A fellowship should be valuable for the specific career goals of the people entering that fellowship. A skill needed in most practice settings should be part of residency training; which is exactly what we have now. Residents learn FAST and procedural ultrasound. Fellows learn skills needed for academic and administrative leadership.
You're so desperate to **** on this you're really going to pretend there are no large community practices with a robust POCUS program that includes credentialing, billing, QI, and training warranting a fellowship trained Ultrasound Director?
You make a good point. I'll grant you that the point of an US fellowship isn't solely to make you better at bedside US. For those going into the community, it's supposed to be an entry point to becoming a community US director (more typically for a hospital system as opposed to a single facility site).
My criticism of this pathway is twofold. It is true that these positions exist. All of the large hospital/staffing companies in my region have an US trained ED physician who gets a stipend for performing this role. I've declined this position in the past because the stipend in no way makes up for the money you'd get by simply working more shifts. The amount of time doing administrative tasks is better spent doing shifts. Granted (much like academics), many folks find gratification and value in doing US administration and feel the decrease in pay is worth it.
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My second criticism of this path is... none of the community docs care and there is no way to make them care. I've been around long enough to see every which way community docs are encouraged to do more ultrasounds. None of it ever works. I have never once seen a simple way to save and documents scan. Even the ubiquitous FAST exam is a PITA to save and document on a trauma activation. People have tried everything. Barcode scanners, dot phrases, wifi archiving, canned text for charting. The truth of the matter is, when your hospital expects you to meet DTG and PPH metrics, futzing with the US machine is by far the last thing on anybody's mind.
I used to be an acolyte. I was involved in streamlining workflows to make scanning easier. After seeing multiple US administrators in multiple hospital systems try to make this easier, I've come to the conclusion that it never will be. ER docs are hyperaware of even little disruptions to our flow. Pop up asking you why you're giving an antibiotic? You immediately adapt to bypassing this as fast as possible. Same goes for US. Your average community doc immediately see this as minimally useful clinically, and it comes with multiple roadblocks to flow. I admit I'm a pessimist, but I do not ever see bedside US being accepted by community ER docs without a significant overhaul to how ERs operate.
Yes, there are robust community programs with everything you list. A director who does QI, manages archiving, and make sure billing occurs. But it's smoke and mirrors. These programs exist, but nobody is really doing US. In my personal experience, 80-90% of ER docs don't even touch the machine. A handful will use it for FAST and procedures. A tiny percentage (probably former fellows; I include myself in this category) will use it for more. By far the the people who touch the machines the most are techs and nurses placing IVs.
It used to be thought it was an age/training issue. I.e. older docs who didn't understand wouldn't use it, but all the new grads would. This is false. The younger docs don't touch it either. They probably liked it in residency and know many of it's applications, but (like everyone else) as soon as they're thrown into the pit with 20 in the waiting room and fires left and right, they realize that it's nearly impossible to reasonably incorporate into practice.