Em/im/ccm

[waterski232002]

Do any of you guys know the status of the EM/IM/CCM residencies at Henry ford and Albert Einstein? Are these programs up and running yet? Are there any new programs in the works? Also... is it possible to transfer into the programs after completing a full EM residency so that you can finish up the IM/CCM portion in less time?

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[Dr.Evil1]

EM/IM/CCU med is up and running at Henry Ford, I know they have graduated at least 1 resident from this program

 

[waterski232002]

EM/IM/CCU med is up and running at Henry Ford, I know they have graduated at least 1 resident from this program

Is there anyone currently in the program right now???

 

[GeneralVeers]

EM/IM/CCU med is up and running at Henry Ford, I know they have graduated at least 1 resident from this program

How many years is that, 10? 20?

Seriously wayyyyy too long at any rate. Not sure if I could tolerate a whole year or two of internal medicine.

 

[waterski232002]

6 years.... only 2 more than a 4-year EM program!

 

[deleted87716]

Not sure if I could tolerate a whole year or two of internal medicine.

What about the joy of sitting for three different board exams, plus periodic recertification? Yowza.

 

[Halaljello]

how practical is this residency anyway?

 

[mward04]

Do any of you guys know the status of the EM/IM/CCM residencies at Henry ford and Albert Einstein? Are these programs up and running yet? Are there any new programs in the works? Also... is it possible to transfer into the programs after completing a full EM residency so that you can finish up the IM/CCM portion in less time?

How could they be on this forum, they're probably studying for their boards!

I heard it was either Maryland or Christiana that was thinking about doing EM/IM/CCM as well. Anyone know?

 

[MedDeac]

I suppose you can actually sit for the CC boards if you do the IM portion? Is that the trick...

 

[bartleby]

If you're IM boarded, yes, you can sit for the CC boards. A lack of boarding in CCM in respect to EM and CCM fellowship-trained physicians does not seem preclude employment given the increasing demand for CCM docs as the boomers start to age and look for their own crack at passing away on a vent at the tender age of 90.

I suppose you can actually sit for the CC boards if you do the IM portion? Is that the trick...

 

[southerndoc]

I have a feeling that EM-trained individuals will have CCM subspecialty certification soon enough.

For what it's worth, CCM is NOT a boarded specialty. It's a subspecialty added or qualified certification.

 

[waterski232002]

SouthernDoc...

Where do you hear this from... The last I've heard on the issue was last year when ABIM banned all non-IM applicants from being able to take positions in IM/CCM fellowships. I was told that the issue of EM/CCM was kind of indefinitely put on hold, and the issue would probably not rise again for at least 5-10 years. I think there's a couple old threads where this was discussed. Has there been some new changes recently???

 

[kbrown]

my understanding about this program at Ford is that you don't "match" into it right away. You basically go the EM/IM route then kind of slide into the CC position after 1, maybe 2 years. This is what I heard from a chic that I was interviewing with at Ford who was going the EM/IM route

 

[MedDeac]

pretty soon we'll be taking care of critical care patients for 2 or 3 days down in the ED waiting on a bed anyway.... that should take care of my CC jones. don't think i'll be wanting to tag a IM residency on after that.

 

[bartleby]

There are a lot of good EM people pushing for this, but there are a lot of shabby political reasons (i.e. a couple of people peed on this particular hydrant first) for us to not hold our collective breath. The bottom line for EM people interested in critical care is that if you're not going to be able to sleep at night if you don't know for sure that you're going to be able to sit for the CCM boards in the next four years, then find another niche.

I have a feeling that EM-trained individuals will have CCM subspecialty certification soon enough.

 

[waterski232002]

Who cares about certification/boards... that's just a peice of paper with your name on it. I care about being able to get a job--a good job!

 

[KGUNNER1]

If anyone is interested in this, now is the time to get involved. We are our numbers each year. The current IOM report dedicated to the state of emergency medicine will actually address this issue (small part of the total report). Please join one of the several groups that are helping move this alone.

ACEP - Critical Care Section
SCCM - EM section
EMRA - Critical care interest group

Several of us, who have done this from all angles (EM/CCM; EM/IM/CCM - 7yr; EM/IM/CCM - 6yr) are very active and are willing to help in any way. ACEP critical care section has a very nice FAQ section that we put together. University of Pitt CCM fellowship website also has this.

If anybody has any other questions, you can email me as well.

Good luck and congrats on the match.

kg

 

[waterski232002]

Kgunner...

I am in a 3 year EM residency program right now, and am interested in doing IM and CCM also. Would I have to do a full 3 year IM residency + 2 year CCM fellowship in order finish everything? (total of 8 years).

Or would it be possible to apply into a 6 year EM/IM/CCM program like henry ford or albert einstein after completing my 3 year EM residency in order to cut some time off?

 

[KGUNNER1]

Kgunner...

I am in a 3 year EM residency program right now, and am interested in doing IM and CCM also. Would I have to do a full 3 year IM residency + 2 year CCM fellowship in order finish everything? (total of 8 years).

Or would it be possible to apply into a 6 year EM/IM/CCM program like henry ford or albert einstein after completing my 3 year EM residency in order to cut some time off?

Your best bet would be to contact the PD at both places and ask them. They could help you out with all the requirements from the RRC. Usually you'll get anywhere from 6months credit to nothing when doing something like this, so it may be 7.5 or 8 years. I did 7 years, so it is doable, long but doable.

Have you considered just doing a 2 yr CCM program and finish in 5?

Good luck,
kg

 

[waterski232002]

I have considered that... but what programs would accept me? I thought that IM programs will no longer accept EM residents. I know UPitt will b/c they are their own department. And shock/trauma will also, but they basically do trauma work and I would like to be trained in all aspects of ICU care (MICU, SICU, TICU, CCU, CTICU, etc...)

There is the list that is on ACEP section of CCM which shows IM programs which are EM friendly, but I believe that was put together before ABIM decided to stop allowing outsiders to train in their fellowship programs.

Any other advice???

 

[KGUNNER1]

I have considered that... but what programs would accept me? I thought that IM programs will no longer accept EM residents. I know UPitt will b/c they are their own department. And shock/trauma will also, but they basically do trauma work and I would like to be trained in all aspects of ICU care (MICU, SICU, TICU, CCU, CTICU, etc...)

There is the list that is on ACEP section of CCM which shows IM programs which are EM friendly, but I believe that was put together before ABIM decided to stop allowing outsiders to train in their fellowship programs.

Any other advice???

Use the ACEP link to the programs and call each one you are interested in. Another source would be to email Dr. David Huang at Pittsburgh. He is the current ACEP Critical Care section chair. David and I put that list together in 2002, so it has changed, but he also could point you in the right direction about any other resources.

The critical care interest group of EMRA may also be a good try.

Good luck,
kg

 

[waterski232002]

Use the ACEP link to the programs and call each one you are interested in. Another source would be to email Dr. David Huang at Pittsburgh. He is the current ACEP Critical Care section chair. David and I put that list together in 2002, so it has changed, but he also could point you in the right direction about any other resources.

The critical care interest group of EMRA may also be a good try.

Good luck,
kg

I am a first year EM resident right now at a 3 year program. If I want to do my fellowship immediately after my residency, when do I need to apply?

 

[KGUNNER1]

I am a first year EM resident right now at a 3 year program. If I want to do my fellowship immediately after my residency, when do I need to apply?

You should apply as early in your second year as you can, especially for programs that fill rather quickly (Pitt). I think Shock Trauma is also filling up rather quickly, so get that on in early as well. I didn't get mine in until the early part of my last year and had plenty of time, but times are changing.

When in doubt, just ask the fellowship coordinators, they are FULL of GREAT information and usually take the time to answer a bunch of practical questions like this.

kg

 

[Gregg]

Ok, off-the-wall idea, but here goes:
Here in Vegas, there is a Sports Med fellowship. This coming year there will be 2 fellows instead of the funded 1. Why? The Air Force is paying his way. Which made me think (rare, but it happens ).
So, here's my idea: Fund your own way. Get a program you like to take you on the condition that you pay the salary for that position. Crazy, eh? Well, you'll at least get back the after-tax portion.
A better way would be to find a hospital in dire need of CCM docs, get them to cover the fellowship costs for you in exchange for a work-for-so-long stipulation. That may give you an end-run around the system.

 

[waterski232002]

You should apply as early in your second year as you can, especially for programs that fill rather quickly (Pitt). I think Shock Trauma is also filling up rather quickly, so get that on in early as well. I didn't get mine in until the early part of my last year and had plenty of time, but times are changing.

When in doubt, just ask the fellowship coordinators, they are FULL of GREAT information and usually take the time to answer a bunch of practical questions like this.

kg

Was it hard for you to get LOR? I assume you have to get at least 2 or 3 in order to apply for a CCM fellowship. I've done MICU, PICU and will be doing CCU later this year. Is it okay to have a PICU attending or fellow write me a letter of rec?

 

[BKN]

So, here's my idea: Fund your own way. Get a program you like to take you on the condition that you pay the salary for that position. Crazy, eh? Well, you'll at least get back the after-tax portion.

Not a new idea. Lots of folks offer to do it. ACGME forbids it for residencies. Not sure about fellowships, but probably the same.

 

[KGUNNER1]

Was it hard for you to get LOR? I assume you have to get at least 2 or 3 in order to apply for a CCM fellowship. I've done MICU, PICU and will be doing CCU later this year. Is it okay to have a PICU attending or fellow write me a letter of rec?

LOR shouldn't be hard if you were good and worked hard. ONE fellow letter is fine. PICU letter is fine, I used one.

kg

 

[KGUNNER1]

Not a new idea. Lots of folks offer to do it. ACGME forbids it for residencies. Not sure about fellowships, but probably the same.

ACGME has no say over ED physicians in critical care fellowships, because they DON'T RECOGNIZE THEM! So even though this is bad, the upside is that you can get very creative in funding and working hours.

A friend of mine (EM/CCM) funded his own fellowship by working part time in the ED as faculty. He is now the medical director of 2 critical care units down in Florida.

kg

 

[jbuckle1]

I just stumbled on to this forum and am happy to offer some information. As the program director for Critical Care Medicine and Pulmonary Medicine at Henry Ford Hospital, I helped create the EM/IM/CCM track here. The Boards of EM and IM have very explicit rules regarding the integrated program. It is six years and candidates must be enrolled in the program by the end of PGY-II. We have been able to make exceptions for some of our EM/IM residents in years 3 and 4, but this is getting harder (the Boards prefer that you enter early) However, the program directors for EM, IM and I all believe that the decision to enter a 6-year integrated program is probably not appropriate for most medical students. Internship and residencies have a way of changing initial career goals, and we have seen terrific residents opt into and out of this planned training. This is normal and to be expected. At Henry Ford, we won't match people directly into the program. Instead, we look at our EM/IM residents as they go through their first two years. If they are interested in the integrated EM/IM/CCM program, our CCM group "interviews" them (Our CCM group is not part of the initial EM/IM interview process for medical students). To date, we have seen excellent applicants and turned down no one. Our CCM faculty are extremely pleased with the quality of trainees coming through the program and a fully supportive. It has been a tremendous success and we hope to see it grow.

 

[Complications]

So I'm a 4th year ... I'm just wondering what do you do? Is that much training excessive? I'm just trying to get a fill of what folks with EM/IM/CCM do day in and day out. I've seen a few posts to this put I'm not clear. For that matter if you want to do CCM ... why do EM first instead of IM?

I'm just not clear on the whole thing.

Thanks.

 

[deuist]

Ok, off-the-wall idea, but here goes:
Here in Vegas, there is a Sports Med fellowship. This coming year there will be 2 fellows instead of the funded 1. Why? The Air Force is paying his way. Which made me think (rare, but it happens ).
So, here's my idea: Fund your own way. Get a program you like to take you on the condition that you pay the salary for that position. Crazy, eh? Well, you'll at least get back the after-tax portion.
A better way would be to find a hospital in dire need of CCM docs, get them to cover the fellowship costs for you in exchange for a work-for-so-long stipulation. That may give you an end-run around the system.

ACGME forbids residents from paying their own way. The reason this person got to be the extra fellow is because a government agency is funding him.