Cardiac Board Certification

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Hork Bajir

Hork Bajir

Compost mentis
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ABA just announced that they’re creating an adult cardiac subspecialty board certification (and exam). They say they’ll start offering the exam as early as 2023.

Is this really necessary? Just another money grab? How have other subspecialties handled whether to grandfather people in? I’d be really annoyed if I needed to study for and take yet another exam, just when I thought I was at the end of that process with echo boards…
 
I just saw this. I do hope they do some sort of grandfathering otherwise I’ll just take the career L. I’m not studying for another exam especially if I stay in private practice. Unless Beth Israel Deaconess or some other nice academic programs want to give me a job and require I’ll just pass or move on to a different anesthesia career

I know some people in Peds got certified but again I feel like they were mostly newer grads who stayed on academics. I don’t think even PP Peds required certification
 
Hopefully it’ll replace the NBE exam so people won’t have to take 2 tests but I doubt that will be the case. I bet most people will end up taking both tests.
 
Agree. One test is reasonable- if they wanted to change the PTE exam to include more clinical content unrelated to imaging, I would think that makes sense… But having two separate tests seems excessive to me.
 
It’ll make cardiac anesthesia an unattractive specialty given all of the exams and the associated costs. Does Peds and ICU have recertification exams? I understand why the PTE has a recertification but I can make an argument against it.
 
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I bet many of us old heads could probably fumble our way through a cardiac test and probably pass it but the problem is that when you're this deep in your career is a board certificate worth it/necessary unless hospitals start changing policies. That's what remains to be seen.
 
Twiggidy said:
It’ll make cardiac anesthesia an unattractive specialty given all of the exams and the associated costs. Does Peds and ICU have recertification exams? I understand why the PTE has a recertification but I can make an argument against it.
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ICU recert is done through MOCA. I get ccm questions in addition to anesthesia questions.
 
vector2 said:
ICU recert is done through MOCA. I get ccm questions in addition to anesthesia questions.
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i honestly think that's how the NBE should do it. I like the model the ABA is doing for board recertification. I know there are people who hate spending that $250? for MOCA but I would much rather spend the year every year answering questions and keeping up to date than waiting ten years to cram for a test.

Should you cram? Probably not, because it's stuff we should just know, but honestly if I mention Vp or e' to my CV surgeon he may throw the aortic cannula at me after we come off pump 🤣

Anyway, there's just a better way than sitting for a test, even if you just want to grab some money. The claim it's to "show you're an expert in the field." Sure.
 
Twiggidy said:
i honestly think that's how the NBE should do it. I like the model the ABA is doing for board recertification. I know there are people who hate spending that $250? for MOCA but I would much rather spend the year every year answering questions and keeping up to date than waiting ten years to cram for a test.

Should you cram? Probably not, because it's stuff we should just know, but honestly if I mention Vp or e' to my CV surgeon he may throw the aortic cannula at me after we come off pump 🤣

Anyway, there's just a better way than sitting for a test, even if you just want to grab some money. The claim it's to "show you're an expert in the field." Sure.
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You forgot axial and lateral resolution and a few non clinical equations out of edelman. 🤷🏽‍♂️

NBE is a PITA. I much prefer the content we do here.
 
The thing that really grinds my gears is how hospitals then make these certs requirements to be credentialed to do these cases yet the board alone isn’t even enough. “Can you send us your last 2 years of TEE logs?” Why? I’m boarded, doesn’t that mean something? Nope.
Same thing will happen with the cardiac board. It’ll quickly be made a hospital requirement yet not enough to prove you can do the cases. Completely pointless.
 
Robotic Wis-Hipple said:
The thing that really grinds my gears is how hospitals then make these certs requirements to be credentialed to do these cases yet the board alone isn’t even enough. “Can you send us your last 2 years of TEE logs?” Why? I’m boarded, doesn’t that mean something? Nope.
Same thing will happen with the cardiac board. It’ll quickly be made a hospital requirement yet not enough to prove you can do the cases. Completely pointless.
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I sort of agree. I don't mind a hospital wanting to know if you've been doing cardiac or peds for the past couple of years for credentialing purposes. I'm not saying after 2 or 3 years you shouldn't be credentialed but you certainly may need some proctoring. But I do see your side in that if someone hasn't done OB for 5 years no one isn't going to prevent them from covering L&D.
 
Twiggidy said:
But I do see your side in that if someone hasn't done OB for 5 years no one isn't going to prevent them from covering L&D.
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Some peds folks havent done adults in 10 years get back into the swing of things. Same with OB.
On a related note, this cardiac test is complete idiocy. It will further fractionate the specialty.. And at some point in the future it will be 2 diff speciaties..
 
Robotic Wis-Hipple said:
The thing that really grinds my gears is how hospitals then make these certs requirements to be credentialed to do these cases yet the board alone isn’t even enough. “Can you send us your last 2 years of TEE logs?” Why? I’m boarded, doesn’t that mean something? Nope.
Same thing will happen with the cardiac board. It’ll quickly be made a hospital requirement yet not enough to prove you can do the cases. Completely pointless.
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Is it really the hospital though? At my place the medical staff (i.e. the anesthesia department in our case) dictates the credentialing requirements. The hospital administration is clueless about our boards and is not involved.
 
Twiggidy said:
I sort of agree. I don't mind a hospital wanting to know if you've been doing cardiac or peds for the past couple of years for credentialing purposes. I'm not saying after 2 or 3 years you shouldn't be credentialed but you certainly may need some proctoring. But I do see your side in that if someone hasn't done OB for 5 years no one isn't going to prevent them from covering L&D.
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If the ABA’s certificate saying I’m “board certified” in ACTA is good for 10 years but doesn’t mean I am qualified for all of those 10 years then what’s the point? If hospitals or groups etc expect that you’ve done x amount of hearts/TEEs in the last x months then an experience based credentialing should suffice.

If the argument is; “we need to show that you are an expert as a minimal level of entry”, well, then guess what, the fellowship does that. Here’s my diploma from an ACTA fellowship.

It’s lunacy. Let’s keep creating additional roadblocks that double as fundraising or professional taxes instead of putting the time/effort into fighting CRNAs etc from arguing they have some entitled scope of practice they can do without proof.

- edited for a spelling error
 
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Robotic Wis-Hipple said:
If the ABA’s certificate saying I’m “board certified” in ACTA is good for 10 years but doesn’t mean I am qualified for all of those 10 years then what’s the point? If hospitals or groups etc expect that you’ve done x amount of hearts/TEEs in the last x months then an experience based credentialing should suffice.

If the argument is; “we need to a how that you are an expert as a minimal level of entry”, well, then guess what, the fellowship does that. Here’s my diploma from an ACTA fellowship.
It’s lunacy. Let’s keep creating additional roadblocks that double as fundraising or professional taxes instead of putting the time/effort into fighting CRNAs etc from arguing they have some entitled scope of practice they can do without proof.
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No I personally don't think it means you're qualified if you haven't been doing hearts during a significant portion of that time. Same as if your ABA certified but haven't done anesthesia for a significant amount of time. You're certified, yes, but you'll likely need some proctoring if you've been out of the game for a while.

Maybe we're talking about two different things

Likewise, yes, I agree with you. It is a money grab but I do think it's beneficially to legitimize the subspecialty (of course I'm biased).
 
For me it's not so much the money in as much as it is the time to study and sit for another test. I hate spending the money but Im glad the ABA changed the recertification process and I hope the NBE and this "cardiac certification" does the same.
 
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so upsetting. I will be one of the first to be taking this ...


Guinea Pig Reaction GIF by MOODMAN
 
My beef with all the new exams is that we add more and more **** to the list of what we have to take, and continue to cede ground to those not trained as we are.

I’m cool paying for all this if hospital admin and lawmakers say “OMFG! Anesthesiologists have all those certificates! This must remain a physician-led specialty”. But that’s not the news I read.
 
Does anybody know how things were handled with respect to grandfathering when peds first developed their certification? I assume the OGs at CHOP didn’t have to take a test 25 years into their careers to prove to hospital admin that they knew how to do peds… My assumption would be that this decision came from the board, and not from the hospital themselves. Something like a “practice pathway” to certification only available for ppl who completed residency or fellowship before XXX year.

On the whole I would agree with everyone’s sentiments, though, this feels like another unnecessary and expensive roadblock. It is a solution looking for a problem
 
Hork Bajir said:
Does anybody know how things were handled with respect to grandfathering when peds first developed their certification? I assume the OGs at CHOP didn’t have to take a test 25 years into their careers to prove to hospital admin that they knew how to do peds… My assumption would be that this decision came from the board, and not from the hospital themselves. Something like a “practice pathway” to certification only available for ppl who completed residency or fellowship before XXX year.

On the whole I would agree with everyone’s sentiments, though, this feels like another unnecessary and expensive roadblock. It is a solution looking for a problem
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At places like CHOP, etc I bet most bit the bullet and just took the test just to protect their careers. More and more many of these hospitals are hanging the "center of excellence" banner outside the building and proclaiming that all their physicians are board certified. This will be much of the same. If people work somewhere that claims it's a "cardiac center of excellence and all our physicians are 'board certified'' then it will likely need to take the test. I think this really holds true as heart volume/structural heart volume is becoming more competitive.
 
I love the ABA email as if this is something any practicing anesthesiologist is looking forward to or thinks is useful.
 
It's a bunch of crap. We already have a board certification of our own on the cardiac side - except it's the NBE collecting those dollars and measuring a specific and unique skill set relevant to the subspecialty, not the ABA. And the ABA has repeatedly proved itself to be a greedy hungry desperate machine. Just look at all the useless crap they've already foisted off on us under the transparent guise of measuring us better
- splitting the written exam into basic and advanced
- adding OSCEs to the oral boards :barf:
- replacing a q10year recert exam (at a 3rd party test center that takes a share of profits) with an annual fee to use their web site

Screw 'em.

I am far more likely to turn my back on the ABA entirely, quit MOCA, and go sign up for NBPAS than I am to take this test. It seems unlikely that any place I'll ever want to work will demand more than I've already got. Will they pay me more if I get yet another certificate suitable for framing? Fire me if I don't? Right.

Looks like the ABA is hell bent on joining the AMA and ASA as another organization which desperately pretends I need it, while actively working to harm me.
 
So are we arguing there shouldn’t be a cardiac anesthesia board certification, there should be two certifications associated with cardiac, or there should be no board certifications period? I’m just curious

I feel like much of the outrage is just because it’s a shock to the system. I think there should be a certification but it should combine the specialty certification with TEE certification so there’s only one test and do MOCA like the ABA. I’d be totally fine with that.
 
Hork Bajir said:
Does anybody know how things were handled with respect to grandfathering when peds first developed their certification? I assume the OGs at CHOP didn’t have to take a test 25 years into their careers to prove to hospital admin that they knew how to do peds… My assumption would be that this decision came from the board, and not from the hospital themselves. Something like a “practice pathway” to certification only available for ppl who completed residency or fellowship before XXX year.

On the whole I would agree with everyone’s sentiments, though, this feels like another unnecessary and expensive roadblock. It is a solution looking for a problem
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going from memory, I believe the first few years of the exam had a VERY high pass rate. A gift to the existing peds anesthesiologists. Since then the pass rate dropped quite a bit. The old eat the young. Of course the young try to do the same to the old. They are just less good at it.😏
 
pgg said:
It's a bunch of crap. We already have a board certification of our own on the cardiac side - except it's the NBE collecting those dollars and measuring a specific and unique skill set relevant to the subspecialty, not the ABA. And the ABA has repeatedly proved itself to be a greedy hungry desperate machine. Just look at all the useless crap they've already foisted off on us under the transparent guise of measuring us better
- splitting the written exam into basic and advanced
- adding OSCEs to the oral boards :barf:
- replacing a q10year recert exam (at a 3rd party test center that takes a share of profits) with an annual fee to use their web site

Screw 'em.

I am far more likely to turn my back on the ABA entirely, quit MOCA, and go sign up for NBPAS than I am to take this test. It seems unlikely that any place I'll ever want to work will demand more than I've already got. Will they pay me more if I get yet another certificate suitable for framing? Fire me if I don't? Right.

Looks like the ABA is hell bent on joining the AMA and ASA as another organization which desperately pretends I need it, while actively working to harm me.
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Probably true. Possible exception, If you change jobs late in your career they might require MOCA and cardiac certification. I never enrolled in MOCA. If I relocated some med staffs wouldn't consider credentialing me for that reason alone.
 
dr doze said:
Probably true. Possible exception, If you change jobs late in your career they might require MOCA and cardiac certification. I never enrolled in MOCA. If I relocated some med staffs wouldn't consider credentialing me for that reason alone.
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As long as the nitwits who come up with these redundant exams and certifications don't end up becoming the majority of clinical chiefs who make hiring decisions then I think we'll be OK. If we get to the point where a group can't hire someone with 5-10 yrs cardiac experience, proven cardiac case log, and PTE diplomate status because that applicant didn't take a stupid ABA cardiac test years after they finished training....then we will be truly lost at that point.
 
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Hork Bajir said:
Does anybody know how things were handled with respect to grandfathering when peds first developed their certification? I assume the OGs at CHOP didn’t have to take a test 25 years into their careers to prove to hospital admin that they knew how to do peds… My assumption would be that this decision came from the board, and not from the hospital themselves. Something like a “practice pathway” to certification only available for ppl who completed residency or fellowship before XXX year.

On the whole I would agree with everyone’s sentiments, though, this feels like another unnecessary and expensive roadblock. It is a solution looking for a problem
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I don’t work in one of the Ivory Towers but at the Children’s Hospital I work at no one was above being required to take the peds board exam. Attendings who had trained me and had been practicing when I was still in diapers had 5 years to pass the exam.
 
Hork Bajir said:
Well, I just took the aPTE exam and I’ve gotta say…

Woooof. Tough test. Much of the material not covered well, if at all, by PTE masters.
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Mostly agree. I think he covered stuff but the test writers wanted an extra level of detail. I will say there wasn’t anything that I had never come across but some nit picky wording

Some of the images had me saying WTF
 
Twiggidy said:
Mostly agree. I think he covered stuff but the test writers wanted an extra level of detail. I will say there wasn’t anything that I had never come across but some nit picky wording

Some of the images had me saying WTF
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I would have to say that all of the written examinations that I had to take in medical school, residency and in practice that it was the most difficult one of all.
 
Hork Bajir said:
Well, I just took the aPTE exam and I’ve gotta say…

Woooof. Tough test. Much of the material not covered well, if at all, by PTE masters.
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A lot of hard questions and suboptimal clips but the pass threshold is not very high. When I took it you only needed 62% correct to pass.
 
Reading this editorial in JCVA about echocardiography and TAVR and ran across this bit

"
Competencies in echocardiography for SHD interventions

To date, formal post-graduate training in interventional echocardiography, including training program guidelines, standards, credentialing, and board examination have not been officially developed or adapted by any professional society. However, a 2019 multi-society expert consensus document discussed the need for a specialized training and proposed a framework for interventional echocardiography training pathways for both cardiology and adult cardiothoracic anesthesiology (ACTA) fellows.3 Core competencies that help define this subspecialty include medical knowledge, patient care and procedural skills, advanced imaging, and communication. Medical knowledge competency reaches beyond simple familiarity with devices, imaging acquisition and analysis. Interventional echocardiographers need to be familiar with MDCT and other imaging modalities typically used. They must understand intraprocedural complications, their hemodynamic manifestations and echocardiographic appearance, and the most efficient ways to demonstrate these findings. The importance of imager integration into the heart team cannot be underestimated."



I guess the next thing after a separate ACTA exam is go ahead and make ACTA fellowships 18 months for the added interventional part and then maybe throw in another exam solely on SHD just for kicks.
 
vector2 said:
Reading this editorial in JCVA about echocardiography and TAVR and ran across this bit

"
Competencies in echocardiography for SHD interventions

To date, formal post-graduate training in interventional echocardiography, including training program guidelines, standards, credentialing, and board examination have not been officially developed or adapted by any professional society. However, a 2019 multi-society expert consensus document discussed the need for a specialized training and proposed a framework for interventional echocardiography training pathways for both cardiology and adult cardiothoracic anesthesiology (ACTA) fellows.3 Core competencies that help define this subspecialty include medical knowledge, patient care and procedural skills, advanced imaging, and communication. Medical knowledge competency reaches beyond simple familiarity with devices, imaging acquisition and analysis. Interventional echocardiographers need to be familiar with MDCT and other imaging modalities typically used. They must understand intraprocedural complications, their hemodynamic manifestations and echocardiographic appearance, and the most efficient ways to demonstrate these findings. The importance of imager integration into the heart team cannot be underestimated."



I guess the next thing after a separate ACTA exam is go ahead and make ACTA fellowships 18 months for the added interventional part and then maybe throw in another exam solely on SHD just for kicks.
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Well, I was yesterday year old when I realized the new procedures for Anesthesiology board certification and now specialty certification is going to be another 2 or more tests. One the one hand "I get it" but on the other it certainly seems like people are reaching into our pockets.
 
I read that 2019 multi-society “expert consensus” position paper, and my official opinion is that it’s a load of horse s?!&. Just a bunch of academic wanks sitting around a room, describing their own accomplishments and saying “if this is how great I am, this is how good anyone must be to do this stuff”.

I get the need for CT anesthesia to become a valued part of the “structural heart team” or whatever. I really do. But at some point, we need to stop throwing up more barriers in the way of our grads- it’s hard enough as is. We don’t need neurosurgery-length training to do echo for an ASD closure or whatever.
 
Hork Bajir said:
I read that 2019 multi-society “expert consensus” position paper, and my official opinion is that it’s a load of horse s?!&. Just a bunch of academic wanks sitting around a room, describing their own accomplishments and saying “if this is how great I am, this is how good anyone must be to do this stuff”.

I get the need for CT anesthesia to become a valued part of the “structural heart team” or whatever. I really do. But at some point, we need to stop throwing up more barriers in the way of our grads- it’s hard enough as is. We don’t need neurosurgery-length training to do echo for an ASD closure or whatever.
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Especially when there are already places where the CRNA will run the probe to find the right amalgam of fuzzy white stuff to make the surgeon happy.
 
OB1🤙 said:
I don’t care if the exit test from fellowship is this or the NBE’s test. But it can’t be both.

And once you pass it, that should be it. No further “recertification.”

So says this NBPAS-certified guy who does not pay the MOCA extortion fee/practice tax.
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One of the few upsides of being really old is a permanent ABA certificate. What’s MOCA? 😉
 
vector2 said:
ABA updated the website with how cardiac board certification is going to work. They also posted a content outline (the exam sounds pretty brutal)

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theaba.org

Subspecialty Exams Archive - The American Board of Anesthesiology

theaba.org theaba.org
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I was just looking at it the other day. Looks like I'll have a LOT of reading to do this next year.

Anyone have any idea on if they will grandfather people in who have been doing cardiac for a long time? Or expect everyone to take the test if they want the designation?
 
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