How do new fellowship pathways form?

[gomavs]

Not too long ago, EM-> pain became a thing. Same with EM—> CCM. What else could we do? I feel like cardiology would be realistic. Who decides? Who do we talk to?

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[Birdstrike]

It happens like this:

Read this post, and this thread.

 

[RustedFox]

When a mommy fellowship and a daddy fellowship love each other very much...

 

[AlmostAnMD]

Em-->cards will never happen. IM won't allow it. Would make a competitive specialty 300% more competitive.

A commonly cited reason that isn't competition related, and I'm not qualified to comment on how true this is, is that cardiology is really just medicine with a focus on the heart. Our medicine training is virtually non-existent. Half the docs I work with outside of iv labetalol/hydralazine would be lost if they had to manage blood pressure.

Myself, I'd do it in a heartbeat (pause for laughter). Read chou's, read O'Keefe, currently working on this beast on a slow shift:

It's actually a really good read. My ekg skills, arrhythmia management and recognition are noticeably better than most of my peers. Lots of fun tips. Kind of bored with EM as usual so learning to do new things like rule people in for flecainide, etc provides some work related amusement

 

[Brigade4Radiant]

Cards often refuses to deal with anything medicine related they could be their own residency with 1 year of IM prelim

 

[Clean7795]

Specialties are set the way they are largely because of entrenched tradition/history. E.g. A FM resident in theory should be well-suited specialize in allergy since they're both outpatient medical fields... but because medical subspecialization is rooted in IM that doesn't happen.

Specialties that already accept more than 1 base residency of training are most within reach to change. CCM always had many specialties involved from the very start.

Cardiology is an entrenched, competitive field and only accepts IM trained residents. No way to break in there.

 

[The kitchen sink]

Cards often refuses to deal with anything medicine related they could be their own residency with 1 year of IM prelim

QFT

once they move into cardiology fellowship, they act way too high and mighty to deal with anything non-cardaic medicine related… maybe it will go the IR residency independent route one day

I remember a pt came in with an obvious NSTEMI , dynamic ecg changes, active chest pain , + troponin… but also was a type 1 diabetic , and was in DKA

Pvt cardiology group didn’t want to hear the whole story on the phone until medicine + endo + ICU was consulted …

 

[deuist]

Em-->cards will never happen. IM won't allow it. Would make a competitive specialty 300% more competitive.

Cardiology is in the process of trying to leave ABIM and create their own boards.

 

[AlmostAnMD]

Cardiology is in the process of trying to leave ABIM and create their own boards.

I read a bit of the article but I'm lost to your point. I know a lot of people are mad at ABIM but to the point of this topic does it really change anything?

 

[deuist]

I read a bit of the article but I'm lost to your point. I know a lot of people are mad at ABIM but to the point of this topic does it really change anything?

If Cardiology gets out from under ABIM, the specialty might be open to non-internists pursuing fellowship.

 

[southerndoc]

If Cardiology gets out from under ABIM, the specialty might be open to non-internists pursuing fellowship.

Would it be a fellowship or just a residency that med students match into directly (or after a TY year)?

 

[Brigade4Radiant]

EM only fellowships are trash no primary care ones can't do sleep pain is competitive


Cards should 1 year prelim medicine and 3 years cards and open the path to more specialties

 

[RuralEDDoc]

But what about Ultrasound……..

 

[deuist]

Would it be a fellowship or just a residency that med students match into directly (or after a TY year)?

They haven't said. They want out from IM according to the article. No mention of what to do after they're successful.

 

[EMhawkeye]

They haven't said. They want out from IM according to the article. No mention of what to do after they're successful.

I do find it funny that out of all the IM subspecialties, they have the highest failure rate on recerting their boards.

 

[gro2001]

Not too long ago, EM-> pain became a thing. Same with EM—> CCM. What else could we do? I feel like cardiology would be realistic. Who decides? Who do we talk to?

It would have to be ABIM and ABEM co-sponsoring a board application to ABMS.

Generally it is preceded by a long period (years to decades) of people forging their own, very uncertain, at best partially recognized path. I am most familiar with how the CCM path worked out, less so with pain.

The initial application to ABMS for an emergency medicine board was actually for a board of emergency medicine and critical care. It did not go through and by the time EM leadership re-applied, surgery, anesthesia, and IM had pushed through their own critical care boards. What followed was decades of EM trained folks doing the fellowships but not being board certified. Some would go on to sit for the European diploma in critical care (EDIC/ESICM) which would certify people trained anywhere as long as they were appropriately trained and passed their exams. Some of these folks gained some prominence in the field (eg Scott Weingart). Then there was a general recognition of several facts that really helped push through a formal pathway for EM trained folks to become board certified:

1) National recognition of a shortage of CCM trained folks (eg Leapfrog report on ICU staffing)
2) General decline in fill rates for CCM fellowships in surgery/anesthesia/IM

Without those two things, board eligibility for EM trained intensivists probably wouldn't exist to this day. One could foresee an alternative future where we reached this point just by virtue of more and more emergency physicians reaching prominence in the critical care world, taking more leadership positions in hospitals and critical care organizations, but this seems less likely. The uncertainty of building a career on a not-quite-recognized pathway pushed away a lot of people, so I doubt we would ever reach a critical mass in the specialty without those outside factors helping.

Unfortunately this doesn't seem to be the case in cardiology. They have no problem filling their spots with IM applicants. So while ABEM would probably be game, I don't see why ABIM would be interested. The only positive factor we have is that there are a few emergency physicians who have earned some fame in the cardiology world (a couple of the ECG gurus come to mind), but there are no emergency physicians practicing in a primarily cardiology/cardiology adjacent space (like there were leading up to CCM recognition) nor are there (to my knowledge, though I could be wrong) famous EM trained cardiology researchers a la Manny Rivers (who was of course EM/IM trained).

 

[Apollyon]

When I was a resident, there was an IM resident going into Cards, and he said, "the worst part of Cards is 3 years of IM". That made me think of Steve Miller and "You got to go through hell/Before you get to heaven".

 

[Birdstrike]

When I was a resident, there was an IM resident going into Cards, and he said, "the worst part of Cards is 3 years of IM". That made me think of Steve Miller and "You got to go through hell/Before you get to heaven".

For me, the worst thing about Pain was the 11 years of EM.