Anyone else's program have trouble meeting EMG requirements for ACGME?

[fyfanatic]

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Hi,

I was wondering if anyone else was in a program where the residents had trouble meeting the 200 EMG requirement for ACGME.
Did the residents in the past have problems graduating if they couldn't log the required amount?
Our program has about 8-10 residents per class and unfortunately our patient show rate isn't the best (even after calling them to confirm), so we've had problems with residents not getting the required numbers. And I heard that the ACGME is getting more strict with the logging, for example you can't log the nerve conduction study and the EMG portion as separate tests...

 

[RUOkie]

The no show/cancellation rate is higher for all appointments this year (anecdotal from my practice and speaking with friends in many specialties) since most people's deductibles went up this year. But even with that, I'm still on track for >700 this year in my practice.

There is no reason any PM&R resident can't get 200 in a three year residency. I know I'm old, but I did over 1000 as a resident 20 yrs ago at a program with 13 residents in my class.

 

[Gauss]

In addition to the high no show rate, the demand for EMG's are down not only private practice but in all large institutions. The reimbursement took a big hit as well which can end up netting financial losses for training programs. A lot of programs shifted EMG training to VA's.
I have a hard time believing ACGME would put a program on probation because they're not able to keep up EMG numbers. The program lists it as a weakness and then shows that it is working on improving the problem.

 

[padresp]

At my program, there was an increasing stress over the last few years to hit the target. All the residents hit the target, but the numbers have been diminishing. For us, it seemed like there were fewer and fewer "simple" tests (carpal tunnel, etc.) but an unchanged number of complex ones (3-limb studies, r/o ALS, etc.). I'm a firm believer that the number of studies does not dictate how well someone is trained.

 

[Louisville04]

I've worked at two VA's. The first one was a small one with limited services. I would get a lot of "frivolous" EMG's since the providers had nothing else to consult. We (two physiatrists) would do about 25-30 EMG's total/week. Now I am at a larger VA with many services (Ortho, Neurosurgery, MRI). However, we (four physiatrists) still do about 25-30 EMG's total/week.

 

[RUOkie]

At my program, there was an increasing stress over the last few years to hit the target. All the residents hit the target, but the numbers have been diminishing. For us, it seemed like there were fewer and fewer "simple" tests (carpal tunnel, etc.) but an unchanged number of complex ones (3-limb studies, r/o ALS, etc.). I'm a firm believer that the number of studies does not dictate how well someone is trained.

You are right, and you are wrong. In order to be proficient in electrodiagnostic medicine you need volume. That is the only way to even have the opportunity to see/hear unusual waveforms or perform unusual studies. I do around 1000 studies a year, but still only do real brachial plexus workups a few times a year. Actually see myopathies??? once every few years. ALS? a few a year. Myokymia? twice in my career.

The volume is what makes you proficient in seeing normal. Being able to distinguish between the motor point and fibrillations.

Finally, in MOST hospitals, in order to get credentialed in EMG/NCS you need 200 during your residency. And IMO it is not enough.