EM-Critical Care certification in jeopardy

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emergiQ

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And..... CUT

Have heard through the various list-servs that the previously "approved" pathway for emergencymedicine residency trained, critical care fellowship prepared candidates to sit for the certificate of added qualification (CAQ) in critical care via ABIM is in jeopardy due to 'cold feet' by various parties in ABIM.

Once again, a renewed call for the American Board of Emergency Medicine to develop their own CAQ is in order.

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And..... CUT

Have heard through the various list-servs that the previously "approved" pathway for emergencymedicine residency trained, critical care fellowship prepared candidates to sit for the certificate of added qualification (CAQ) in critical care via ABIM is in jeopardy due to 'cold feet' by various parties in ABIM.

Once again, a renewed call for the American Board of Emergency Medicine to develop their own CAQ is in order.

Anyone else heard about this or have more inforamtion?
Anyone with some "inside" info regarding ABIM 'cold feet'?

Thanks, HH
 
ABEM, ABIM Reach Accord on Critical Care Certification
Agreement opens pathway for EPs.

By Alicia Ault
Elsevier Global Medical News


In a long-awaited move, the American Board of Emergency Medicine and the American Board of Internal Medicine have agreed to cosponsor a pathway to certification in Internal Medicine Critical Care Medicine.

The landmark agreement comes after decades of effort to find an appropriate mechanism for emergency physicians to receive certification in the subspecialty of critical care medicine.

Emergency physicians have been receiving advanced training through critical care fellowships since the late 1980s, but there was never a pathway to board certification, Dr. Eric Holmboe, the ABIM's chief medical officer, Quality Research and Academic Affairs, said in an interview.

Many of those critical care fellows have gone on to take an examination through the European Society of Intensive Care Medicine. In general, some hospitals accept that overseas exam certification as a surrogate due to the lack of an equivalent U.S. examination, said Dr. Lillian L. Emlet, chair of the Critical Care Medicine section of the American College of Emergency Physicians.

The impact of the new certification is unclear, but "it's a very exciting thing for all of us," Dr. Emlet said in an interview. At a minimum, it should facilitate additional communication between the ABEM and the two other boards that currently certify in adult critical care medicine, the American Board of Surgery and the American Board of Anesthesiology, said Dr. Emlet, of the University of Pittsburgh.

But the availability of a 2-year fellowship and subsequent U.S. certification will also help produce more U.S.-trained intensivists, Dr. Emlet said.

Currently, about 20 emergency medicine residents enter a critical care fellowship each year, Dr. Emlet said, adding that there's a natural affinity between emergency medicine and critical care medicine. A recently published survey of emergency physicians in a critical care medicine fellowship found that of those who had completed their fellowship, 49% (36 of 73) were practicing both specialties (Acad. Emerg. Med. 2010;17:325-9).

The number of emergency physicians who have completed critical care fellowships has risen from 12 over the 1974-1989 time period to 43 in 2000-2007, according to the survey.

Even so, Dr. Debra G. Perina, ABEM president, said that there is a continuing shortage of critical care physicians in the United States--a problem discussed in a 2006 report by the Institute of Medicine called "The Future of Emergency Care in the United States Health System."

The current boards are not supplying enough specialists to meet the demand in critical care medicine, Dr. Perina, an associate professor at the University of Virginia, Charlottesville, said in an interview.

A 2005 white paper--published by the ACEP, the Council of Emergency Medicine Residency Directors, the Emergency Medicine Residents' Association, the Society for Academic Emergency Medicine, and the Society of Critical Care Medicine--urged an expansion of training to allow emergency physicians to become certified in critical care medicine.

The new certification program still requires approval from the American Board of Medical Specialties. At this point, "we're not aware of any issues that would keep this from coming to fruition," Dr. Perina said.

She and Dr. Holmboe said they expected the first certification exam to be offered in 2012.


I know that the ABIM board of directors still has to vote before an ABMS proposal is submitted. I have heard that the ABIM board vote is this summer. However, the above news piece has been out since May and includes commentary on the mattery by Dr. Eric Holmboe speaking on behalf of ABIM. Both Perina and Holmboe seem pretty positive.
 
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@EMCritCare --

Yes, this reflects the spirit of the original release.

But I have heard that since then, there are some 'cold feet' players that might prevent this from becoming a reality. In fact, the phrases I've heard from a few fellowship directors out there (they must be reading this on the various list-servs) is that the whole plan is "unravelling".

Have to say, I'm not disappointed. While I appreciate that many in the EM-critical care community think we should take what we can get (and thus think that any other specialty recognizing us is a positive step) I think that by getting into bed with ABIM we risk having any progress on other fronts (like recognition from the ABS or via anesthesia) stopped cold.

Which is why again I urge ABEM to just go it alone and develop their own added CAQ or explain to the members why they can't (i.e. either substantiating or de-bunking the rumor that there is some ancient 'deal' in place preventing them from doing so).

I, for one, will no longer be supporting ABEM until they at the very least release an official statement of where they stand on the issue. My contribution and membership in ACEP and AAEM is also under scrutiny for the same reasons.

Do any of these organizations want to step up within our own specialty and either help or clarify where we're at?
 
“Yes, this reflects the spirit of the original release.”
Yes and no. The original release was a one-sided statement by ABEM. Prior to the posted new piece, there was no significant public acknowledgement by ABIM. The new piece includes acknowledgement by Holmboe speaking on behalf of ABIM. Also, the original release made no mention of a timetable for the first ABIM exam open to EM candidates.
“In fact, the phrases I've heard from a few fellowship directors out there (they must be reading this on the various list-servs) is that the whole plan is ‘unraveling’.”
To exactly which unnamed fellowship directors would you be cryptically referring to? The directors of non-ACGME accredited EM-CCM fellowships? If they are posting to a public forum like email list serves, then let’s be open about names instead of making unattributed statements.
I know for a fact that the IM RRC accredited CCM fellowship directors at Univ of Pittsburgh, Stanford, Cooper Hospital, St. John’s Mercy/SLU (amongst other places) have already moved to begin considering EM applicants as part of their IM fellowship pools for ACGME reporting and tracking purposes. They are doing this because they anticipate that EM fellows will very soon count against their ACGME fellow allotments and in order to maintain ABIM board eligibility for these candidates.
“I think that by getting into bed with ABIM we risk having any progress on other fronts (like recognition from the ABS or via anesthesia) stopped cold.”
This statement betrays a serious lack of historical perspective of this issue, and I mean decades of history. While I really wish that EM candidates could have continued access to great surgery programs (Shock Trauma) and anesthesia programs (Wash U, Hopkins, MGH, Brigham, etc.) while being able to obtain ABMS certification, this is not feasible. Historically, the ABA has engaged in talks with ABEM sporadically for years now. Do you know what we have to show for this? ABSOLUTELY NOTHING. Even as anesthesia CCM programs fell to fill rates of less than 50% due to declining anesthesia resident interest in CCM, the best the ABA offered was the distraction of combined EM/anesthesia residency programs. We do not need any more abortive compromises in the form of yet another combined residency program.
Politically, the ABS is even worse. Despite active recruitment of qualified EM candidates by Shock Trauma, who have thrived in their program, the issue of ABS certification for EM folks is dead in the water. The ABS is too conservative for this to happen, even with people from within Shock Trauma advocating on the behalf of EM. Furthermore, even within the world of surgical CC the struggle for a unified identity for surgical CC/trauma surgery/acute care surgery is overriding any attempts to throw EM into the mix. Despite years of trying, even trauma surgery remains without an ABS CAQ, largely due to the complex politics driving differences of opinion within the surgical CC versus other surgeons world. EM is not going to get anywhere with the ABS and they have made it clear that the issue is a non-starter for the foreseeable future.
I sincerely hope that the agreement with ABIM goes through, as I am tired of ABEM getting nowhere with ABA and ABS despite years of trying. Formal ABMS board recognition is needed in order to help the forward movement and development of EM-CCM. If ABIM is willing to play ball, then so be it. Pediatric emergency medicine is under the auspices of ABP and ABEM is a secondary co-sponsor. Sports medicine is under the administration of ABFM with ABEM as a co-sponsor. The proposed deal with ABIM is similar in principle.
“I urge ABEM to just go it alone and develop their own added CAQ or explain to the members why they can't (i.e. either substantiating or de-bunking the rumor that there is some ancient 'deal' in place preventing them from doing so).”
Even a cursory review of the history of this matter will demonstrate that ABEM has tried for years to obtain its own CAQ. I agree that having our own CAQ would be ideal, but it is simply not going to happen at this juncture. The “ancient deal” is a factual part of the history of EM (please refer to any of Brian Zink’s publications on the matter). Decades ago, ABEM traded its pursuit of access to CCM in exchange for full board status and ABIM giving up its plan to develop a CAQ in emergency internal medicine. However, as the “deal” passed into remote history, ABEM renewed its attempts to obtain a CAQ only to be told there was no chance in hell. It is politically very difficult to obtain ABMS approval for an independent CAQ in a specialty that is already claimed by other boards. On the other hand, it is far easier to become a co-sponsor for an existing subspecialty.
Rome was not built in a day- even ABEM started out as a conjoint board under family medicine. It took years for ABEM to become a fully independent board. The evolution of EM-CCM in the United States is in its nascent stages. Co-sponsoring the ABIM CCM board is an appropriate route to obtaining formal ABMS recognition. The clear majority of adult intensivists in the US are boarded by the ABIM. Having access to 30-34 IM CCM fellowships would be a major step forward in our evolution. This story is just beginning.
“I, for one, will no longer be supporting ABEM until they at the very least release an official statement of where they stand on the issue.”
This statement is utterly ridiculous given the years of effort put forth pursuing board access by multiple members of ABEM and deserves no further comment.
“My contribution and membership in ACEP and AAEM is also under scrutiny for the same reasons.”
Both ACEP and AAEM have made statements on the issue of board access publically available for years. ACEP has even published periodic reaffirmations of its statement in support.
Again, I think that the ABIM board of directors vote this summer will lend some clarity. I, for one, am looking forward hopefully to the submission of an ABMS proposal.
 
“Yes, this reflects the spirit of the original release.”
Yes and no. The original release was a one-sided statement by ABEM. Prior to the posted new piece, there was no significant public acknowledgement by ABIM. The new piece includes acknowledgement by Holmboe speaking on behalf of ABIM. Also, the original release made no mention of a timetable for the first ABIM exam open to EM candidates.
“In fact, the phrases I've heard from a few fellowship directors out there (they must be reading this on the various list-servs) is that the whole plan is ‘unraveling’.”
To exactly which unnamed fellowship directors would you be cryptically referring to? The directors of non-ACGME accredited EM-CCM fellowships? If they are posting to a public forum like email list serves, then let’s be open about names instead of making unattributed statements.
I know for a fact that the IM RRC accredited CCM fellowship directors at Univ of Pittsburgh, Stanford, Cooper Hospital, St. John’s Mercy/SLU (amongst other places) have already moved to begin considering EM applicants as part of their IM fellowship pools for ACGME reporting and tracking purposes. They are doing this because they anticipate that EM fellows will very soon count against their ACGME fellow allotments and in order to maintain ABIM board eligibility for these candidates.
“I think that by getting into bed with ABIM we risk having any progress on other fronts (like recognition from the ABS or via anesthesia) stopped cold.”
This statement betrays a serious lack of historical perspective of this issue, and I mean decades of history. While I really wish that EM candidates could have continued access to great surgery programs (Shock Trauma) and anesthesia programs (Wash U, Hopkins, MGH, Brigham, etc.) while being able to obtain ABMS certification, this is not feasible. Historically, the ABA has engaged in talks with ABEM sporadically for years now. Do you know what we have to show for this? ABSOLUTELY NOTHING. Even as anesthesia CCM programs fell to fill rates of less than 50% due to declining anesthesia resident interest in CCM, the best the ABA offered was the distraction of combined EM/anesthesia residency programs. We do not need any more abortive compromises in the form of yet another combined residency program.
Politically, the ABS is even worse. Despite active recruitment of qualified EM candidates by Shock Trauma, who have thrived in their program, the issue of ABS certification for EM folks is dead in the water. The ABS is too conservative for this to happen, even with people from within Shock Trauma advocating on the behalf of EM. Furthermore, even within the world of surgical CC the struggle for a unified identity for surgical CC/trauma surgery/acute care surgery is overriding any attempts to throw EM into the mix. Despite years of trying, even trauma surgery remains without an ABS CAQ, largely due to the complex politics driving differences of opinion within the surgical CC versus other surgeons world. EM is not going to get anywhere with the ABS and they have made it clear that the issue is a non-starter for the foreseeable future.
I sincerely hope that the agreement with ABIM goes through, as I am tired of ABEM getting nowhere with ABA and ABS despite years of trying. Formal ABMS board recognition is needed in order to help the forward movement and development of EM-CCM. If ABIM is willing to play ball, then so be it. Pediatric emergency medicine is under the auspices of ABP and ABEM is a secondary co-sponsor. Sports medicine is under the administration of ABFM with ABEM as a co-sponsor. The proposed deal with ABIM is similar in principle.
“I urge ABEM to just go it alone and develop their own added CAQ or explain to the members why they can't (i.e. either substantiating or de-bunking the rumor that there is some ancient 'deal' in place preventing them from doing so).”
Even a cursory review of the history of this matter will demonstrate that ABEM has tried for years to obtain its own CAQ. I agree that having our own CAQ would be ideal, but it is simply not going to happen at this juncture. The “ancient deal” is a factual part of the history of EM (please refer to any of Brian Zink’s publications on the matter). Decades ago, ABEM traded its pursuit of access to CCM in exchange for full board status and ABIM giving up its plan to develop a CAQ in emergency internal medicine. However, as the “deal” passed into remote history, ABEM renewed its attempts to obtain a CAQ only to be told there was no chance in hell. It is politically very difficult to obtain ABMS approval for an independent CAQ in a specialty that is already claimed by other boards. On the other hand, it is far easier to become a co-sponsor for an existing subspecialty.
Rome was not built in a day- even ABEM started out as a conjoint board under family medicine. It took years for ABEM to become a fully independent board. The evolution of EM-CCM in the United States is in its nascent stages. Co-sponsoring the ABIM CCM board is an appropriate route to obtaining formal ABMS recognition. The clear majority of adult intensivists in the US are boarded by the ABIM. Having access to 30-34 IM CCM fellowships would be a major step forward in our evolution. This story is just beginning.
“I, for one, will no longer be supporting ABEM until they at the very least release an official statement of where they stand on the issue.”
This statement is utterly ridiculous given the years of effort put forth pursuing board access by multiple members of ABEM and deserves no further comment.
“My contribution and membership in ACEP and AAEM is also under scrutiny for the same reasons.”
Both ACEP and AAEM have made statements on the issue of board access publically available for years. ACEP has even published periodic reaffirmations of its statement in support.
Again, I think that the ABIM board of directors vote this summer will lend some clarity. I, for one, am looking forward hopefully to the submission of an ABMS proposal.

Well written EMCritCare. I agree. :thumbup::thumbup:

KG
 
@ EMCritCare: Sorry, didn't mean to make you feel like you were under attack.

I heard the information about the CAQ via ABIM unravelling from a surgical critical care fellowship director from a program that has taken emergency medicine graduates in the past. That's as detailed as I can get, I'm afraid. Not trying to be evasive or piss you off, but there are clearly reasons why such an individual would not want to be "outed". This individual in turn got this information from the list-serv for those fellowship directors in the context of a conversation, among other things, of how the newly broadened eligibility criteria for entering surgical critical care fellows STILL does not include provisions for emergency medicine graduates. As an aside, it is curious that surgery CC fellowship programs now permit ANESTHESIA grads to enter; Presumably this means an anesthesia grad would still sit anesthesia-critical care CAQ after completing the fellowship but amounts to an attempt by the surgical programs to fill their spots, perhaps offering a specific location that would interest an anesthesia grad -- because other than a specific location or salary level (of which on the latter I'm not even sure there is a difference -- it's probably standard institution policy for whatever the PGY- level of the candidate is), why else would an anesthesia grad *not* just stay in an anesthesia-based critical care program (shrug).

Your other points in your post, as KGun pointed out, do have merit, and I would be an ass to dismiss most of them. I am glad you discussed them as at no time did I want this to be acrimonious as if I was against you - clearly we are on the same side. I would only add that not all (it's not like I'm some renegade) are in favor of getting completely in bed with ABIM as you (hey - perhaps RIGHTLY - we won't know for a few years!) suggested. Your well-placed link to the monthly sub-section newsletter which, of course, I also read -- goes into more detail about why some individuals are against it. Acknowledging both sides of the argument, and that neither one of the camps in which you (and KGun) vs. I seem to reside in will be proven "right" for many years is important for all of our junior colleagues to be conversant in.

Finally, I understand the "deal" (re: Brian Zink) and the fact that it is part of the "history" of EM - but it is ludicrous that such an arrangement remains in effect, either overtly or in a subtle fashion. That was a back-room, old-boys club enactment that could never be executed in today's environment of transparency and professionalism. It is for this reason -- the inability of ACEP, among others to expose this, speak out about it, and unequivocally state that we as a professional society are not bound by any such ancient and shady deals -- that I am disappointed in our professional representation by ACEP, etc. While I understand they do a lot of great work to argue FOR CAQ certification through various other boards, it is my opinion that they remain too week, meek, and apologetic about our specialty to just stand up, denounce the "ancient law" and offer up their own CAQ. In my opinion. Not against you personally, but it is merely an opposing opinion and one, might I add, that is shared by at least some of my colleagues, though perhaps in a minority fashion (I hope we're in the minority, otherwise I'd be pissed ACEP is ignoring this!)

If I hear anything more concrete about the pending ABIM CAQ, I'll do my best to post and substantiate. I am hopeful that the meeting this summer will affirm it one way or the other; And we can move forward from there and see how it affects us.

Good luck.

"Yes, this reflects the spirit of the original release."
Yes and no. The original release was a one-sided statement by ABEM. Prior to the posted new piece, there was no significant public acknowledgement by ABIM. The new piece includes acknowledgement by Holmboe speaking on behalf of ABIM. Also, the original release made no mention of a timetable for the first ABIM exam open to EM candidates.
"In fact, the phrases I've heard from a few fellowship directors out there (they must be reading this on the various list-servs) is that the whole plan is ‘unraveling'."
To exactly which unnamed fellowship directors would you be cryptically referring to? The directors of non-ACGME accredited EM-CCM fellowships? If they are posting to a public forum like email list serves, then let's be open about names instead of making unattributed statements.
I know for a fact that the IM RRC accredited CCM fellowship directors at Univ of Pittsburgh, Stanford, Cooper Hospital, St. John's Mercy/SLU (amongst other places) have already moved to begin considering EM applicants as part of their IM fellowship pools for ACGME reporting and tracking purposes. They are doing this because they anticipate that EM fellows will very soon count against their ACGME fellow allotments and in order to maintain ABIM board eligibility for these candidates.
"I think that by getting into bed with ABIM we risk having any progress on other fronts (like recognition from the ABS or via anesthesia) stopped cold."
This statement betrays a serious lack of historical perspective of this issue, and I mean decades of history. While I really wish that EM candidates could have continued access to great surgery programs (Shock Trauma) and anesthesia programs (Wash U, Hopkins, MGH, Brigham, etc.) while being able to obtain ABMS certification, this is not feasible. Historically, the ABA has engaged in talks with ABEM sporadically for years now. Do you know what we have to show for this? ABSOLUTELY NOTHING. Even as anesthesia CCM programs fell to fill rates of less than 50% due to declining anesthesia resident interest in CCM, the best the ABA offered was the distraction of combined EM/anesthesia residency programs. We do not need any more abortive compromises in the form of yet another combined residency program.
Politically, the ABS is even worse. Despite active recruitment of qualified EM candidates by Shock Trauma, who have thrived in their program, the issue of ABS certification for EM folks is dead in the water. The ABS is too conservative for this to happen, even with people from within Shock Trauma advocating on the behalf of EM. Furthermore, even within the world of surgical CC the struggle for a unified identity for surgical CC/trauma surgery/acute care surgery is overriding any attempts to throw EM into the mix. Despite years of trying, even trauma surgery remains without an ABS CAQ, largely due to the complex politics driving differences of opinion within the surgical CC versus other surgeons world. EM is not going to get anywhere with the ABS and they have made it clear that the issue is a non-starter for the foreseeable future.
I sincerely hope that the agreement with ABIM goes through, as I am tired of ABEM getting nowhere with ABA and ABS despite years of trying. Formal ABMS board recognition is needed in order to help the forward movement and development of EM-CCM. If ABIM is willing to play ball, then so be it. Pediatric emergency medicine is under the auspices of ABP and ABEM is a secondary co-sponsor. Sports medicine is under the administration of ABFM with ABEM as a co-sponsor. The proposed deal with ABIM is similar in principle.
"I urge ABEM to just go it alone and develop their own added CAQ or explain to the members why they can't (i.e. either substantiating or de-bunking the rumor that there is some ancient 'deal' in place preventing them from doing so)."
Even a cursory review of the history of this matter will demonstrate that ABEM has tried for years to obtain its own CAQ. I agree that having our own CAQ would be ideal, but it is simply not going to happen at this juncture. The "ancient deal" is a factual part of the history of EM (please refer to any of Brian Zink's publications on the matter). Decades ago, ABEM traded its pursuit of access to CCM in exchange for full board status and ABIM giving up its plan to develop a CAQ in emergency internal medicine. However, as the "deal" passed into remote history, ABEM renewed its attempts to obtain a CAQ only to be told there was no chance in hell. It is politically very difficult to obtain ABMS approval for an independent CAQ in a specialty that is already claimed by other boards. On the other hand, it is far easier to become a co-sponsor for an existing subspecialty.
Rome was not built in a day- even ABEM started out as a conjoint board under family medicine. It took years for ABEM to become a fully independent board. The evolution of EM-CCM in the United States is in its nascent stages. Co-sponsoring the ABIM CCM board is an appropriate route to obtaining formal ABMS recognition. The clear majority of adult intensivists in the US are boarded by the ABIM. Having access to 30-34 IM CCM fellowships would be a major step forward in our evolution. This story is just beginning.
"I, for one, will no longer be supporting ABEM until they at the very least release an official statement of where they stand on the issue."
This statement is utterly ridiculous given the years of effort put forth pursuing board access by multiple members of ABEM and deserves no further comment.
"My contribution and membership in ACEP and AAEM is also under scrutiny for the same reasons."
Both ACEP and AAEM have made statements on the issue of board access publically available for years. ACEP has even published periodic reaffirmations of its statement in support.
Again, I think that the ABIM board of directors vote this summer will lend some clarity. I, for one, am looking forward hopefully to the submission of an ABMS proposal.
 
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@emergiQ


Thanks for posting back. I think that the free discussion of opinions is one of the best parts of anonymous forums. No umbrage or offense was taken at all. However, I think that clear, open attributation of sources is always helpful when discussing factual news/events or information items. This helps the audience make a rough assessment as to the quality of the information and raises the quality of the discussion. It helps separate rumor and hearsay from the more solid information that the people reading this thread may be seeking.


But that's just my opinion.


It's somewhat apropos that the anonymous source is a surgical CC fellowship director, reporting the matter based on what is essentially hearsay over a listserv presumably for surgical CC fellowship directors. The deal between the ABA and ABS has been cooking for a little while now, and I believe that the reciprocity for CC training and board eligibility which they are developing was yet another reason why the ABA dropped out of talks with ABEM about letting us have access to the ABA CAQ in CCM. The ABS is the most conservative and has been consistently against letting us have access to their surgical CC CAQ, and historically vociferous in opposing ABEM's attempts to obtain its own CAQ. I find it ironic that these surgical CC program directors were musing about how the "broadened eligibility criteria for entering surgical critical care fellows STILL does not include provisions for emergency medicine graduates," when they know full well that giving us access to the surgical CC CAQ is a non-starter due to the political hang ups within the ABS.


Having tracked this issue for several years now, I think the ABA is entering this arrangement with the ABS in order to preserve the legacy of American anesthesia CC as the number of training programs/practitioners stagnates and dwindles. The ABA knows that the surgical CC programs are more stable at least in terms of recent fill rates and less likely to disappear. By doing this, they will at least ensure continued access to CC training for whichever few anesthesia residents that choose to pursue it. In order to get this done with the ABS, and in the wake of the proposed ABIM-ABEM deal, the ABA's most recent round of discussions with ABEM died. Well, I don't think anyone was waiting for combined EM/anesthesia residency programs with baited breath anyway.


I can't say that I understand how exactly the proposed ABIM-ABEM deal (of which few details are publically available) entails "getting completely in bed with ABIM." Is ABEM totally in bed with ABP because they are a secondary co-sponsor of peds EM and not the administering board? Multiple subspecialties are arranged in this fashion mostly for two common reasons: 1) When the subspecialty was originally recognized by ABMS, the primary boards that wanted access agreed on an administering board with co-sponsoring boards for the subspecialty or each original claimant primary board got its own CAQ (EM obviously was cut out of the picture when the latter was done for CCM). 2) After the subspecialty was already recognized by ABMS, if an additional primary board wanted access, the best it could do is get approval from the other primary boards to become a co-sponsor (this is what the proposed deal with ABIM entails).


The rules and politics governing ABMS make it extremely difficult for any primary board to issue a CAQ in any subspecialty that is claimed by other boards, or even start a "new" subspecialty that shares territory with an existent one. Witness the years and years of conflict when the American Board of Otolaryngology decided it wanted to issue a CAQ in facial plastic surgery. The American Board of Plastic Surgery fought tooth and nail as it argued that this CAQ would infringe on the scope of plastic surgery as per the purview of ABPS. After years of fighting the compromise was that ABO could co-sponsor the CAQ for Plastic Surgery within the Head and Neck along with ABPS- they did not get an independent CAQ.


This is why ABEM can't just somehow unilaterally declare that they are going to issue their own CAQ in CCM. ABEM has tried to pursue its own CAQ intermittently for years. Seminal figures from ABEM (like George Podgorny) have argued that ABEM was promised access to CCM in the future, notwithstanding the "ancient deal" that finally got ABEM to full board status. So, ABEM has tried lobbying the other relevant boards whose agreement would be absolutely essential for this to happen. However, getting all the other ABMS boards with a stake in the CCM issue and ABMS voting rights to allow ABEM to have its own CAQ quickly became a no chance in hell scenario. It is not a matter of being week or not pursuing the matter aggressively, it is the simple fact that ABEM can't issue its own CCM CAQ due to the rules/politics of ABMS. This is why saying that ABEM should somehow issue its own CAQ is divorced from very concrete realities at this point in time. While co-sponsoring the ABIM CCM board is much, much easier to get through ABMS because it does not entail the creation of an entirely new CAQ and ABIM seems to be willing to let us co-sponsor, even the proposed deal would require ABMS approval- which could be made difficult by the ABA and ABS should they so choose. Although it was suggested back in October 2009 at the ACEP meeting that the ABA and ABS were willing to let us have this co-sponsor deal with ABIM.


Also, to clarify, ACEP has nothing to do with the actual administration/issuance of ABMS board certification in EM or any other subspecialty. ACEP can't "offer up their own CAQ," as they are not a board organization. ABEM is the member board responsible for all things related to ABMS certification, board co-sponsorship, and issuance of EM CAQs. ACEP is a professional society, like AAEM, and can offer an organizational position statement/opinion on these issues. I do not understand why one would feel that ACEP (which has no control over ABMS rules/politics) would be able to fix this situation so as to enable ABEM to get its own CCM CAQ.


Again, I think it would have been ideal for ABEM to have ABMS approval to issue its own CCM CAQ. This would have given us more flexibility in training and would have probably ensured some way to grandfather in all the folks who trained in the past. This has been tried already for years and has failed; just saying "try harder" to ABEM is not cutting it. So, what do we do? Saying no thanks to the only potentially serious offer for access to ABMS certification in generations and waiting another twenty plus years to see if anything changes would be foolish. If the ABA/ABS/ABIM are not going to let us have our own CAQ, and the ABA/ABS are unwilling at this juncture to let us sit for their CAQ exams- then EM-CCM should continue to move forward as a subspecialty by making sensible use of what will hopefully soon become available. I hope the ABIM deal goes through because I believe that access to ABMS certification will increse the number of EM residents pursuing critical care training and will increase our numbers. Hopefully, with additional numbers with come additional leverage.
 
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@EMCritCare -

Thanks for clarifying. Your points are well presented and well taken. It seems I am holding ABEM responsible for something that, in fact, they have zero influence over. Still disappointing, but clearly they are an unfair target of my angst.


@emergiQ


Thanks for posting back. I think that the free discussion of opinions is one of the best parts of anonymous forums. No umbrage or offense was taken at all. However, I think that clear, open attributation of sources is always helpful when discussing factual news/events or information items. This helps the audience make a rough assessment as to the quality of the information and raises the quality of the discussion. It helps separate rumor and hearsay from the more solid information that the people reading this thread may be seeking.


But that’s just my opinion.


It’s somewhat apropos that the anonymous source is a surgical CC fellowship director, reporting the matter based on what is essentially hearsay over a listserv presumably for surgical CC fellowship directors. The deal between the ABA and ABS has been cooking for a little while now, and I believe that the reciprocity for CC training and board eligibility which they are developing was yet another reason why the ABA dropped out of talks with ABEM about letting us have access to the ABA CAQ in CCM. The ABS is the most conservative and has been consistently against letting us have access to their surgical CC CAQ, and historically vociferous in opposing ABEM’s attempts to obtain its own CAQ. I find it ironic that these surgical CC program directors were musing about how the “broadened eligibility criteria for entering surgical critical care fellows STILL does not include provisions for emergency medicine graduates,” when they know full well that giving us access to the surgical CC CAQ is a non-starter due to the political hang ups within the ABS.


Having tracked this issue for several years now, I think the ABA is entering this arrangement with the ABS in order to preserve the legacy of American anesthesia CC as the number of training programs/practitioners stagnates and dwindles. The ABA knows that the surgical CC programs are more stable at least in terms of recent fill rates and less likely to disappear. By doing this, they will at least ensure continued access to CC training for whichever few anesthesia residents that choose to pursue it. In order to get this done with the ABS, and in the wake of the proposed ABIM-ABEM deal, the ABA’s most recent round of discussions with ABEM died. Well, I don’t think anyone was waiting for combined EM/anesthesia residency programs with baited breath anyway.


I can’t say that I understand how exactly the proposed ABIM-ABEM deal (of which few details are publically available) entails “getting completely in bed with ABIM.” Is ABEM totally in bed with ABP because they are a secondary co-sponsor of peds EM and not the administering board? Multiple subspecialties are arranged in this fashion mostly for two common reasons: 1) When the subspecialty was originally recognized by ABMS, the primary boards that wanted access agreed on an administering board with co-sponsoring boards for the subspecialty or each original claimant primary board got its own CAQ (EM obviously was cut out of the picture when the latter was done for CCM). 2) After the subspecialty was already recognized by ABMS, if an additional primary board wanted access, the best it could do is get approval from the other primary boards to become a co-sponsor (this is what the proposed deal with ABIM entails).


The rules and politics governing ABMS make it extremely difficult for any primary board to issue a CAQ in any subspecialty that is claimed by other boards, or even start a “new” subspecialty that shares territory with an existent one. Witness the years and years of conflict when the American Board of Otolaryngology decided it wanted to issue a CAQ in facial plastic surgery. The American Board of Plastic Surgery fought tooth and nail as it argued that this CAQ would infringe on the scope of plastic surgery as per the purview of ABPS. After years of fighting the compromise was that ABO could co-sponsor the CAQ for Plastic Surgery within the Head and Neck along with ABPS- they did not get an independent CAQ.


This is why ABEM can’t just somehow unilaterally declare that they are going to issue their own CAQ in CCM. ABEM has tried to pursue its own CAQ intermittently for years. Seminal figures from ABEM (like George Podgorny) have argued that ABEM was promised access to CCM in the future, notwithstanding the “ancient deal” that finally got ABEM to full board status. So, ABEM has tried lobbying the other relevant boards whose agreement would be absolutely essential for this to happen. However, getting all the other ABMS boards with a stake in the CCM issue and ABMS voting rights to allow ABEM to have its own CAQ quickly became a no chance in hell scenario. It is not a matter of being week or not pursuing the matter aggressively, it is the simple fact that ABEM can’t issue its own CCM CAQ due to the rules/politics of ABMS. This is why saying that ABEM should somehow issue its own CAQ is divorced from very concrete realities at this point in time. While co-sponsoring the ABIM CCM board is much, much easier to get through ABMS because it does not entail the creation of an entirely new CAQ and ABIM seems to be willing to let us co-sponsor, even the proposed deal would require ABMS approval- which could be made difficult by the ABA and ABS should they so choose. Although it was suggested back in October 2009 at the ACEP meeting that the ABA and ABS were willing to let us have this co-sponsor deal with ABIM.


Also, to clarify, ACEP has nothing to do with the actual administration/issuance of ABMS board certification in EM or any other subspecialty. ACEP can’t “offer up their own CAQ,” as they are not a board organization. ABEM is the member board responsible for all things related to ABMS certification, board co-sponsorship, and issuance of EM CAQs. ACEP is a professional society, like AAEM, and can offer an organizational position statement/opinion on these issues. I do not understand why one would feel that ACEP (which has no control over ABMS rules/politics) would be able to fix this situation so as to enable ABEM to get its own CCM CAQ.


Again, I think it would have been ideal for ABEM to have ABMS approval to issue its own CCM CAQ. This would have given us more flexibility in training and would have probably ensured some way to grandfather in all the folks who trained in the past. This has been tried already for years and has failed; just saying “try harder” to ABEM is not cutting it. So, what do we do? Saying no thanks to the only potentially serious offer for access to ABMS certification in generations and waiting another twenty plus years to see if anything changes would be foolish. If the ABA/ABS/ABIM are not going to let us have our own CAQ, and the ABA/ABS are unwilling at this juncture to let us sit for their CAQ exams- then EM-CCM should continue to move forward as a subspecialty by making sensible use of what will hopefully soon become available. I hope the ABIM deal goes through because I believe that access to ABMS certification will increse the number of EM residents pursuing critical care training and will increase our numbers. Hopefully, with additional numbers with come additional leverage.
 
Another convulution to this is ACGME funding which for many places is limiting EM people from going in. I know a number of programs that would love to take EM people, however, its not acgme (limiting thier ability to pay someone). It makes financing a fellowship more difficult.
 
Another convulution to this is ACGME funding which for many places is limiting EM people from going in. I know a number of programs that would love to take EM people, however, its not acgme (limiting thier ability to pay someone). It makes financing a fellowship more difficult.
If the ABIM deal goes through and ABMS approval is obtained, ACGME funding will cease to be an issue for EM residents going into IM RRC approved fellowships. The presence of ABMS approval for EM candidates to site for the ABIM CCM exam will lead to IM RRC approval for EM candidates to take up ACGME allotted slots. Even now, some IM CCM fellowships (Pitt, Stanford, Cooper, St. John's Mercy/SLU, amongst others) have already moved to begin considering EM applicants as part of their IM fellowship pools for ACGME tracking in anticipation of ABIM eligibility and these potential fellows counting against their existing ACGME fellow allotments.
 
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