EMS Board Certification

[Plectron]

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Long time lurker, first time poster here. I wanted to say thanks for all of the laughs and interesting discussions.

What are people's thought on the new subspecialty certification in EMS? What do you think of the requirements?

 

[FDNewbie]

I think it's a great idea to formalize the field of EMS/Prehospital medicine, and focus more on clinical aspects rather than (traditionally) administrative duties. If you go straight to the horse's mouth here: http://www.saem.org/SAEMDNN/Portals/0/AM2010/didactics/handouts/EMS_Fellowships.pdf, it discusses the NEED for making this a formalized subspeciality.

"Substantial variation exists nationwide in how medical oversight and review are conducted; in many localities, physicians with little or no training and experience in out-of hospital medical care provide this service. The committee believes that physicians who provide medical direction for EMS systems should meet standardized minimum requirements for training and certification that are reflective of their responsibilities...”

That presentation also notes that the major delay in this standardization through a formally recognized & boarded fellowship/subspeciality was the feeling that EMS was too much administrative work, and not enough clinical, leading to ABEM's decision on July 31, 1997 electing not to pursue formalizing this subspecialty.

Re: the requirements, I think they know in general WHAT they want, but not necessarily HOW to achieve it. That bit is going to take some time. So for example, when it comes to TEMS, what are the requirements? Training only? Actual field experience? If so, how many hours? Or is it sustained? If a program does not have sufficient/adequate TEMS experience locally, do they not qualify for certification?

Being someone who's intent on pursuing an EMS Fellowship, my sense from my conversations with various fellowship directors is that most programs are keeping a close eye on this, but also realize that it will more than likely be a year or so until the curriculum & board exam are finalized, and then another year or two until progams are actually certified. So it's gonna be a while.

So my take is, it's great, but doesn't affect me @ present, and more than likely by the time it is all said & done, those of us who have completed the fellowship already will get grandfathered in.

That's my $0.02.

 

[IntheDraft6]

Sorry to bring up an old thread but does anyone know if this will include HEMS? I know there are a limited number of helicopters around that staff with physicians, so would that count as your field experience?

 

[FDNewbie]

Sorry to bring up an old thread but does anyone know if this will include HEMS? I know there are a limited number of helicopters around that staff with physicians, so would that count as your field experience?

Your mileage may vary. Some programs want to give you the entire well-rounded experience, which is - IMO - what you want to look for. Because I'm pretty sure the trend now is going to move toward Board Certified Medical Directors. And if you don't have enough experience to sit for and/or pass the boards, or you simply just don't have the experience in it of itself to manage the entire EMS system where you're at, that's a scary thought.

Having said that, I don't know of an EMS Fellowship that WON'T let you participate in flight activities. But some places actually overemphasize flight experience over anything else. Here's an example: http://www.umassemfellowships.com/ems.php. My concern about such situations is, you NEED ground experience. That's the bread & butter of EMS. So a place that doesn't offer extensive opportunities for BOTH (ie flight experience AND a Physician Response Vehicle for ground stuff) isn't well balanced, and thus won't offer you the full breadth of experiences. Again, IMO.

 

[EM_Rebuilder]

Question about the EMS Practice Pathway for Board Certification...

The article from ABEM states: "The EMS practice pathway and practice-plus-training pathway will be available for the first five years after the Accreditation Council on Graduate Medical Education (ACGME) begins accrediting EMS fellowships."

We looked at the ACGME website and if you go to EMS Fellowships, NOTHING is listed....

I was trying to figure this out for a friend and was curious, if someone was to start being an EMS Director today, would they still qualify for the practice pathway? Or has there already been ACGME accredited programs? If not, anyone know when we could expect any?

Thanks!

 

[FDNewbie]

Question about the EMS Practice Pathway for Board Certification...

The article from ABEM states: "The EMS practice pathway and practice-plus-training pathway will be available for the first five years after the Accreditation Council on Graduate Medical Education (ACGME) begins accrediting EMS fellowships."

We looked at the ACGME website and if you go to EMS Fellowships, NOTHING is listed....

I was trying to figure this out for a friend and was curious, if someone was to start being an EMS Director today, would they still qualify for the practice pathway? Or has there already been ACGME accredited programs? If not, anyone know when we could expect any?

Thanks!

As of right now, they have only completed the required objectives and the board exam itself. They haven't begun the actual program certification process yet.

Word on the street is, it's wayyyy too expensive to perform independent site visits just for EMS Fellowship accreditation, so they will likely review the fellowships when the EM Residency program itself is up for re-accreditation/re-evaluation. So for a program here and there, that may be in a year or so. For most programs, however, that will inevitably be sometime over the next several years. So it will likely be a decade before every existent EMS Fellowship is evaluated for accreditation.

So to answer your question in brief...for the current situation (to the best of my knowledge):
- You can still become an EMS Director today and qualify for the practice pathway
- You can still undertake an UNaccredited EMS fellowship and qualify via that pathway
- You CANNOT join an accredited EMS fellowship, because they don't exist - YET.

To be smart/prudent, and confirm the accuracy of the above statements, give ABEM a call and confirm with them any significant decision you plan on undertaking.

 

[docB]

As of right now, they have only completed the required objectives and the board exam itself. They haven't begun the actual program certification process yet.

Word on the street is, it's wayyyy too expensive to perform independent site visits just for EMS Fellowship accreditation, so they will likely review the fellowships when the EM Residency program itself is up for re-accreditation/re-evaluation. So for a program here and there, that may be in a year or so. For most programs, however, that will inevitably be sometime over the next several years. So it will likely be a decade before every existent EMS Fellowship is evaluated for accreditation.

So to answer your question in brief...for the current situation (to the best of my knowledge):
- You can still become an EMS Director today and qualify for the practice pathway
- You can still undertake an UNaccredited EMS fellowship and qualify via that pathway
- You CANNOT join an accredited EMS fellowship, because they don't exist - YET.

To be smart/prudent, and confirm the accuracy of the above statements, give ABEM a call and confirm with them any significant decision you plan on undertaking.

I plan to grandfather in but of the 7 or 8 emails I've sent to ABEM I've gotten no replies. I don't think they really have it together yet.

 

[fiznat]

Excuse the ******* med-student question, but I was wondering about this fellowship. I've been a paramedic for a long time and this interests me for obvious reasons, but I was wondering how the arrangement works with the hospitals. Do medical directors get a stipend or some other additional pay for serving as a medical director? How does establishing this certification change this arrangement (if at all)? Does the individual physician shoulder the liability for what EMS providers do/don't do out in the field? How does all that work?

 

[deleted109597]

EMS director writes/implements the offline medical direction. He does the QA.
He usually isn't paid by any hospital. If he is director of a private company, he makes money for them (and sometimes this is a bad arrangement*). If he is director of a county agency, usually they pay, depending on size of the county. Some counties are poor/only have BLS, and director for them is usually voluntary.

*some of the private companies have 1 director for 15 agencies, and they all serve basically to defraud the government. Ambulance taxi can be lucrative.

 

[fiznat]

So the way things currently are, what is the draw for EM physicians to do this fellowship? Is it just out of interest in EMS? It kinda sounds like a fair amount of work, not all that lucrative, and a real potential for liability/fraud. Where's the up side?

 

[docB]

So the way things currently are, what is the draw for EM physicians to do this fellowship? Is it just out of interest in EMS? It kinda sounds like a fair amount of work, not all that lucrative, and a real potential for liability/fraud. Where's the up side?

Good question. I think that the fellowship training and board certification will eventually eclipse the ability of those who don't have them to sit at the table in EMS admin. Up til now EMS medical direction has been the domain of docs who had EMS experience or interest or hopefully both. With the new certs those will slowly become prerequisites for involvement first in big cities and then slowly in smaller areas. Think of it like being board certified in EM. Back in the day it wasn't required because no one had it. Now you can't get a job in an urban area without it. EMS will be the same way.

 

[FDNewbie]

Good question. I think that the fellowship training and board certification will eventually eclipse the ability of those who don't have them to sit at the table in EMS admin. Up til now EMS medical direction has been the domain of docs who had EMS experience or interest or hopefully both. With the new certs those will slowly become prerequisites for involvement first in big cities and then slowly in smaller areas. Think of it like being board certified in EM. Back in the day it wasn't required because no one had it. Now you can't get a job in an urban area without it. EMS will be the same way.

To piggyback on this, the primary reason it took this long for the Board to recognize EMS as an accredited fellowship was they found it to be too administrative, and significantly lacking the clinical aspects. The Fellowship *heavily* emphasizes hands-on prehospital clinical competency for the EMS Fellow. Ie you don't just oversee & Q&A; you have actual hands-on experience (and continue to be involved) in prehospital medicine. Ie, you're a prehospital physician who provides QA *through* prehospital participation - not just sitting at a desk doing chart reviews & discussing protocols.

And I agree w/ docB; soon enough, you won't be able to become or maintain your medical directorship without being boarded in EMS.

 

[docB]

So the ABEM EMS Board Certification is a reality. The application process has started for a paltry $475. Apps will be approved or not by March and then you can register for the test. The test will be in October 2013.

The information about what will be on the test is really vague. ABEM won't recommend any texts or outside sources to study from. I also don't know of any review classes for this which makes sense as no one knows what's on the test. Anyone have any ideas? Does anyone think the test will be way too hard or way to easy as is the problem with new tests?

Of note any doc who is boarded in any ABMS recognized can sit for the exam.

 

[VeerTheTIGuy]

My understanding was that NAEMSP along with some other groups were collaborating on a review course? I know I received some surveys via the ACEP EMS Section listserv as well as heard talk of it at the Section Meeting at SA.

 

[FDNewbie]

DocB, VeerTheTIGuy is right; they've been working on putting together a review course and review course staff.

And contrary to what I had said prior about programs not being accredited until their EM Residency Program site visit occurs, programs are now allowed to submit PIFs (Program Information Forms), traditionally known to as residency applications to the EM RRC (Residency Review Committee). So they can submit a request for probationary accreditation for their EMS Fellowship *this* year for the upcoming academic year (2012-2013).

And I'm told by the same program that the expected # of PIF applications this year is 20-30. Of which probably at least half will not qualify.

So the exam is coming, and the accredited fellowships are coming. Right around the corner.

 

[docB]

There are 3 pathways for eligibility to take the exam. There's the experience pathway which is 6 years of clinical EMS leadership. There's graduating from an accredited fellowship which doesn't exist yet. And there's the experience + training at a non-accredited fellowship. So they've been pretty liberal about letting people in at the beginning. The practice pathway will go away after 5 years and I assume they'll start limiting the non-accredited fellowships about the same time.

Has anyone heard of a time line or any other hard info on the NAEMSP review course? I know I'll be interested.

 

[FDNewbie]

I plan to grandfather in but of the 7 or 8 emails I've sent to ABEM I've gotten no replies. I don't think they really have it together yet.

Sorry I somehow missed this post. Did you see this? https://www.abem.org/PUBLIC/_Rainbow/Documents/EMS%20Elig%20Criteria%20FINAL%20April%202011.pdf. It's from here: http://www.abem.org/PUBLIC/portal/alias__Rainbow/lang__en-US/tabID__4128/DesktopDefault.aspx.

And yes it's prob that they're still coming up with this as a concrete pathway/process etc, PLUS the fact that the VAST MAJORITY of EMS docs don't do it full time; it's a side hobby/passion they do. So they're still juggling work, admin requirements, family life, financial stuff, etc in ADDITION to their EMS work.

Excuse the ******* med-student question, but I was wondering about this fellowship. I've been a paramedic for a long time and this interests me for obvious reasons, but I was wondering how the arrangement works with the hospitals. Do medical directors get a stipend or some other additional pay for serving as a medical director? How does establishing this certification change this arrangement (if at all)? Does the individual physician shoulder the liability for what EMS providers do/don't do out in the field? How does all that work?

In addition to what Dr. Ninja mentioned, there are docs who are part-time medical directors, and a handful of full-time medical directors.

What does that mean? To use the full-time medical director as an example, these are docs who's FULL TIME JOB is to do EMS. Ridealongs. Physician field response. QA. Protocol revision/development. Budgetary issues. Etc etc. It is their 100% full-time job. They typically work somewhere around 4 shifts in the actual ED a MONTH. Because their primary job is NOT an EM Physician. They're FULL-TIME EMS Physicians. This outfit is primarily reserved for where medical control authorities exist, which requires a centralization of ALL EMS Direction to one center.

Part-time would be just that. You're paid part-time for EMS stuff, and supplement the rest of your income by working in the ED.

The VAST majority, however, fall under what Dr. Ninja mentioned. They're full-time ED docs, who VOLUNTEER their spare time (or in lieu of a minor stipend) for EMS-related activities, regardless of how many hours they spend doing it (ie even if it's full-time hours, it's still not considered a full-time position).

There are 3 pathways for eligibility to take the exam. There's the experience pathway which is 6 years of clinical EMS leadership. There's graduating from an accredited fellowship which doesn't exist yet. And there's the experience + training at a non-accredited fellowship. So they've been pretty liberal about letting people in at the beginning. The practice pathway will go away after 5 years and I assume they'll start limiting the non-accredited fellowships about the same time.

Whoops. I guess you already saw this info haha.

Has anyone heard of a time line or any other hard info on the NAEMSP review course? I know I'll be interested.

Negative. EMS list was just recruiting for staff for this like a month ago IIRC. And looks like they have a LOT of time to put it together, w/ the first exam scheduled to be Oct 2013.

 

[ptarmigan]

Where did they come up with 400 hours a year? I can't get to that number as a medical director for a medium sized system. I guess this is a subspecialty made just for the academicians.

The EMS fellows where I trained might do 200 hours in their one year program but even that is probably a stretch - it's basically going to some meetings, reviewing some charts, and riding on the command car once a month. A few fellowships do more, but most do not.

Has anyone heard when the cutoff will be for folks with prior experience? If you have your 800 hours (4 times what a one year fellowship will do) by xx/xx/xx you are still able to submit an application?

 

[FDNewbie]

Where did they come up with 400 hours a year? I can't get to that number as a medical director for a medium sized system. I guess this is a subspecialty made just for the academicians.

They're going for active part- to full-time EM directors. 400 hr/yr works out to about 30 hrs a month, which isn't that much at all IMO.

The EMS fellows where I trained might do 200 hours in their one year program but even that is probably a stretch - it's basically going to some meetings, reviewing some charts, and riding on the command car once a month. A few fellowships do more, but most do not.

I think that's their whole point. They're trying to pull AWAY from some random administrative requirements, and HEAVILY emphasize *active* clinical participation. And the hours must include actual medical directorship (procotol writing & revision, etc).

Remember, the WHOLE reason it took a few *decades* to be recognized as an accredited subspeciality was in the past it was considered too "administrative," so there weren't concrete clinical expectations one could measure. Hence why there's a clear clinical requirement/commitment here.

Has anyone heard when the cutoff will be for folks with prior experience? If you have your 800 hours (4 times what a one year fellowship will do) by xx/xx/xx you are still able to submit an application?

It's gonna be a few years, and they'll announce the deadline prior. Just like they gave docs in EM a few years to get grandfathered in before ABEM certification became the only way, they'll follow that model in EMS as well. Remember, it's the same guys doin it 😉

 

[docB]

I'm pretty sure the practice track will last for 5 years and then end.

 

[drpcb]

I took the exam in October. It had some tough questions. Hard to prepare for a new board exam since there is no existing review material. Fingers crossed.

 

[drpcb]

Well, I passed. But barely squeaked by. The pass rate was 58% of takers. I don't know if fellowship trained did better than practice pathway. It shoud be easier next cycle since people will know what to study.

 

[Emergency!]

According to data shared at NAEMSP, fellowship trained people did significantly better than practice path. I don't remember the exact numbers, but > 75% of fellowship trained people passed, and around 50% of non-fellowship cat rained passed.

 

[drpcb]

Yes. 79% of those with fellowship training (unaccredited) and 53% without.

Overall rate of 55.8%.

I imagine it was very challenging for folks who weren't even EM trained. I expect the next exam will be a much higher pass rate since it is criterion referenced and nothing precludes 100% pass. Now that the content is better appreciated, it will be easier to prepare for. I think the NAEMSP course was awesome, but was still a hard test despite being residency trained EM with 25 years in EMS as paramedic, EMS director, etc. Fellowship year spent reviewing all the esoteric stuff in addition to the bread and butter should make it a lot easier to pass. To be fair though I haven't taken a board exam in 8 years so that might have been why it seemed harder.

 

[USNavy EM Doc]

Well, I passed. But barely squeaked by. The pass rate was 58% of takers. I don't know if fellowship trained did better than practice pathway. It shoud be easier next cycle since people will know what to study.

I'm fellowship trained and preparing for the exam this November. Was wondering what you used to prepare for the exam? What areas would you focus on or concentrate on for the exam? Do you think the NAEMSP text is sufficient preparation? Thoughts on the review course-helpful or a waste of time? Thanks.

 

[The White Coat Investor]

So the way things currently are, what is the draw for EM physicians to do this fellowship? Is it just out of interest in EMS? It kinda sounds like a fair amount of work, not all that lucrative, and a real potential for liability/fraud. Where's the up side?

You can get a job at an academic center requiring fellowship training of all their docs.

It's like Peds EM. Two more years of training to make less money.