bulgethetwine

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This is mostly (slight edit) a cross post from the emergency medicine thread. I'l like to hear any comments on it, even from tradiational non-EM streams who might or might not be in favor of EM trained docs taking positions in critical care (i.e. attending in a unit).

Is the EDIC (European diplomat intensive care) really an end-around as regards EM-trained, fellowship-completed doctors getting certified in critical care? What value does the EDIC really have (and no, this isn't rhetorical -- I am also trying to tease this question out for my own career).

We need to define what opportunities would exist with and without EDIC certification for those who have completed fellowship, and, for that matter, we need to define what opportunities might exist if we COULD get U.S. board certified. Think of it as three groups of people:

1 - EM trained, fellowship completed, non-boarded
2 - EM trained, fellowship completed, EDIC certified
3 - EM trained, fellowship completed, U.S. board certified intensivist (which, obviously, doesn't exist yet).

I have heard, anecdotally, that it is currently possible (usually in community hospitals as opposed to big, academic institutions) for an EM-trained, CC fellowship completed doc to work in both the ED and the ICU. But what I haven't heard is whether or not the people filling these jobs got the job, at least in part, because they were "EDIC certified".

If you have completed a fellowship AND you are EDIC certified, does this mean that the number of jobs that you might be eligible for increases? Has anyone actually seen an employment ad that states "EDIC certification necessary if you are coming from an EM residency/CC fellowship background"?

For that matter, what if tomorrow, thanks to the EM lobby and the IOM report etc., EM-trained, CC-fellowship completed docs could now get board certification in critical care? Would still more jobs open up? Even in academic centers?

The whole notion of board certified really needs to be considered in a critical light (no pun intended).

In my ED, you can't work as an attending unless you are "board certified" in EM. But in the units, not only is this not true in some places (fortunate for us in EM) but even if we WERE certified tomorrow, I don't know that it would result in immediate job options for some time.
 

KGUNNER1

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You raise some good points. But unfortunately you (we) will just have to live with the fact that we don't have a uniformed answer.

I can say this, each hospital/department is different for EVERY specialty. Of course you won't have a general internist getting cardiac cath privileges, but they could easily get ICU privileges, WITHOUT any training or certificate.

A piece of paper can't change anybody's attitude or entrenched biases. I don't care how many boards or special certifications one has, if that dept. chair doesn't like EM, you're not getting a job there.

The University of Pittsburgh mandates that ALL intensivists have to be board certified. They don't say ABMS board certified, because they understand the political climate of EM/CCM grads. They value this training and want to make positions available for these grads. But, you will have to sit for the EDIC boards.

Also, in my group, we have 3 EM/CCM (1 EM/IM/CCM) and all have either taken EDIC or are planning on taking the EDIC. (except the EM/IM/CCM)

My take on this is that you can approach this two ways. You can complete your CCM training, hold your ground and tell every department chair you are NOT going to take the EDIC because it hasn't been US approved and we don't know what the future holds etc... If they don't mind, then great, you have a job. If they do mind, then you don’t have a job and it may be only because of your reluctance to sit for some type of boards (billing, hospital credentials etc…) They may or may not tell you this.

Or you can just plan on taking the boards, showing the Dept. Chair that you are a very dedicated intensivist and nothing can hold you back, not even the fact that your own country won't let you sit for a board exam that you are more than capable of taking. You'll do everything possible, including going all the way to Europe to take their exam.

This extra effort may pay off. It may not. You have to decide if it is worth it. I know some EM/CCM docs practicing critical care medicine that haven't taken the EDIC. Those of us who are practicing can only give you some advice, but not hard answers.

Needless to say, there is a strong, more politically correct push for recognized ABMS certification in EM/CCM. Hopefully we'll have some positive answers in the near future.

Hope this helps.
kg
 

DocChez

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Bulgethetwine, this was a question I had to pursue myself this year as I hope to ultimately practice EM/CCM (though with any luck the match will lead me the EM/IM/CCM route). As for the anectodal stories about EM/CCM practicioners I can tell you a little about one particular attending whom I met at University of Pennsylvania. He completed an EM residency and then the 1 year Trauma/Critical Care fellowship at Shock Trauma at University of Maryland. He then went and obtained his EDIC certification and was offered a position at HUP (Hospital of the University of Pennsylvania). I'm not sure what his agreement was with the Department of Surgery, but he chose to spend a year acting solely as an ED attending and then once he was well established at the institution he would readdress the question of attending in the ICU. Supposedly about 1 year and 1 month after he started the Department of Surgery came to him to ask him if he would attend in the SICU. He now works 75% of the time in the ED and 25% of the time in the SICU (he was attending in the ICU while I was interviewing at Penn). I believe he commented that the EDIC certification was a helpful factor in obtaining the position he did at what is obviously a large academic hospital. So it seems at least somewhat that the EDIC end-around may help open the doors until we finally manage to loosen the vice grip that the stodgy folks on ABSM have on the board certification process and finally allow EM trained, CCM fellowship trained docs to sit for the boards.
 
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MS05'

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Can you sit for the European boards after a one year CC fellowship, or do you need to complete 2 years?
 

bulgethetwine

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Can you sit for the European boards after a one year CC fellowship, or do you need to complete 2 years?

I believe you can do it after one. But it might depend on what rotations, etc. you did during the year and/or residency.
 

bulgethetwine

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See the "guidelines" pdf about half way down on this page for everything you ever wanted to know about the EDIC.

http://esicm.org/PAGE_europeandiploma?mpas#EPARA_edicobjectives

kg

KG,

Well, I read it and I'm still uncertain about how the criteria might be applied. Criteria for EDIC Part 2 state "Satisfactory completion of national intensive care medicine training programme or 24 months of training/experience in ICM**

So am I correct in assuming that satisfactory completion of a national intensive care medicine training program, even if it is only one year, is adequate? Or, should I be banking on being able to say that between my emergency medicine residency AND a one year fellowship, I am able to claim a total of 24 months in good faith?

I guess the bottom line, KG, is this:

For your colleagues who have completed a one year fellowship, did they sit for the EDIC immediately?
 

KGUNNER1

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KG,

Well, I read it and I'm still uncertain about how the criteria might be applied. Criteria for EDIC Part 2 state "Satisfactory completion of national intensive care medicine training programme or 24 months of training/experience in ICM**

So am I correct in assuming that satisfactory completion of a national intensive care medicine training program, even if it is only one year, is adequate? Or, should I be banking on being able to say that between my emergency medicine residency AND a one year fellowship, I am able to claim a total of 24 months in good faith?

I guess the bottom line, KG, is this:

For your colleagues who have completed a one year fellowship, did they sit for the EDIC immediately?

Yes. Here's the deal. EDIC is two parts - first one written, second oral (just like ED). In order to take the oral, you have to pass the written.

After 1 year of fellowship, you are qualified to take the written part.
After 2 years of fellowship OR 1 yr fellowship + 1 yr of practicing critical care, you are now able to take the oral part. This is a modified practice track.

So lets say you grad from a 3 yr ED program, then go to Shock Trauma for a 1yr CC fellowship. After your fellowship, you get a job working in an ED and Trauma ICU somewhere. As soon as you graduate from CC fellowship, you can take the written EDIC part. After you practice CC for a year, and pass the written, you can take the oral part.

Make sense?

kg
 
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