
- To increase the ‘pipeline’ of potential fellows, offer an elective rotation through the Obesity Medicine clinic for students and residents.
- When giving lectures, be sure to mention your Obesity Medicine fellowship program. OMFC-recognized fellowships are the ONLY fellowships that ABOM allows to sit for the exam through the fellowship pathway (no CME requirement).
Training time recommendations:
- The average number of clinical sessions in the outpatient OM clinic is about 6 per week across all OM fellowships. Time is also spent in elective rotations, didactics, research, and teaching. Institutions are encouraged to tailor the training to their strengths and the interests of their fellows.
- Leaves of absence: The official requirements are that programs must be at least 12 months in length. Each program must allow at least 6 weeks of absence for fellows unable to perform their patient care responsibilities without penalty. Additional leave policy details are at the discretion of the institution. Be sure to check with your institutional GME office, as they may have fellowship requirements separate from the OMFC.