ABFM & ABIM Critical Care Cosponsorship?

[RadialDoc]

I have seen a few presentations by the Society of Hospital Medicine in regards to Family Physicians who are working as hospitalists for further formal training in Critical Care Medicine. I know where I work, it is an open ICU where I routinely admit patients to the ICU and do the initial vent management, intubate, place central lines when the Intensivist is at home after 7 pm. Having something like this would be really nice to have actual training. I did do a search for this and found a few things which I hope I can link to this post.

There was an AAFP update to the working party 2018 in which it was explicitly stated,

"The proposal from the Society for Hospital Medicine for the creation of a certification pathway for family physicians to seek certification in Critical Care Medicine, similar to the pathway created for emergency medicine physicians in 2012, wasreviewed andapproved by our Board ofDirectors at their recent Annual Meeting. This would require co-sponsorship of the Critical Care Medicine certificate currently offered by ABIM and revision of the eligibility requirements of the ACGME program requirements for Critical Care Medicine. We have initiated a conversation with ABIM about the feasibility of doing so and are awaiting an indication of their receptivity to moving forward with submission of a proposal to the ABMS Committee on Certification(COCERT)for approval."

I have been searching for updates in regards to this but have not seen anything. Did this ultimately die? Or is this still being worked on?

Hospitalists trained in family medicine seek critical care training pathway

https://www.aafp.org/dam/foundation/documents/Internal/workingparty/ABFM.pdf

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[Lurts]

I sure hope this becomes something. Never understood why FM (particularly those with heavy inpatient training/practices) doesn’t have access to critical care.

 

[Make Or Break]

I sure hope this becomes something. Never understood why FM (particularly those with heavy inpatient training/practices) doesn’t have access to critical care.

Yet a lot of job postings I’ve seen for Hospitalists that accept fm say “open icu”

 

[deleted480308]

I have seen a few presentations by the Society of Hospital Medicine in regards to Family Physicians who are working as hospitalists for further formal training in Critical Care Medicine. I know where I work, it is an open ICU where I routinely admit patients to the ICU and do the initial vent management, intubate, place central lines when the Intensivist is at home after 7 pm. Having something like this would be really nice to have actual training. I did do a search for this and found a few things which I hope I can link to this post.

There was an AAFP update to the working party 2018 in which it was explicitly stated,

"The proposal from the Society for Hospital Medicine for the creation of a certification pathway for family physicians to seek certification in Critical Care Medicine, similar to the pathway created for emergency medicine physicians in 2012, wasreviewed andapproved by our Board ofDirectors at their recent Annual Meeting. This would require co-sponsorship of the Critical Care Medicine certificate currently offered by ABIM and revision of the eligibility requirements of the ACGME program requirements for Critical Care Medicine. We have initiated a conversation with ABIM about the feasibility of doing so and are awaiting an indication of their receptivity to moving forward with submission of a proposal to the ABMS Committee on Certification(COCERT)for approval."

I have been searching for updates in regards to this but have not seen anything. Did this ultimately die? Or is this still being worked on?

Hospitalists trained in family medicine seek critical care training pathway

https://www.aafp.org/dam/foundation/documents/Internal/workingparty/ABFM.pdf

I would picture it ending up like pain, where techinically the FM grads are eligible but they pretty much are only eligible in name only from a practical standpoint

 

[Lexdiamondz]

I'd be in favour of this, but it would likely require FM residencies to restructure their curricula to include more critical care time - as it is currently most FM grads get at most 1-2 mos of dedicated ICU time, and it would be somewhat awkward for them to be fellows overseeing medicine and EM residents with more critical care exposure than them in an academic setting.

 

[CCM-MD]

Yet a lot of job postings I’ve seen for Hospitalists that accept fm say “open icu”

I'm a CCM doc. All the hospitals I have worked at as an intensivist have had "open" ICUs. An ICU being "open" does not mean there is no CCM coverage. Most (nearly 75%) community hospital ICUs in the US are open.

Agree with sb247. Creation of a pathway may not necessarily translate to fellowships taking FM docs. Still bias against EM even though a pathway has existed forever - only ~150 certificates issued since inception.

 

[VA Hopeful Dr]

I'm a CCM doc. All the hospitals I have worked at as an intensivist have had "open" ICUs. An ICU being "open" does not mean there is no CCM coverage. Most (nearly 75%) community hospital ICUs in the US are open.

Agree with sb247. Creation of a pathway may not necessarily translate to fellowships taking FM docs. Still bias against EM even though a pathway has existed forever - only ~150 certificates issued since inception.

Agreed. I mean, if you get an FM grad who did all of their elective time in the ICU (which would translate to 6-8 months today depending on the program) I could see them having a shot, maybe.

Your average FM grad, not a chance (nor would 99.99% of them want to do it).

 

[betamale]

Great, hopefully that goes through. We had ICU fellows rotate in the hospital that sponsored our unopposed FM residency. The FM residents worked in Neuro, cvicu, micu, nicu. Our residency hospital is 500+ bed, level II trauma, urban, stroke center, level III nicu, chest pain center, tons of high risk OB. Most of the hospitalists were FM. Would be great to have FM CCM fellows in our hospital.

The FM hospitalists in our hospital make 300k+, intensivists 400k+...so a bunch of our grads do hospitalist work. A couple of the IM hospitalists went back to do CCM. I would be interested in CCM training since I work mostly in dedicated adult ED now.

 

[MedicineZ0Z]

Agreed. I mean, if you get an FM grad who did all of their elective time in the ICU (which would translate to 6-8 months today depending on the program) I could see them having a shot, maybe.

Your average FM grad, not a chance (nor would 99.99% of them want to do it).

A lot of IM residencies do 2-3 months of ICU . It's not uncommon to imagine an FM residency that's inpatient heavy also allowing 3+ months of electives in ICU on top of 1-2 required blocks. In which case the FM resident is up to par and has more exp than the IM resident does.

Absolutely not the average FM grad. So much of it is also hospital and staff culture. There are unopposed residencies where residents are encouraged to do a lot and attendings go out of their way to get a resident to do cool stuff. There are also unopposed residencies where you have to go out of your way to do stuff because the staff aren't interested.

 

[Lexdiamondz]

A lot of IM residencies do 2-3 months of ICU . It's not uncommon to imagine an FM residency that's inpatient heavy also allowing 3+ months of electives in ICU on top of 1-2 required blocks. In which case the FM resident is up to par and has more exp than the IM resident does.

Absolutely not the average FM grad. So much of it is also hospital and staff culture. There are unopposed residencies where residents are encouraged to do a lot and attendings go out of their way to get a resident to do cool stuff. There are also unopposed residencies where you have to go out of your way to do stuff because the staff aren't interested.

Not saying you're wrong, but the ACGME requires all IM residents to have at least 3 mos of ICU, and most critical care applicants will have closer to 5-6 months. Now if an FM grad can get 6 months of critical care exposure I don't see why they shouldn't be allowed to apply, but that's gonna be pretty uncommon regardless of how dedicated one is - most programmes just aren't going to offer that type of experience.

Also consider the setting that most CCM fellowships are in - an unopposed FM residency might give you a greater procedural competence and autonomy, but the environment will be pretty different to that of a quatenary care centre with severalfold more complex patients.

 

[MedicineZ0Z]

Not saying you're wrong, but the ACGME requires all IM residents to have at least 3 mos of ICU, and most critical care applicants will have closer to 5-6 months. Now if an FM grad can get 6 months of critical care exposure I don't see why they shouldn't be allowed to apply, but that's gonna be pretty uncommon regardless of how dedicated one is - most programmes just aren't going to offer that type of experience.

Also consider the setting that most CCM fellowships are in - an unopposed FM residency might give you a greater procedural competence and autonomy, but the environment will be pretty different to that of a quatenary care centre with severalfold more complex patients.

Ah, yes 3 months.. divided into pgy1-3 equally. I think whether or not you get 6 months depends on allowed elective time. Places give 4 months usually, up to 6 months. If an FM resident wanted CCM, they'd do 1 if not 2 electives at those academic places also. And a lot of IM residencies are in very similar hospitals.

 

[VA Hopeful Dr]

Not saying you're wrong, but the ACGME requires all IM residents to have at least 3 mos of ICU, and most critical care applicants will have closer to 5-6 months. Now if an FM grad can get 6 months of critical care exposure I don't see why they shouldn't be allowed to apply, but that's gonna be pretty uncommon regardless of how dedicated one is - most programmes just aren't going to offer that type of experience.

Also consider the setting that most CCM fellowships are in - an unopposed FM residency might give you a greater procedural competence and autonomy, but the environment will be pretty different to that of a quatenary care centre with severalfold more complex patients.

Yep, every IM program in my state requires a minimum of 4 months. Every resident I've known has gone on to do more.

So yes, FM could manage that but would take some hard work. Very doable for the very driven FM resident.

 

[Lexdiamondz]

Ah, yes 3 months.. divided into pgy1-3 equally. I think whether or not you get 6 months depends on allowed elective time. Places give 4 months usually, up to 6 months. If an FM resident wanted CCM, they'd do 1 if not 2 electives at those academic places also. And a lot of IM residencies are in very similar hospitals.

And alot of those IM applicants from unknown community programmes have a hard time getting fellowships.

More to your point - I think if FM was willing to restructure it's curriculum to add more ICU time in the way EM did after board certification opened up to us, I don't see why they shouldn't be allowed to apply. As things are now, however, realistically you would have to ask yourselves what unique skills and perspectives FM has to offer to the world of CCM

 

[VA Hopeful Dr]

And alot of those IM applicants from unknown community programmes have a hard time getting fellowships.

More to your point - I think if FM was willing to restructure it's curriculum to add more ICU time in the way EM did after board certification opened up to us, I don't see why they shouldn't be allowed to apply. As things are now, however, realistically you would have to ask yourselves what unique skills and perspectives FM has to offer to the world of CCM

I don't think that's the right question to ask.

The one that matters is this: can FPs be trained to be equal while training and afterwards compared to existing fellows/attendings using the current training model. If yes, allow a trial run. If not, then no dice.

 

[Lexdiamondz]

I don't think that's the right question to ask.

The one that matters is this: can FPs be trained to be equal while training and afterwards compared to existing fellows/attendings using the current training model. If yes, allow a trial run. If not, then no dice.

I think the question of what FPs are bringing to the Crit Care table is a valid one.

Consider the role of a fellow - they're simultaneously learning a specialty and also supervising other learners (residents). Regardless of whether or not an FP can be trained to be equally competent as a critical care attending, it's hard to argue than an FM trained PGY-4 should be supervising gen surg and gas PGY-4s and 5s who have far more experience caring for critically ill surgical patients, or supervising IM trained PGY-3s who likely have both greater inpatient and ICU training. Unless you're bringing something unique to the practice of resuscitation and care for the critically it, it's a tough sell to let you supervise people who on paper have more experience than you do.

 

[VA Hopeful Dr]

I think the question of what FPs are bringing to the Crit Care table is a valid one.

Consider the role of a fellow - they're simultaneously learning a specialty and also supervising other learners (residents). Regardless of whether or not an FP can be trained to be equally competent as a critical care attending, it's hard to argue than an FM trained PGY-4 should be supervising gen surg and gas PGY-4s and 5s who have far more experience caring for critically ill surgical patients, or supervising IM trained PGY-3s who likely have both greater inpatient and ICU training. Unless you're bringing something unique to the practice of resuscitation and care for the critically it, it's a tough sell to let you supervise people who on paper have more experience than you do.

I would suggest reading my posts better:

I don't think that's the right question to ask.

The one that matters is this: can FPs be trained to be equal while training and afterwards compared to existing fellows/attendings using the current training model. If yes, allow a trial run. If not, then no dice.

If an FM-trained CCM fellow is on the same level as an IM-trained fellow at the same point in fellowship, that should be good enough.

Obviously if you have an FM-trained PGY-4 who is routinely overshadowed by the IM PGY-3s that's a problem... but that's also a problem if the IM PGY-4 is overshadowed by those same PGY-3s.

 

[RadialDoc]

A “Targeted temperature management” bump, but I got some updates on the ABFM and ABIM Critical care cosponsorship. It seems the Critical Care Medicine board will initiate a pilot program for Family Medicine trained physicians to train in IM-CCM programs and be eligible to take the IM-CCM boards. It seems ABIM was open to training of FM trained physicians “under the framework of the ACGME Advancing Innovation in Residency Education (AIRE) program.”
I wonder what the requirements will be for FM docs? 3 years of Hospitalist work to get that Focused Practice in Hospital Medicine certification before applying or applying straight from Residency after completing a certain number of required rotations in the ICU?

From the Blog post:

Spring 2019 Specialty Board Summaries

Introduction As Chair of ABIM Council, the ABIM governance body that oversees the various discipline-specific Specialty Boards, I am very pleased to share with you a summary of the discussions that took place in spring 2019 at the ABIM Specialty Board meetings. The Council and Specialty Boards...

blog.abim.org

The Pulmonary Disease Board and CCM Board discussed the idea of a pilot program to test the feasibility of incorporating family medicine-trained physicians into internal medicine critical care medicine fellowships, with successful completion resulting in eligibility for certification in IM-CCM. This would allow gathering data to inform the possible co-sponsorship of IM-CCM by the American Board of Family Medicine (ABFM). The Pulmonary Disease Board gave guidance to the CCM Board before the CCM Board continued their deliberations separately.
The CCM Board voted to explore a potential pilot program proposal (as described above) from the ABFM, under the framework of the ACGME Advancing Innovation in Residency Education (AIRE) program

I have seen a few presentations by the Society of Hospital Medicine in regards to Family Physicians who are working as hospitalists for further formal training in Critical Care Medicine. I know where I work, it is an open ICU where I routinely admit patients to the ICU and do the initial vent management, intubate, place central lines when the Intensivist is at home after 7 pm. Having something like this would be really nice to have actual training. I did do a search for this and found a few things which I hope I can link to this post.

There was an AAFP update to the working party 2018 in which it was explicitly stated,

"The proposal from the Society for Hospital Medicine for the creation of a certification pathway for family physicians to seek certification in Critical Care Medicine, similar to the pathway created for emergency medicine physicians in 2012, wasreviewed andapproved by our Board ofDirectors at their recent Annual Meeting. This would require co-sponsorship of the Critical Care Medicine certificate currently offered by ABIM and revision of the eligibility requirements of the ACGME program requirements for Critical Care Medicine. We have initiated a conversation with ABIM about the feasibility of doing so and are awaiting an indication of their receptivity to moving forward with submission of a proposal to the ABMS Committee on Certification(COCERT)for approval."

I have been searching for updates in regards to this but have not seen anything. Did this ultimately die? Or is this still being worked on?

Hospitalists trained in family medicine seek critical care training pathway

https://www.aafp.org/dam/foundation/documents/Internal/workingparty/ABFM.pdf

 

[betamale]

wonderful. i'd be very interested. i work 100% ED these days and it would be nice to have more critical care training

 

[FP-hospitalist]

I have been searching for updates in regards to this but have not seen anything since the 2019 CCM board summary. Did this ultimately die? Is this still being worked on?

 

[MedicineZ0Z]

I have been searching for updates in regards to this but have not seen anything since the 2019 CCM board summary. Did this ultimately die? Is this still being worked on?

This would only be a thing if there was interest. Many FM residents these days have limited interest for anything beyond bread and butter outpatient (of course, some absolutely like the full scope). Unfortunately, bread and butter outpatient will not be sustainable in the long term and isn't going to be earning the inflation equivalent of 250k years down the road as AI develops and midlevels proliferate.
So I think if FM had more of an interest, and the elective time was there - this could be further pursued.

 

[deleted87716]

CCM/ICU was never really part of “full scope” FM to begin with.

 

[betamale]

CCM/ICU was never really part of “full scope” FM to begin with.

Well, I've work at many rural hospitals with open ICUs staffed by FPs; many of them are very skilled. There are many articles by FPs asking for CCM training. There is more interest than you would think

 

[deleted87716]

Well, I've work at many rural hospitals with open ICUs staffed by FPs; many of them are very skilled. There are many articles by FPs asking for CCM training. There is more interest than you would think

I'm not saying you can't learn it or shouldn't do it. I did it in residency - supervised by BC intensivists, of course. I wouldn't have wanted to be flying solo.

 

[MedicineZ0Z]

CCM/ICU was never really part of “full scope” FM to begin with.

Vast majority of open-ICU hospitalist jobs take family med docs. By definition, it's part of FM scope. It's drastically easier to get a job covering an ICU solo overnight where you're responsible for all procedures as a family med doc than it is getting basic low risk Ob privileges.

 

[GoSpursGo]

A number of argumentative posts have been moved to the off-topic forum. If there is someone whose opinion you dislike or who you disagree with, please place them on ignore. There is no need to go bicker back and forth in thread.

 

[Reboa]

I do wonder if opening up a critical care pathway would also make those fm docs that pursued it more competitive for er jobs since em fellowships seem to be an uphill battle

 

[VA Hopeful Dr]

I do wonder if opening up a critical care pathway would also make those fm docs that pursued it more competitive for er jobs since em fellowships seem to be an uphill battle

I doubt it. You're learning CC, not EM.

 

[topraman]

Agree, there is a lot of rural demand and I think entirely within FM scope, from womb to tomb remember. We must be empowered to take on the needs of our community.

Note that the most of critical care's value is in the really the close nursing. That's the vital part of the model. Yes, there's some key medicine, and a few key procedures, all of which cross-train well. The most difficult part of the job in the long run, as intensivists will tell you, is family decision-making and palliative care, which FM is well suited for. I think we are also more comfortable with the mixed ICUs (MICU and SICU) that these settings have. For community hospital ICUs the type of cases one manages, and the type of resources available, are not something so out of the ordinary or mystical in anyway. I do critical care and know several FM docs who do as well, including a few unit directors. As far as training, we had 3 months of full time ICU in residency. This is more than most, and less than IM but consider the exposure and responsibility - for us there was no senior, no fellow, as the resident we did it all. Add on 4 months of ER, 1 month of anesthesia, 2 months of inpatient general surgery, again more than the time involved these were high quality experiences where one had primary responsibility, and elective blocks and it easily meets or beats the preparation received by other disciplines in cognitive and procedural skills for critical care.

 

[MedicineZ0Z]

Agree, there is a lot of rural demand and I think entirely within FM scope, from womb to tomb remember. We must be empowered to take on the needs of our community.

Note that the most of critical care's value is in the really the close nursing. That's the vital part of the model. Yes, there's some key medicine, and a few key procedures, all of which cross-train well. The most difficult part of the job in the long run, as intensivists will tell you, is family decision-making and palliative care, which FM is well suited for. I think we are also more comfortable with the mixed ICUs (MICU and SICU) that these settings have. For community hospital ICUs the type of cases one manages, and the type of resources available, are not something so out of the ordinary or mystical in anyway. I do critical care and know several FM docs who do as well, including a few unit directors. As far as training, we had 3 months of full time ICU in residency. This is more than most, and less than IM but consider the exposure and responsibility - for us there was no senior, no fellow, as the resident we did it all. Add on 4 months of ER, 1 month of anesthesia, 2 months of inpatient general surgery, again more than the time involved these were high quality experiences where one had primary responsibility, and elective blocks and it easily meets or beats the preparation received by other disciplines in cognitive and procedural skills for critical care.

Tell that to these folks: The lack of control of Emergency medicine | Student Doctor Network
Their minds are blown at the idea of FM doing what you describe.

 

[Reboa]

Tell that to these folks: The lack of control of Emergency medicine | Student Doctor Network
Their minds are blown at the idea of FM doing what you describe.

Man that was miserable to read, the amount of train wreck admissions I’ve gotten from BC em docs is just as laughable. Apparently we can manage the actual pt they dispo to us, but we can’t handle the first fifteen minutes of the case that their pa handles for them.

And I disagree with you va hopeful dr, critical care training on top of what you’ve already learned in any half way decent fm residency and you should be able to staff a level one ED. Since it’s the extensive critical care training and exposure to trauma we’re lacking right? But let’s be serious acute care surgery is running the show in the trauma world not em so some sicu exposure would probably be sufficient.

 

[VA Hopeful Dr]

Man that was miserable to read, the amount of train wreck admissions I’ve gotten from BC em docs is just as laughable. Apparently we can manage the actual pt they dispo to us, but we can’t handle the first fifteen minutes of the case that their pa handles for them.

And I disagree with you va hopeful dr, critical care training on top of what you’ve already learned in any half way decent fm residency and you should be able to staff a level one ED. Since it’s the extensive critical care training and exposure to trauma we’re lacking right? But let’s be serious acute care surgery is running the show in the trauma world not em so some sicu exposure would probably be sufficient.

So CC trained IM should also be able to staff tertiary EDs?

 

[Reboa]

No, because of the lack of surgery peds and obgyn training that falls in Em’s scope and ours. Although I’d imagine an intensivist is just as competent at resuscitating an adult pt as an Ed doc is. But what skills does a pulmcrit doc not have that em can do? Aside from high volume turn around and managing lower acuity issues. Dispo is also not hard to wrap your head around when you’ve admitted, managed and discharged enough pts. The more legitimate career options we can create from fm the more attractive it becomes to med students in my opinion.

 

[deleted87716]

There is some overlap in every field. That doesn’t mean that another specially can do your job as well as you can.

 

[VA Hopeful Dr]

No, because of the lack of surgery peds and obgyn training that falls in Em’s scope and ours. Although I’d imagine an intensivist is just as competent at resuscitating an adult pt as an Ed doc is. But what skills does a pulmcrit doc not have that em can do? Aside from high volume turn around and managing lower acuity issues. Dispo is also not hard to wrap your head around when you’ve admitted, managed and discharged enough pts. The more legitimate career options we can create from fm the more attractive it becomes to med students in my opinion.

Significant experience working in an ED?

But you're missing the point. The original question was if a CC fellowship would make an FP more competitive for ED jobs. I don't think it would because it's not getting an FP any additional EM experience. You're free to disagree but I see no reason why it would help.

 

[MedicineZ0Z]

Man that was miserable to read, the amount of train wreck admissions I’ve gotten from BC em docs is just as laughable. Apparently we can manage the actual pt they dispo to us, but we can’t handle the first fifteen minutes of the case that their pa handles for them.

And I disagree with you va hopeful dr, critical care training on top of what you’ve already learned in any half way decent fm residency and you should be able to staff a level one ED. Since it’s the extensive critical care training and exposure to trauma we’re lacking right? But let’s be serious acute care surgery is running the show in the trauma world not em so some sicu exposure would probably be sufficient.

It's not even just that. Apparently I can admit patients to the open ICU for 3 years of residencies, run codes and do their procedures. But dare I suggest that I do it as an attending? Apparently I need to be humbled with things that can go wrong (as if I don't know that patients can crash). But they'll gladly go to sleep and let their PA run the ICU with literally *zero* supervision.

I try and be very pro physician but they seem to go out of their way to attack FM docs specifically.

There is some overlap in every field. That doesn’t mean that another specially can do your job as well as you can.

Yes but if you're not a physician, you can jump around 5 different specialties apparently and do it all with no supervision. The new PA has more autonomy than a PGY3 and the NP has more autonomy than the fellow. We all know this is true, yet ignore it. But god forbid FM physicians want to practice medicine at its full scope.

Significant experience working in an ED?

But you're missing the point. The original question was if a CC fellowship would make an FP more competitive for ED jobs. I don't think it would because it's not getting an FP any additional EM experience. You're free to disagree but I see no reason why it would help.

Give it another 5-10 years. Midlevels will be independently running everything with 0 supervision while doctors are talking about adding a 5th fellowship to do the same thing.

 

[A Nonie Meus]

It’s already happened in peds with fellowships for anything more than well visits. First hospitalist fellowships and now peds urgent care fellowships popping up. Soon there will be peds outpatient fellowships. Meanwhile, we have fresh NP and PA grads manning all 3.

Fellowships/Training – Society for Pediatric Urgent Care

Pediatric Urgent Care Physician Fellowship Pediatric Urgent Care Fellowship is designed for residency graduates and pediatricians who want to enhance their training in the rapidly growing field of pediatric urgent care medicine. These programs are typically one year in duration (with some...

www.urgentcarepeds.org

 

[TwistedTea]

It’s already happened in peds with fellowships for anything more than well visits. First hospitalist fellowships and now peds urgent care fellowships popping up. Soon there will be peds outpatient fellowships. Meanwhile, we have fresh NP and PA grads manning all 3.

Fellowships/Training – Society for Pediatric Urgent Care

Pediatric Urgent Care Physician Fellowship Pediatric Urgent Care Fellowship is designed for residency graduates and pediatricians who want to enhance their training in the rapidly growing field of pediatric urgent care medicine. These programs are typically one year in duration (with some...

www.urgentcarepeds.org

Lol peds leadership is such a joke. Just sucking more cheap labor from pediatric residents/fellows knowing that peds are usually to friendly to fight back.

"i know you just spent 8 months a year on inpatient peds wards but you need an additional 3 year fellowship to do what you have been doing"

What a bunch of crock!

 

[MedicineZ0Z]

It’s already happened in peds with fellowships for anything more than well visits. First hospitalist fellowships and now peds urgent care fellowships popping up. Soon there will be peds outpatient fellowships. Meanwhile, we have fresh NP and PA grads manning all 3.

Fellowships/Training – Society for Pediatric Urgent Care

Pediatric Urgent Care Physician Fellowship Pediatric Urgent Care Fellowship is designed for residency graduates and pediatricians who want to enhance their training in the rapidly growing field of pediatric urgent care medicine. These programs are typically one year in duration (with some...

www.urgentcarepeds.org

looll wtf. peds urgent care fellowship? Ridiculous.

 

[topraman]

looll wtf. peds urgent care fellowship? Ridiculous.

Wow.

Reminds me of this wonderful recent piece.

Champions of Generalism

journals.stfm.org

"The approval of a new subspecialty in CFP is, in itself, not a big deal. But every physician who abandons the general practice of their specialty is a physician who moves farther from the demands of community service. To be worth the investment of time and money, more training should prepare people to do more, not less. Why in the world should it take 6 years of postgraduate training to produce a physician to provide complex family planning? If the ACGME really thinks this is necessary, how can we reasonably argue that a family physician can learn to deliver comprehensive care to all family members in just 3 years? The founders of our discipline hoped that family physicians would be champions of generalism in our profession. They dreamed we would restore sanity to American medicine and not simply take up residence in the asylum with the other specialties. Teaching physicians to care for fewer and fewer problems is silly when it comes to population health. It is our job to say so, and to manage our own specialty accordingly."

 

[betamale]

Wow.

Reminds me of this wonderful recent piece.

Champions of Generalism

journals.stfm.org

"The approval of a new subspecialty in CFP is, in itself, not a big deal. But every physician who abandons the general practice of their specialty is a physician who moves farther from the demands of community service. To be worth the investment of time and money, more training should prepare people to do more, not less. Why in the world should it take 6 years of postgraduate training to produce a physician to provide complex family planning? If the ACGME really thinks this is necessary, how can we reasonably argue that a family physician can learn to deliver comprehensive care to all family members in just 3 years? The founders of our discipline hoped that family physicians would be champions of generalism in our profession. They dreamed we would restore sanity to American medicine and not simply take up residence in the asylum with the other specialties. Teaching physicians to care for fewer and fewer problems is silly when it comes to population health. It is our job to say so, and to manage our own specialty accordingly."

That's good. I hope you're not implying that Critical care fellowship with narrow an FPs practice. Arguably, an FP with critical care skills could care for more patients in a variety of settings such as ER, wards, ICU, virtual (tele-ICU), which many of us do now, but in many places barred because of hospital by-laws.

 

[topraman]

Yes not at all that it narrows. Support it fully.

All fellowships should add skill, not reduce scope. And conversely the lack of a fellowship should not preclude scope for many areas of medicine (like family planning or pediatric urgent care).

 

[andrewsmack05]

Does anyone know who to reach out to about a pilot program? I have emailed and been in contact with the ACGME and ABFM president Warren Newton about opening up a CC pathway for FM residents that meet certain qualifications. He has been on board but talks have stalled with COVID. Is there a specific person or committee in the ABIM to reach out to? Thanks!

 

[deleted1025203]

Does anyone know who to reach out to about a pilot program? I have emailed and been in contact with the ACGME and ABFM president Warren Newton about opening up a CC pathway for FM residents that meet certain qualifications. He has been on board but talks have stalled with COVID. Is there a specific person or committee in the ABIM to reach out to? Thanks!

If you haven't already join up and get involved with the AAFP hospital medicine MIG and SHM family medicine SIG. The SHM HTFM group has been working on this pathway for a few years.

From the minutes of the last SHM HTFM meeting in December:

• Critical Care Pathway Update
  • Spoke to Dr. Furman MacDonald
  • Spoke to Dr. Newton
  • Working on AIRE
• Working on letter for SHM to sign on to for Board/CEO to sign in support
• Certification of Added Qualification
  • 3 months of intensive ICU experience
  • Writing in that experience can be obtained

 

[AlbinoHawk DO]

It's not even just that. Apparently I can admit patients to the open ICU for 3 years of residencies, run codes and do their procedures. But dare I suggest that I do it as an attending? Apparently I need to be humbled with things that can go wrong (as if I don't know that patients can crash). But they'll gladly go to sleep and let their PA run the ICU with literally *zero* supervision.

I try and be very pro physician but they seem to go out of their way to attack FM docs specifically.

In all fairness, you can make this argument for any specialty you wanted: I can admit people to nephrology department and do procedures, but date I suggest do that as an attending?

Obviously there's a reason for residency and that is that you have a backup there in case **** hits the fan. Just because you admitted to an open ICU as a resident doesn't mean you have acquired the necessary skills. I admitted people to the open ICU in my first month of intern year. Does this mean I should be fast-tracked into fellowship?

If an intensivist lets their PA run the show solo, that's irresponsible and someday it'll come back to haunt them. That's not a reason to lower the standards though. Maybe we should get rid of medical school altogether and just make everyone a PA? No?

 

[MedicineZ0Z]

In all fairness, you can make this argument for any specialty you wanted: I can admit people to nephrology department and do procedures, but date I suggest do that as an attending?

Obviously there's a reason for residency and that is that you have a backup there in case **** hits the fan. Just because you admitted to an open ICU as a resident doesn't mean you have acquired the necessary skills. I admitted people to the open ICU in my first month of intern year. Does this mean I should be fast-tracked into fellowship?

If an intensivist lets their PA run the show solo, that's irresponsible and someday it'll come back to haunt them. That's not a reason to lower the standards though. Maybe we should get rid of medical school altogether and just make everyone a PA? No?

Except in my case I did those things with an FM attending (theoretically) supervising. I can say the same for many other programs too. It's not an intensivist supervising that....
There are a lot of open-ICUs which hire FM docs as hospitalists.

 

[AlbinoHawk DO]

Except in my case I did those things with an FM attending (theoretically) supervising. I can say the same for many other programs too. It's not an intensivist supervising that....
There are a lot of open-ICUs which hire FM docs as hospitalists.

Were you and the attending able to consult critical care? Because that seems key in every open ICU I've seen

 

[MedicineZ0Z]

Were you and the attending able to consult critical care? Because that seems key in every open ICU I've seen

Do you mean did we have the ability to do so? Yes. In many open ICUs, that can involve a tele-icu consult with very limited availability.
Did we for low pressor requirements or bipap etc? Definitely not.

 

[CCM-MD]

Were you and the attending able to consult critical care? Because that seems key in every open ICU I've seen

Agree. All ICUs I have worked in as an attending intensivist have been Open ICUs. Just because it’s an open ICU doesn’t mean there isn’t an intensivist available. Many places require an automatic critical care consult. This is the most common set up in the community to avoid pissing of private physicians and surgeons.

 

[Splenda88]

I think we should borrow a page from Canada when it comes to allow FM docs to have more skills if they wish to...

Enhanced Skills in Family Medicine

www.dfcm.utoronto.ca

 

[topraman]

I think we should borrow a page from Canada when it comes to allow FM docs to have more skills if they wish to...

Enhanced Skills in Family Medicine

www.dfcm.utoronto.ca

Agree and that's a partial list, they also have FP Anesthesia, and FP Enhanced Surgical Skills (a year each). Very sensible. Note that their base is two years, so in well run 3-4 year programs a lot of this is, or can be, integrated.

Re: open ICUs, I don't think anyone is saying have CC consultation is not helpful, obviously it is. The question is can FM have enough of a foundation to be comfortable in a setting where that consultation made be tele-based, or limited availability or pursue their own further CC fellowship? For the right FM program, the answer is an easy yes.

By the way, something terrifying about some Pulm/CC programs? Low volume of airway/intubation experience. Hard to believe but I kid you not. We had one such graduate join our County hospital after fellowship at a large, private urban hospital who admitted the same limitation (though was otherwise excellent).

"Whereas at 21% of programs, the PCCM fellow was “rarely or never” the primary operator responsible for intubating in the ICU"

https://www.atsjournals.org/doi/full/10.34197/ats-scholar.2020-0004OC

UW, median number by third year of fellowship 9, and majority of fellows uncomfortable with induction meds or paralytics or a back up plan.

https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2016.193.1_MeetingAbstracts.A3200

They have other strengths I'm sure and CC is much more than airway management but I finished a three year FM residency with 125 intubations, 25+ emergent ER/ICU based, and very comfortable with meds and back up options. What a world we've come to...