Critical Care

I don't any specifics, but, as a general vibe about things, peeps that have talked about such stuff like at Henry Ford (where they have a 6-year EM/IM/CC program) and Hopkins seem pretty optimistic that EM CC folks will be accepted into the fold in the not too distant future. As for fellowships, there should be a number of EM CC fellowships out there... I think the board and licensure thing is the main speedbump.

When I emailed ABEM, the person replying to my email mentioned that this was discussed during their last meeting. She also stated that unfortunately, critical care certification for EM-trained individuals is not likely to occur in the near future. Neither the internal med nor the anesthesiology boards will allow EM-trained individuals to sit for their critical care subspecialty certification exams. Both have turned down requests by ABEM to allow testing, and according to ABEM, the IM and anesthesia boards are standing firm in their decision.

So, the only option right now is European boards. ABEM clearly stated that they do not foresee critical care subspecialty certification within the next 10 years.

don't remember exactly where i heard this but at one of my interviews someone discussed getting to CC thru surgery rather than anesthesia or IM? is this possible?

waterski232002 said:

Yeah... (as long as they haven't black-balled EM too) But I know Maryland takes EM graduates into their CC fellowship

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ABIM and the RRC has changed ALL IM fellowships to accept only residents with IM training. This applies to the Neurologist that want's CCM training etc...

However, this is only for the alloted spots and GME funding. The great thing about EM right now is that you could easily do a fellowship in an IM CCM program (that was open minded) for "free". You could pay back the dept of IM for the benefits by working as a moonlighter in the ER and have those funds go directly to you. There was a recent grad, I think at UAB that did something similar to this.

You don't need to worry about accreditation rules and regulations since CCM is not a recognized subspeciality of EM. The Europeans don't care one way or the other. They just require you to get the training.

Traditional programs like Shock Trauma and U. Pitt will still accept EM grads, no problem.

Check out the Pitt website www.ccm.upmc.edu

Good luck,
Kyle

KGUNNER1 said:

ABIM and the RRC has changed ALL IM fellowships to accept only residents with IM training. This applies to the Neurologist that want's CCM training etc...

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Of only trivial interest, the only exception is FP grads that want to do Geriatric fellowships - that popular track is still open.

waterski232002 said:

From what I've heard, the issue isn't really sitting for the certification exam (you can't sit for EM boards if you're FP or IM, but you can still work in an ED in rural places)....

The more recent that I was curious about, was whether EM graduates can actually get accepted into an IM-CC fellowship. I heard that there was recently (last few months) a decision by IM people not to accept EM people into any of their CC fellowships. In essence, you can't even get trained in CC regardless of whether you can sit for the boards. Have you guys heard this too about not being able to enter IM-CC fellowsihps???

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There are many CCM fellowships that take EM trained individuals. UAB, Johns Hopkins, UPitt, etc. A complete list is available under the EM Fellowships section of the SAEM website (www.saem.org).

waterski232002 said:

Yeah... (as long as they haven't black-balled EM too) But I know Maryland takes EM graduates into their CC fellowship

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Maryland's CC fellowships do not take EM graduates. Maryland's Shock Trauma has a Trama/CC fellowship for EM graduates. However, EM graduates still have the same problem with CC board certification.

You cannot complete a pulm/CC fellowship, but a standard straight out CCM fellowship should be open to you.

waterski232002 said:

I've seen that list; however, it only has the above programs plus maryland and univ. of florida. Correct me if I'm wrong, but these (at least maryland & JHH) are Trauma/CC fellowships and different than a IM-CCM fellowship, right? These are specifically geared for EM graduates, and NOT IM or surgery graduates?

If these fellowships are completed, is it realistic to be able to obtain a job as an intensivist without also being IM boarded or surgery boarded?

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I hope this clarifies things a little. There is nothing magical about the different types of critical care base training (IM/Surg/Anesth). The only reason each one has their own certification is pure politics. Nothing else!!! Several years ago a movement was tried to unite everyone under the auspice of Multidisciplinary Critical Care and be all inclusive rather than give the impression of division. Each base speciality would then take only 1 exam, the exact same one. This idea fell apart.

The current training in Multidisciplinary Critical Care programs, which I think more programs are going towards, has the surgeons training right next to the IM and Anesth grads. I know at Pitt we had all 4 specialities (IM/EM/Anes/Surg) and at least 6 subspecialities (Pulm, Nephro, Cards, Vasc Surg, Transplant Surg, CT surg) all training in one class. We all learned from each other and we could all function in ANY type of unit we were thrown in.

I also know Shock trauma has a similar set up. The only differences is that most programs make the surgeons take a few months of Trauma Surg call.

There are several EM/CCM grads in academic centers practicing both EM and CCM. Just a few off the top of my head are Scott Gunn, David Huang at Pitt; Ted Kimball at Univ Utah, Tiffany Osborn at UVA, Imo Aisiku at VCU, and Alan Tuttle at Univ New Mexico. This is only a few.

I won't lie and tell you it will be easy. It won't, some Medical ICU's want only board certified IM docs for their own RRC requirements. However, most surgical ICU's won't mind. I think if you train at a well know place, have good letters, and plan on taking the European boards you'll be fine.

KG

KGUNNER1 said:

There is nothing magical about the different types of critical care base training (IM/Surg/Anesth). The only reason each one has their own certification is pure politics. Nothing else!!!

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One difference is in the length of training for IM vs. Surg graduates. Based on this I have a question.

An IM graduate has about 18 months of ward training, 6 months of ICU training, plus about 12 months of electives. Because of the relatively low amount of ICU training, he/she requires 2 years of CC fellowship training. Surgery graduates have significantly more ward and ICU training, and therefore require only 1 year of CC fellowship training.

My question is this: An EM graduate has maybe 1 month of medical ward training and 3 months of ICU training. This is less training than IM or Surg graduates receive. Yes, I agree with KGUNNER1 that part of the issue is political. But isn't there is a legitimate question about the lack of preparation of EM graduates for a CC fellowship?

I think we are equally well prepared for CCM if not more prepared. We see all sorts of ICU players while in the ED. Most of them are admitted through the ED and initially managed there. The RRC only requires 2 ICU months, but many programs have significantly more ICU months. My program has 2 PICU, 2 MICU, and 2 CCU months, not to mention that when you do trauma, you often manage SICU patients. As for ward months I don't think that makes much of a difference, when it comes to managing ICU patients.

just my 2 cents

ntmed said:

One difference is in the length of training for IM vs. Surg graduates. Based on this I have a question.

An IM graduate has about 18 months of ward training, 6 months of ICU training, plus about 12 months of electives. Because of the relatively low amount of ICU training, he/she requires 2 years of CC fellowship training. Surgery graduates have significantly more ward and ICU training, and therefore require only 1 year of CC fellowship training.

My question is this: An EM graduate has maybe 1 month of medical ward training and 3 months of ICU training. This is less training than IM or Surg graduates receive. Yes, I agree with KGUNNER1 that part of the issue is political. But isn't there is a legitimate question about the lack of preparation of EM graduates for a CC fellowship?

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No lack of preparation in current EM training. Some residencies will have less acuity than others, but the holds true for IM/Surg/Anesth. Today's ED's have higher acuity and longer wait times, for all patients. The ED resident is exposed every day to ACUTE critical care.

The EM grad brings great skill sets to fellowship. They are different than IM/Surg/Anesth, but just as important. Each base has different strengths and weaknesses. I can tell you from experience, when the pure EM grad is placed in a very intense fellowship, such as Pitt, next to the Anesth, Surg, or IM grad, they can easily hold their own. Two years of pure critical care is plenty time to teach the EM grad critical care.

KG

KGUNNER1 said:

No lack of preparation in current EM training....

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pinbor1 said:

I think we are equally well prepared for CCM if not more prepared....

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Thanks KGUNNER1 and pinbor1.

ntmed said:

One difference is in the length of training for IM vs. Surg graduates. Based on this I have a question.

An IM graduate has about 18 months of ward training, 6 months of ICU training, plus about 12 months of electives. Because of the relatively low amount of ICU training, he/she requires 2 years of CC fellowship training. Surgery graduates have significantly more ward and ICU training, and therefore require only 1 year of CC fellowship training.

My question is this: An EM graduate has maybe 1 month of medical ward training and 3 months of ICU training. This is less training than IM or Surg graduates receive. Yes, I agree with KGUNNER1 that part of the issue is political. But isn't there is a legitimate question about the lack of preparation of EM graduates for a CC fellowship?

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I have a feeling the IM residents do not spend time in surgery ICU's during their residency, nor do the surgery residents spend time in medical ICU's.

My program requires 2 CCU, 2 MICU, 1 PICU, and 1 SICU rotation.

southerndoc said:

I have a feeling the IM residents do not spend time in surgery ICU's during their residency, nor do the surgery residents spend time in medical ICU's.

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If there's only one ICU, they do. That's what it's like at Geisinger - if there is a medicine senior and surgery junior, the senior directs the junior in the chest tube (for example), and likewise if roles are reversed. It seems to work pretty well.