Crit Care and EM: The joke continues

[bulgethetwine]

This from the Spring 2007 ABEM Memo for those of you who didn't see it:

CRITICAL CARE MEDICINE

ABEM has a long-standing interest in obtaining a route to certification in critical care medicine (CCM) for its diplomates who complete Accreditation Council for Graduate Medical Education-(ACGME) accredited Critical Care training. ABEM has recently been in contact with three ABMS member boards that offer certification in Critical Care: American Board of Anesthesioogy (ABA), American Board of Internal Medicine (ABIM), and American Board of Surgery (ABS).

All conversations have been friendly, but no progress to date has been made in the conversations with the ABA. The conversations between ABEM and ABS recently led to a draft proposal to certify EM graduates who complete accredited Surgical Critical Care (SCC) training. ABS, upon further consideratoin, however, declined to support the proposal, explaining that ABS was developing a different approach to Surgical and SCC training. ABS has submitted a new proposal on Surgical and SCC training for consideration by the ABMS. This proposal excluses involvement for EM.

ABEM is continuing its discussions with ABIM representatives, with the goal of exploring the Emergency Medicine and Critical Care competencies needed for ABEM diplomates' certification in CCM

(END OF ARTICLE)


I, personally, have resisted being cynical about this issue for several years. I have always maintained that a bombastic approach to criticizing the lack of progress was counterproductive. Clearly, I have been suckered along with the rest of our specialty members.

When will the endless series of articles, updates, and pathetically limp statements about how we are "progressing" towards the ultimate goal stop? When we will we see RESULTS?

Three things are clear:

1) Achieving this goal has precedents elsewhere -- namely Europe and Canada. So it's not like "exploring the Emergency Medicine and Critical Care competencies needed for ABEM diplomates' certification in CCM" should remain so elusive.

2) Why do we CONTINUE to seek certification in conjunction with other specialty boards? How many times can they "jerk our chain"? The ABS failed to support their own proposal?!?. It is time for ABEM to consider stepping up and offering their OWN certification. Yes, we risk an environment where an ABEM CC-certified grad may be discriminated against by some hospitals that may choose to only hire certain flavors of "certified" grads (i.e. not ABEM's certification). But I believe that with the pending shortage of intensivists this will not be the case, particularly given some time. And I bet this "time" will be less than the current strategy will take.

3) It may be time for a more aggressive leadership to take over from the EM perspective to steward these worthy aspirations to the next level. I understand that we should, whenever possible, strive to strengthen ties with other member boards including the ABA, ABIM and ABS.

But I for one am tired of being viewed as the one from the "weak sister" specialty when we're all sitting at the critical care table.

Please! Someone talk me down from the ledge! KGunner? BKN? Apolyon? MudPhud? EdinOH? Quinn? Any other of the established guard out there??!!??

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Members don't see this ad.

 

[Apollyon]

Take a deep breath...you're OK...

KGunner has said that things are going on behind the scenes, and I've heard the same from other sources.

The urologists will tell you that the colic gets worse the closer you are to passing the stone. The ABA and ABS jockeying for position is, I believe, part of the same.

There aren't enough bodies to go around. These little "window-dressing" efforts are stop-gap things that are bumps in the road.

One question, though - the typos in that article make it look suspicious. Are those typing goofs from you, or did you cut and paste that specifically?

 

[DeLaughterDO]

I've grown rather tired of the strange dance in which EM has become involved with the surgical, medicine, and anesthesia boards to come up with collaborative agreements to allow EM to become a CCM board-certifiable specialty.

From what I understand, and I may be WAAAAAY off base here, is that some of the resistance coming from the above-mentioned boards and ABMS is that way back in antiquity when EM was struggling to become recognized as an independent specialty, some under-the-table agreements were made that have hindered our progress. What exactly the issue is now, I don't know or understand.

Will it happen, probably. Will it happen soon? Anyone's guess. At least, for now, there still seems to be friction and balking on the part of the societies. Most of the individual physicians and intensivists I've spoken to have been more than supportive of my interest in CCM after EM residency. Take it for what it is worth...

jd

 

[bulgethetwine]

Take a deep breath...you're OK...

KGunner has said that things are going on behind the scenes, and I've heard the same from other sources.

The urologists will tell you that the colic gets worse the closer you are to passing the stone. The ABA and ABS jockeying for position is, I believe, part of the same.

There aren't enough bodies to go around. These little "window-dressing" efforts are stop-gap things that are bumps in the road.

One question, though - the typos in that article make it look suspicious. Are those typing goofs from you, or did you cut and paste that specifically?

No, they're typing gaffes from me. I got the ABEM memo in my mailbox this morning.

 

[KGUNNER1]

Take a deep breath...you're OK...

KGunner has said that things are going on behind the scenes, and I've heard the same from other sources.

The urologists will tell you that the colic gets worse the closer you are to passing the stone. The ABA and ABS jockeying for position is, I believe, part of the same.

There aren't enough bodies to go around. These little "window-dressing" efforts are stop-gap things that are bumps in the road.

One question, though - the typos in that article make it look suspicious. Are those typing goofs from you, or did you cut and paste that specifically?

Hey Bulge, don't jump just yet!!! We (4 or 5 of us who have been working on this latest movement for the last 6 or so years) went aggressively at ABEM asking the same thing. I have a couple off-the-record opinions about this, but a realistic HUGE hurdle is that ABMS has to "sign off" on any new subspecialty development (i.e. critical care in EM). There a few dinosaurs in ABMS that still don't like us EM folk.

Another "big picture item" is addressing how critical care is taught, tested, and certified in the US. The cc leaders from Anesth, IM, and Surg all have made changes in their curriculum lately. There is a lot of talk about drastically changing the way critical training will be done in the future.

Some of the ideas being thrown around are as radical as having critical care break off as its own, free standing, specialty. Other ideas are similar to the CoBaTrICE project in Europe where all eligible specialties (EM included) are trained with a similar curriculum and take the same certifying exam that is recognized by each specialty in each country.

I think we will see something similar to the CoBaTrICE project here in the states. So I think that we have a lot of new supporters in our camp, but rather than really push right now, they'll support including EM if we go to an all inclusive training/exam/certification process.

This is just my speculation, I could be wrong (these politics are maddening!).

Don't give up, tell all your EM/CCM buddies about our EM survey, (we have more than 40 responses already). http://survey.emccm.org

Keep the faith!

KG