gen. anesthesiologist sitting for peds anesthesia exam although not meeting grandfathering criteria

[bilson]

I was wondering if this is being done at other facilities....my place is allowing a general anesthesiologist to sit for the peds anesthesia board exam in 2014 when that person does not even meet the grandfathering criteria. I mean that person has not been practicing peds primarily for the last 2 years as per the ABA grandfathering crieria.
I do not know what to do... I do not want to tell the ABA as I may lose my job.. It makes feel sick to know that I did a peds anesthesia fellowship and this person does n0t even meet the criteria and is being allowed to sit for the exam..
Any advice on how I should handle this AND not hurt myself?

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[invitro]

I was wondering if this is being done at other facilities....my place is allowing a general anesthesiologist to sit for the peds anesthesia board exam in 2014 when that person does not even meet the grandfathering criteria. I mean that person has not been practicing peds primarily for the last 2 years as per the ABA grandfathering crieria.
I do not know what to do... I do not want to tell the ABA as I may lose my job.. It makes feel sick to know that I did a peds anesthesia fellowship and this person does n0t even meet the criteria and is being allowed to sit for the exam..
Any advice on how I should handle this AND not hurt myself?

Man I wouldn't lose any sleep over it. There were a couple of people that did that at my hospital (no peds fellowship...relatively low peds volume). well, there are always some people that get in the back door. It seems like that option is gonna go away after 2015. No peds fellowship = no board certification in peds Anesthesia.

 

[urge]

There is a lot of that going on, mostly from private groups. I have heard some groups are encouraging everybody, even people who have never touched a child, to take the exam.

There is other grandfathering criteria. Doing 30% peds for over 5 years counts as well. However, this includes neonates which I doubt.

My guess is that if you blow the whistle the ABA will ask them for a case log.

 

[deleted171991]

I was wondering if this is being done at other facilities....my place is allowing a general anesthesiologist to sit for the peds anesthesia board exam in 2014 when that person does not even meet the grandfathering criteria. I mean that person has not been practicing peds primarily for the last 2 years as per the ABA grandfathering crieria.

"An anesthesiologist’s clinical practice has been devoted primarily to pediatric anesthesiology for the last 2 years, or at least 30% of an anesthesiologist’s clinical practice, averaged over the last 5 years, has been devoted to pediatric anesthesiology."

Are you sure s/he doesn't qualify by the latter? That can mean even just 12.5% a year for 4 years, and 100% for the 5th.

 

[nimbus]

Why is this distressing you? Is he good at pediatric anesthesia? If so, more power to him. I wouldn't lose sleep over this either, unless you have some political agenda.

 

[deleted126335]

Why is this distressing you? Is he good at pediatric anesthesia? If so, more power to him. I wouldn't lose sleep over this either, unless you have some political agenda.

He did the fellowship. He would like it recognized and to be compensated for it, with the certification that supposedly has defined criteria. Sounds like one of his colleagues is claiming eligibility to sit for the exam when they haven't earned the right to do so. I understand his distress. Short of asking the ABA (maybe anonymously) to audit the eligibility of this individual, not much that you can do.

 

[deleted171991]

This is what happens when you introduce board certification with grandfathering criteria. Board-certification in a subspecialty should never happen without having graduated a 12-month fellowship, period.

Either that, or you let any board-certified anesthesiologist take the subspecialty board. Anything in-between is arbitrary and susceptible to human nature.

 

[bilson]

The individual I am talking about recently graduated in past couple of years....so the grandfathering criteria of an average of 30 % over the past 5 yrs Does not apply...the Only criteria that does apply is primarily pediatric anesthesia over the past 2 yrs at time of application... this person is not at a children's hospital but at an adult hospital where the person does mainly adults with some peds cases so does not meet the criteria.

it is distressing to me because I had to work hard by doing a fellowship and passed the peds board exam and this person is being signed off by my chairman and receiving permission by the ABA to sit for the examination.
Tomorrow..that person can say I am just as good as you are.

 

[bilson]

Man I wouldn't lose any sleep over it. There were a couple of people that did that at my hospital (no peds fellowship...relatively low peds volume). well, there are always some people that get in the back door. It seems like that option is gonna go away after 2015. No peds fellowship = no board certification in peds Anesthesia.

thats 2015....until then people can lie and say they are also board certified and your equals...they may give us competition when applying for peds anesthesia jobs.

 

[bilson]

He did the fellowship. He would like it recognized and to be compensated for it, with the certification that supposedly has defined criteria. Sounds like one of his colleagues is claiming eligibility to sit for the exam when they haven't earned the right to do so. I understand his distress. Short of asking the ABA (maybe anonymously) to audit the eligibility of this individual, not much that you can do.

I was thinking of writing a letter to ABA....the problem is that my chairman and this person may get in trouble for lying.....this may come and backfire on me....I may end up loosing my job...I dont know what to do.

 

[nimbus]

And because it is a new certification, it's meaning and value is not established. I have partners who have been doing exclusively pediatric anesthesia at a pediatric referral center for over 20-30+ years who have not taken the exam. I would choose one of them over some newly minted, newly certified "specialist" with 2 years experience any time.

It will take 5-10 years minimum for the certification to have real meaning. Until then it's very amorphous.

As for compensation, we all know it depends on the revenues we generate. Not on certification status.

 

[nimbus]

I was thinking of writing a letter to ABA....the problem is that my chairman and this person may get in trouble for lying.....this may come and backfire on me....I may end up loosing my job...I dont know what to do.

Still don't understand your stake in this. If it affects patient care, then it is your duty to report. If he takes good care of the kids, then it is his business. Not yours.

 

[BobBarker]

MYOB.

 

[sleepallday]

The individual I am talking about recently graduated in past couple of years....so the grandfathering criteria of an average of 30 % over the past 5 yrs Does not apply...the Only criteria that does apply is primarily pediatric anesthesia over the past 2 yrs at time of application... this person is not at a children's hospital but at an adult hospital where the person does mainly adults with some peds cases so does not meet the criteria.

it is distressing to me because I had to work hard by doing a fellowship and passed the peds board exam and this person is being signed off by my chairman and receiving permission by the ABA to sit for the examination.
Tomorrow..that person can say I am just as good as you are.

Do you know where s/he trained? Some residencies have great exposure to peds, and honestly, a fellowship really isn't necessary. Many people choose not to do fellowships because: a.) they had great exposure to it in residency (CV, peds, regional, etc), and b.) it was not a boarded fellowship.

These same people should not be penalized because the subspecialty is now boarded. If they do not have the expertise to do peds, then they would probably fail the boards.

 

[urge]

Still don't understand your stake in this. If it affects patient care, then it is your duty to report. If he takes good care of the kids, then it is his business. Not yours.

Very easy to understand, unless your job depends on not understanding it.

 

[urge]

Do you know where s/he trained? Some residencies have great exposure to peds, and honestly, a fellowship really isn't necessary. Many people choose not to do fellowships because: a.) they had great exposure to it in residency (CV, peds, regional, etc), and b.) it was not a boarded fellowship.

These same people should not be penalized because the subspecialty is now boarded. If they do not have the expertise to do peds, then they would probably fail the boards.

The experience pathway seems better to me. I don't think there is any residency where you would do enough peds numbers to qualify for the test.

Plus, If somebody is not doing peds, why would they want the board other than to deceptively market themselves?

 

[BuzzPhreed]

bilson seriously get a grip. There are far bigger things to worry about. Think about all the CRNAs in private practice who do pediatric anesthesia with no additional training or board certification. Just because someone thinks they are good with kids. Give me a break. Or maybe you haven't experienced that yet? Get over yourself a little. It's all a racket. If you're good your skill will trump an extra board certification that just means more money going into the ABA's pocket anyway. Besides I've met plenty of general anesthesiologists who are far better at peds than fellowship trained ones.

Find something more important to worry about. Like how you might not have a job five years from now unless you hide out in academics making half the salary you deserve.

 

[nap$ter]

I was thinking of writing a letter to ABA....the problem is that my chairman and this person may get in trouble for lying.....this may come and backfire on me....I may end up loosing my job...I dont know what to do.

i would write the letter. i would explain my situation to the ABA and ask for anonymity. hopefully they will be sensitive to your situation. if you lose your job because of this, my suspicion is that it would be a good thing in the long run, even if it is painful in the short term.

your chairman and colleague are falsifying qualifications to attain a certification that you (and I) worked hard to earn. we shouldn't have to compete with folks taking shortcuts. if your colleague wants the certificate, he/she needs to do a fellowship. if a crna wants to call himself doctor, he/she needs to go to medical school.

the question here isn't whether this dishonest colleague can safely care for kids, and it isn't whether he/she could pass. this colleague is dishonestly obtaining a title/certificate, and where i come from that is fraud worthy of firing and/or loss of medical licenses and/or board certificates.

 

[BuzzPhreed]

You are assuming a lot slavin. Be careful. I have met plenty of non fellowship trained anesthesiologists who are better than fellowship trained ones in taking care of kids. Yes including hemi-Fontans and complex premie cases. Some of those non fellowship trained anesthesiologists even trained some of the pedi fellows during their fellowship. Would you exclude them too?

 

[nap$ter]

You are assuming a lot slavin. Be careful. I have met plenty of non fellowship trained anesthesiologists who are better than fellowship trained ones in taking care of kids. Yes including hemi-Fontans and complex premie cases. Some of those non fellowship trained anesthesiologists even trained some of the pedi fellows during their fellowship. Would you exclude them too?

i made no assumption.

and no, i would not exclude any fantastic (or crappy) non-fellowship trained anesthesiologist who was honest and qualified to sit for the exam.

you are missing the point, and sound like an AANA ad man. clinical competence does not qualify you to sit for an exam. i have met a (very) few crna's who were far better than the lowest 30% of anesthesiologists clinically, but they should still never be allowed to sit for the anesthesiologist boards. the boards are the final step in a long path, and just because you could pass the boards doesn't mean you have achieved the other steps and have attained the appropriate amount of experience/fund of knowledge.

the OP's colleague is lying about his clinical experience to attain a certification. lying. misrepresenting his credentials to a certification board. since when is that ok just because he can do a hemi-fontan?

 

[IlDestriero]

You are assuming a lot slavin. Be careful. I have met plenty of non fellowship trained anesthesiologists who are better than fellowship trained ones in taking care of kids. Yes including hemi-Fontans and complex premie cases. Some of those non fellowship trained anesthesiologists even trained some of the pedi fellows during their fellowship. Would you exclude them too?

They would quality to take the exam.
I'm with Slavin, if the applicant doesn't qualify, and the chairman/president is lying to support their application, that is wrong. Period. No matter how fantastical an anesthetist of children they are. They either meet the criteria or they don't. He doesn't. That means no grandfathering and no certification.
I'm not sure why that's not clear to everyone. There is no grey area.
I would send a not anonymous letter, asking to remain anonymous, saying that you work with this person and they absolutely do not meet the criteria for certification and suggest they request a case log. The board will either follow up or not. Either way, you did what was right.
A chief who would support this lie is suspect. What other ethically suspect things are they doing that you don't know about?

 

[IlDestriero]

Can I get cardiac certification because I was awesome with hearts and can do a basic echo exam. I'm smart enough to study for a test. I can afford some weekend classes. Should I fabricate a TEE log saying I popped in and did TEEs on all the kids they did last year? I can forge the chairmans signature on a confirmation letter sent to my fax on official letterhead, right?
No problem because I'm a wizard at difficult lines, remember my cardiac stuff including complex congenital Peds and adult congenital survivors. And I can actuality perform a TEE exam. I was better than 1/2 the cardiac faculty. I'm more qualified right, because of all my Peds cardiac.
Do they still allow grandfathering? Sounds like a good career move for me.

 

[nimbus]

Can I get cardiac certification because I was awesome with hearts and can do a basic echo exam. I'm smart enough to study for a test. I can afford some weekend classes. Should I fabricate a TEE log saying I popped in and did TEEs on all the kids they did last year? I can forge the chairmans signature on a confirmation letter sent to my fax on official letterhead, right?
No problem because I'm a wizard at difficult lines, remember my cardiac stuff including complex congenital Peds and adult congenital survivors. And I can actuality perform a TEE exam. I was better than 1/2 the cardiac faculty. I'm more qualified right, because of all my Peds cardiac.
Do they still allow grandfathering? Sounds like a good career move for me.

There is no sub specialty certification in cardiac anesthesia. You can get certified in echocardiography, and if you finished residency in 2009 or before, you can be grandfathered for certification without a fellowship. It is a good career move for anyone.

 

[BuzzPhreed]

I would send a not anonymous letter, asking to remain anonymous, saying that you work with this person and they absolutely do not meet the criteria for certification and suggest they request a case log.

Trust me when I tell you that this is bad bad advice. Whoever does something like this needs to be prepared for a lawsuit.

 

[IlDestriero]

There is no sub specialty certification in cardiac anesthesia. You can get certified in echocardiography, and if you finished residency in 2009 or before, you can be grandfathered for certification without a fellowship. It is a good career move for anyone.

Making up the fact that I'm not actually eligible is a good career move?

 

[Libertas]

truth is a defense against libel, no? as long as he's actually sure.

 

[deleted126335]

"Truth" is not the sole issue.

If you notify the ABA there is no guarantee that they will act on your information.
If you reveal your identity to the ABA there is no guarantee that they will keep your confidence.
If you notify the ABA anonymously there is even less likelihood that they will act on the information.
If you get discovered you will have made at least two enemies. One of whom is your boss.
You have most likely signed confidentiality agreement(s) which the above would probably be a violation of. Doing so might very well expose you to a civil suit as well as be possible grounds for termination. Not to mention a poor future reference.
If you notify the ABA anonymously and your employer suspects that you dropped a dime and you are asked by your employer if you did so, you have a duty to be truthful. Lying to your employer is also frequently grounds for termination.

I understand your distress and I would be pissed if I were in your shoes, but the risk/benefit ratio of acting on your feelings does not appear favorable.

 

[norwood]

They would qualify to take the exam.

Would they, though? If they didn't meet the 30% cutoff, is there another way in for them?

JMHO but the arbitrary cutoffs seem silly to me, especially for things like the TEE exam. You either know how to do the study or you don't.

 

[imfrankie]

They would quality to take the exam.
I'm with Slavin, if the applicant doesn't qualify, and the chairman/president is lying to support their application, that is wrong. Period. No matter how fantastical an anesthetist of children they are. They either meet the criteria or they don't. He doesn't. That means no grandfathering and no certification.
I'm not sure why that's not clear to everyone. There is no grey area.
I would send a not anonymous letter, asking to remain anonymous, saying that you work with this person and they absolutely do not meet the criteria for certification and suggest they request a case log. The board will either follow up or not. Either way, you did what was right.
A chief who would support this lie is suspect. What other ethically suspect things are they doing that you don't know about?

I am with IlDes and Slavin on this. All in. No one is saying the person can't do pediatric anesthesia; but I can't abide the lying for an undeserved certification. I expect a more beneficial outcome to your whistle-blowing would be a thorough departmental house cleaning. You don't want to, nor need to work for a liar. You and your hospital deserve better.

 

[imfrankie]

Trust me when I tell you that this is bad bad advice. Whoever does something like this needs to be prepared for a lawsuit.

I disagree, but even if true, so what?

 

[IlDestriero]

The truth is the defense for libel. If the guy is eligible, his case log would show it and he could get certified. No damages.

 

[deleted126335]

The truth is the defense for liable. If the guy is eligible, his case log would show it and he could get certified. No damages

It is not that simple. There could be damages for breaching confidentiality. Whistleblower statutes probably wouldn't apply as the ABA is not a governmental organization. Not a lawyer, but I know enough to know that it is not as simple to say "that if you speak the truth you are covered". There are still the issues of making enemies and getting fired.

BTW it is libel not liable.

 

[IlDestriero]

I don't have any confidentiality agreement in my contract. And I'm not sure if it applies to covering up fraud.

 

[Guy Caballero]

In my opinion, this is one of the world's problems that you don't need to solve. Any employer will easily be able to know the difference between board certified in pedi and fellowship trained and board certified. The issue will take care of itself. A few will get certified who probably should not have been. A few will not be certified who probably could have been. It will be a wash.
The ABA is a big organization and will police their members as they see fit. You are a cog in the machine.

 

[nimbus]

Making up the fact that I'm not actually eligible is a good career move?

If you finished residency in 2009 or before, you are eligible through the practice experience pathway.

 

[nimbus]

To Bilson,

If this is really something you want to pursue, you can provide the details of the case to one of your several supporters here on SDN. That individual can write a letter to the ABA, leaving your name out of it. You will be protected and your SDN supporter gets to play ABA police and stop a horrific injustice.

 

[Guy Caballero]

To Bilson,

If this is really something you want to pursue, you can provide the details of the case to one of your several supporters here on SDN. That individual can write a letter to the ABA, leaving your name out of it. You will be protected and your SDN supporter gets to play ABA police and stop a horrific injustice.

Supporters slowly back away...

 

[Guy Caballero]

I was driving through the projects one day and saw somebody selling crack. Selling crack is wrong. I told the guy not to sell crack because it was against the rules. I showed him that I had my phone and I was calling the police. I knew it was my duty to stop this.
The police arrived while the crack dealer had me pinned down at gunpoint after getting a black eye and two broken ribs. The crack dealer gave the policeman $650 crack registration fee and then a $300 crack exam fee. The policeman told me to mind my own business and don't come around here no more.

 

[IlDestriero]

Why would anyone write a letter for the OP? That's a ridiculous suggestion.
Let's face it, he's already noted he's afraid of being fired, his chairman is complicit in the fraud. Nobody is writing any letters to anyone.
I'm sure many will sneak through this way. They won't take a job from me at a major children's hospital, and they wouldn't want to anyway.
And maybe, just maybe, if the guy really does not qualify because he's only been practicing for a couple years, they may notice on review and not allow him to be certified.
They are clear when you sign up that passing the exam does not equal certification.

 

[nimbus]

Why would anyone write a letter for the OP? That's a ridiculous suggestion.
Let's face it, he's already noted he's afraid of being fired, his chairman is complicit in the fraud. Nobody is writing any letters to anyone.
I'm sure many will sneak through this way. They won't take a job from me at a major children's hospital, and they wouldn't want t to anyway.

Bingo! Nobody gets a job at a children's hospital these days without fellowship. The certification...for now.....is meaningless.

This entire thread is ridiculous.

 

[IlDestriero]

Well it looks like the OP did a fellowship and practices in a combined adult and peds practice. This guy will be competition for his job, promotions, etc. I can see why he would be incensed.
Meanwhile the CRNA down the hall is signed up for his/her peds intensive CME week and is marketing him/herself as a peds specialist, complete with a "certification of completion". After all, they did a year as a nurse in the Peds ED 5 years ago, so they've got what it takes.

 

[norwood]

I disagree, but even if true, so what?

Like Doze said, this has the potential to cause massive disruption in your career.

Personally, I'm much more bothered by the dishonesty on charts at the AMCs running 4:1. Present for induction? Yep, signed! Present for emergence? Yep, signed!

When things inevitably go wrong sooner or later, this dishonesty lets the AMC claim that it was just the fault of a rogue anesthesiologist who wasn't monitoring his cases. After all, he'd signed a legal document saying he was there - it wasn't the fault of the poor innocent AMC for trusting him! (heavy sarcasm)

 

[nimbus]

Well it looks like the OP did a fellowship and practices in a combined adult and peds practice. This guy will be competition for his job, promotions, etc. I can see why he would be incensed.
Meanwhile the CRNA down the hall is signed up for his/her peds intensive CME week and is marketing him/herself as a peds specialist, complete with a "certification of completion". After all, they did a year as a nurse in the Peds ED 5 years ago, so they've got what it takes.

If OPs fellowship enables him to perform better than his rival in his current practice, then it was worthwhile and he should have no regret or resentment. If not, then it was a waste of time and $$.

 

[Guy Caballero]

Do you think the ABA wants more or less pedi certified anesthesiologists. If they have less, it will be seen as not necessary. They need a critical mass of pedi certified anesthesiologists so that it becomes the de facto requirement in order to take care of kids. Same for cardiac. Certification in that is coming, which will make the Echo exam obsolete in 10 years. Why would the ABA watch the income stream go to another certifying board? OB will likely follow.
Pretty soon, you will not be able to practice without a couple of subspecialty certifications. Each one will have their 10 year limit and MOCA recertification. This will be the next generations cost of doing business. It is big business.

 

[michigangirl]

Maybe I am completely overestimating the Board, but it seems like THIS would be the red flag resulting in a rejected application:

"this person is not at a children's hospital but at an adult hospital where the person does mainly adults with some peds cases" -- is it safe to assume that neonates aren't anesthetized at the adult hospital?

I do believe that anyone trying to apply via Grandfathering criteria (didn't do a bonafide 12-month fellowship) should be required to submit case logs for the last 2 or 5 years depending on the route they are trying to get in. That would include me.

 

[deleted126335]

Bingo! Nobody gets a job at a children's hospital these days without fellowship. The certification...for now.....is meaningless.

This entire thread is ridiculous.

The certification is a niche that would be an edge for somebody looking to be the resource person for a group that does a mix of adult and peds. Ten to Fifteen years from now the Peds certification will matter quite a bit, if one wants to do anything more than bread and butter peds. The OP is right to feel cheated and the year of fellowship that he gave up is devalued by people who skirt the rules.

Fifteen years ago nobody cared if you passed the echo boards or not as long as you had the skills. That is no longer the case.

It is kin to the PhD CRNAs and DNAPs referring to themselves as "Dr." in the health care setting. Maybe that doesn't bother you either?

 

[Planktonmd]

This whole discussion is a little bit childish...
If the entity that administers the exam (the ABA) is allowing this to happen, and not strictly scrutinizing the applicants, then they are wanting this to happen, So your issue is with the ABA not with the individual who is benefiting from their crappy policy.
Going after your colleague is childish and silly.

 

[somedumbDO]

Do you know where s/he trained? Some residencies have great exposure to peds, and honestly, a fellowship really isn't necessary. Many people choose not to do fellowships because: a.) they had great exposure to it in residency (CV, peds, regional, etc), and b.) it was not a boarded fellowship.

These same people should not be penalized because the subspecialty is now boarded. If they do not have the expertise to do peds, then they would probably fail the boards.

You DO NOT have enough exposure in residency to do neonates and congenital hearts PERIOD. Now is this is out of the way, yes there are some guys who have done it for years w/o fellowship, they are amazing they get grandfathered in thats why they have the stipulation. It will be over soon the grandfather clause. The yahoos w/o expirence who try and cheat the system and take peds boards (which were rediculously easy) will pass and certify. But wait till they practice and the group will know their worth. I wouldn't tattle but I would seriously reconsider working for a chief that would blatantly cheat the system. IMHO.

 

[nap$ter]

This whole discussion is a little bit childish...
If the entity that administers the exam (the ABA) is allowing this to happen, and not strictly scrutinizing the applicants, then they are wanting this to happen, So your issue is with the ABA not with the individual who is benefiting from their crappy policy.
Going after your colleague is childish and silly.

weird perspective. the police don't patrol my street at night. does that mean that they want me to steal my neighbor's boat? and if i do, should i tell my neighbor to complain to the police?

plank, if you discover your colleague is a crna who fabricated med school and residency records in order to sit for and pass our boards would you be cool with it? or would it be "childish" to report it?

i imagine your response to be "the crna was never one of my colleagues, so it would be ok to report".

the OP's "colleague " is only a colleague in the arena of general anesthesia, not in the subspecialty of pediatric anesthesia...

 

[Planktonmd]

weird perspective. the police don't patrol my street at night. does that mean that they want me to steal my neighbor's boat? and if i do, should i tell my neighbor to complain to the police?

plank, if you discover your colleague is a crna who fabricated med school and residency records in order to sit for and pass our boards would you be cool with it? or would it be "childish" to report it?

i imagine your response to be "the crna was never one of my colleagues, so it would be ok to report".

the OP's "colleague " is only a colleague in the arena of general anesthesia, not in the subspecialty of pediatric anesthesia...

I didn't realize that an anesthesiologist and a pediatric anesthesiologist are not colleagues anymore!
I mean the guys who did a long torturous year fellowship and learned the secrets and intricacies of anesthetizing kids would not mind me calling them colleagues sometimes would they?