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nvshelat

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Hi,

I'm trying to get a consensus on if/how long people think it will be before EP can become certified in CCM? As I understand it, there are emergency physicians who have gone on to do a fellowship in CCM and work in that arena (either SICU or MICU), though they aren't CC certified. Any insights appreciated,

NV
 
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AmoryBlaine

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A non-scientific reply (without having read the EMResident article):

The shortage of intensivists is going to be bad in the future. I think there is every reason to expect that you will be able to board in CCM.
 

Hawkeye Kid

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You can now. In Europe, which reciprocates.

there is a grad of my program in a CC fellowship and one of our R3s is going to do it next year. they will take the euro cc boards, which as the EMRes article states, is an end-around the cert issues.
 

bulgethetwine

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there is a grad of my program in a CC fellowship and one of our R3s is going to do it next year. they will take the euro cc boards, which as the EMRes article states, is an end-around the cert issues.

This is an intresting topic -- is the EDIC cert really an end-around? 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.



Oh, and I've cross posted this to the critical care forum, so maybe we'll get some pointers or guidance from that direction, too.
 

KGUNNER1

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Quite a bit has already been posted on this very good question. All the previous posts in this thread were accurate.

The bottom line, any physician can bill critical care hours. If I remember correctly from the Medicare database (2001), the top 6 CC billers were Internal Medicine, Pulmonary, Cardiology, Emergency Medicine, Family Practice, and Intensivists (non-pulm).

All you need is a hospital to grant you privileges to round in an ICU. In a lot of hospitals you don't even need formal critical care training or certification.

Add this to the fact that while total hospital beds are shrinking, total ICU beds are growing and thus the ratio of ICU beds to total hospital beds is increasing. The number of surgical CC fellows each year is about 70 and stagnant, same for Anesth/CC. IM/Pulm trains the most, but the vast majority of these grads are looking for a diversified practice, not full time critical care.

This leaves the door open for 1) open units...anybody can "play intensivist" - majority of hospitals currently 2) creative options for specialty training (neuro-intensivists...also no ABMS recognized board, or EM-CCM)

We (ACEP/SCCM) are trying to follow all the EM/CCM grads and see where they are getting jobs. I won't lie and say it is very easy to get a CC job, but it isn't that hard either. The more difficult jobs to find are at very traditional CC programs in big academic centers. Old habits just die hard. But, just about everyone I know that is EM/CCM trained has a job in the ICU.

I'll post a link to a paper we wrote a couple of years ago addressing this. Also check out the FAQ section at U.Pitt website (below).

We are SLOWLY trying to move the political machine. Until then, we recommend taking the EDIC just so you can show your administrators/dept heads that you have made an effort to become certified in this specialty.


http://www.ncbi.nlm.nih.gov/entrez/..._uids=16148486&query_hl=1&itool=pubmed_docsum
http://www.ccm.upmc.edu/education/adult/fellowship_emc.html

Hope this helps a little.

kg
 

KGUNNER1

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Basically you bill for the services you rendered. For the most part that is tied to the patient encounter and the complexity of the problem, which is ultimately linked to the amount of documentation you provide, ie your detailed note.

For procedures, you just perform the same procedures you were taught how to perform while in training AND that the hospital has granted you privileges to perform.

In most ED settings, the EM doc has privileges for a very wide variety of procedures. You may never perform many of these, but you can do them AND bill for them if you need to as long as you have hospital privileges.


kg
 
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