New TEE Requirement

[B-Bone]

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I also work at a community hospital that does hearts. We do about 300/year, covered by our group of 17 anesthesiologists. One has CV fellowship/TEE boards. We all do hearts. In a smallish group, everybody needs to be able to do everything. We do CABG, valves, aortic work, circ arrest cases, TAVRs, minimally invasive, robotic, ECMO, occasional VAD. No transplant. We do our own TEE with cardiology backup if needed. I call cardiology about once a year. I graduated in 2010 from a residency with high volume cardiac and TEE exposure. I worked my butt off the first two years in practice doing TEE on every heart that came through the joint when I was there (including my partners' cases). I took additional CME courses (SCA/ASE and others) and got basic TEE cert. I can't get advanced cert, due to graduation date, but I may still take advanced exam for a "feather in my cap". We're not going to get enough fellowship trained folks to maintain a subspecialty call team, but patients still get excellent care at our facility. Outcomes are tracked and compared with our high-volume sister hospital across town. No appreciable differences, except theirs tend to be a bit worse (expected with a higher acuity level).

 

[caligas]

Why not certification for peripheral regional anesthesia, for thoracic epidurals, for vascular, for PA catheters, for bariatrics, for transplants, for liver resections, for interventional for ambulatory, for robotic surgery, for ENT, for off site anesthesia, for on site anesthesia...?

 

[GA8314]

I also work at a community hospital that does hearts. We do about 300/year, covered by our group of 17 anesthesiologists. One has CV fellowship/TEE boards. We all do hearts. In a smallish group, everybody needs to be able to do everything. We do CABG, valves, aortic work, circ arrest cases, TAVRs, minimally invasive, robotic, ECMO, occasional VAD. No transplant. We do our own TEE with cardiology backup if needed. I call cardiology about once a year. I graduated in 2010 from a residency with high volume cardiac and TEE exposure. I worked my butt off the first two years in practice doing TEE on every heart that came through the joint when I was there (including my partners' cases). I took additional CME courses (SCA/ASE and others) and got basic TEE cert. I can't get advanced cert, due to graduation date, but I may still take advanced exam for a "feather in my cap". We're not going to get enough fellowship trained folks to maintain a subspecialty call team, but patients still get excellent care at our facility. Outcomes are tracked and compared with our high-volume sister hospital across town. No appreciable differences, except theirs tend to be a bit worse (expected with a higher acuity level).

You sound like a lazy slacker who didn't have the motivation or willingness to get off your a.ss and do a CT fellowship. Shame shame....😎

 

[GA8314]

What is the standard of care for performing Cardiac Anesthesia? Honestly I don't know the answer but I am sure someone would argue that training in TEE is a modern day standard skill set for cardiac anesthesia.

In our group there are reasons why we have slowly evolved to a cardiac team.
1. When everyone was doing hearts I would get called into a room to perform a TEE while at the same time covering my 3-4 other rooms. Essentially doing multiple peoples jobs.
2. To any of us TEE people to keep our numbers up and say competent we needed to be in the rooms more often
3. It was very hard to be in room looking at an echo and not make recommendations to my partner and the surgeon what to do coming off pump- uncomfortable position
4. Cardiac surgeons wanted more reproducibly in the rooms.
5. Concern among some partners about being held to similar standards as the TEE guys especially with the middle of the night dissections. Some of that was a way for them to not work with the heart surgeons or have to deal with sitting in the long cases.

Don't get me wrong, I do NOT believe the ASA/ABA/NBE went in the right direction by requiring fellowship for doing TEE. It is a skill that can be learned on the job (the point i was trying to make with my last post). I feel it has done a disservice, especially to our Critical Care fellows who now feel they need to do extra years to be in the heart rooms. Should we all go back to fellowship before we place a continuous peripheral nerve catheter? I have yet to hear a general surgeon going back and doing a fellowship to learn robotic colectomies. Even a better example would be to ask the interventional cardiologists to redo a fellowship to place TAVRs.

Routine Cardiac Anesthesia is not difficult to preform. What i feel is the most important is having the skills that required no matter the case. IF you have been doing cardiac cases and have learned TEE and are comfortable that you perform an exam at the same level and standards as anyone who does TEE, then a fellowship should not be required.

Overall it sounds like the either the hospital, the surgeons or the lawyers ( malpractice ) are asking that a standard be obtained; Or its just that a couple of guys are trying to steal all the heart cases for themselves.

I agree. I really respect and will never minimize those that did/do a CT fellowship. I just feel we are not handling this very well, as a specialty (anesthesiology in general).

I would be very interested in a pathway that allowed lower volume folks in PP to get TEE certified. Extra coursework, passing the exam (of course), logging cases etc.

I really feel there are a lot of people (especially newer grads but not just new grads) that would take this opportunity and strengthen their skills. Willing to work hard to become better at a TOOL of the trade. TEE is a TOOL.

I understand all points, but we can see on this forum alone that many places are NOT large tertiary care centers yet still doing a wide array of cardiac cases. I personally will eventually take the Advanced exam. I will be basic certified hopefully Fall of 2016. For lots of reasons, fellowship isn't an option for many people. It's not as simple as "unwilling to suck it up" etc. etc.

 

[urge]

I agree. I really respect and will never minimize those that did/do a CT fellowship. I just feel we are not handling this very well, as a specialty (anesthesiology in general).

I would be very interested in a pathway that allowed lower volume folks in PP to get TEE certified. Extra coursework, passing the exam (of course), logging cases etc.

I really feel there are a lot of people (especially newer grads but not just new grads) that would take this opportunity and strengthen their skills. Willing to work hard to become better at a TOOL of the trade. TEE is a TOOL.

I understand all points, but we can see on this forum alone that many places are NOT large tertiary care centers yet still doing a wide array of cardiac cases. I personally will eventually take the Advanced exam. I will be basic certified hopefully Fall of 2016. For lots of reasons, fellowship isn't an option for many people. It's not as simple as "unwilling to suck it up" etc. etc.

I think it is clear that higher volumes lead to better outcomes. Don't see a point in certifying 20 anesthesiologist so that each can do 1 or 2 cases a month.

Just have 1 or 2 get certified and let them handle all the cases.

Fellowship is optional as well as a career doing cardiac.

 

[GA8314]

I think it is clear that higher volumes lead to better outcomes. Don't see a point in certifying 20 anesthesiologist so that each can do 1 or 2 cases a month.

Just have 1 or 2 get certified and let them handle all the cases.

Fellowship is optional as well as a career doing cardiac.

I'm sure outcomes depends on many factors. I don't know the actual data on this issue. At my gig, it was a huge advantage that I felt comfortable doing hearts. We do not have an Advance Certification requirement. So, for my gig, and many many like it, it was essentially expected that you be able to do cardiac cases (as well as healthy peds, OB, vascular, huge amounts of regional, and general).

Academia, in my experience having been a recent resident, is NOT tuned into these types of practices. But, a lot of anesthesia in the community is handled by general anesthesiologists doing a wide array of cases. Frankly, you get some very good clinicians this way, and I am a better anesthesiologist overall for my breadth of cases. And I am not alone. I do not claim to be the best at sick pediatric patients or complicated hearts requiring TEE skills beyond my own.

 

[caligas]

Just have 1 or 2 get certified and let them handle all the cases.

.

...and take q2 call.

 

[nimbus]

...and take q2 call.

For 100cases/year....it's easy call. We have 3 people for 200-250cases/year and it's very manageable.

As an aside, I have a buddy who did a 2 month locums gig between jobs. He was covering for a guy who was on call every day covering a low volume place. He finished prior to 2009 and had passed his advanced pteexam so he was a testamur. He was taking 2months off to go back to his old residency program to read a bunch of echos and get his cert. For those who finished early enough that is one way to get certified. And his call stipend was excellent.

 

[DrBeaker]

To the OP ,

This person wants you to be certified by the NBE correct? Not just testamur?

I am a recent graduate, after 2009 so I don't fall into the practice pathway for certification from NBE. I passed the advanced perioperative exam as a resident. I have also passed the special competence in adult echo exam, Same test as a graduated cardiology fellow. I am an anesthesiologist, I do cardiac anesthesia. But I also read echo usually once per week. Sometimes it's for the OR cases, sometimes it is in the echo lab where we do both TTE and exercise/dobutamine stress echo. I have plenty of numbers to be certified, but I can't because because I didn't do a cardiac fellowship. I think it's bogus, and I would argue that my training rivals that of a cardiac anesthesia fellow.

If I was told this mandate, and my testamur status for advanced perioperative and adult comprehensive weren't enough I would be pretty upset. Sure hope a mandate like that isn't coming my way anytime soon.

 

[urge]

If I was told this mandate, and my testamur status for advanced perioperative and adult comprehensive weren't enough I would be pretty upset. Sure hope a mandate like that isn't coming my way anytime soon.

A non certified person running an echolab? How long do you expect that to last?

 

[Spinach Dip]

1. Hire a CRNA.
2. Have them take a 1-week echo course. Preferably online.
3. Now nothing can go wrong because CRNAs have the same outcomes and MDs, regardless of training.

Glad I could solve this problem for you! 👍

 

[caligas]

A non certified person running an echolab? How long do you expect that to last?

For the record, I don't think he said he is running the echo lab.

 

[sevoflurane]

Tons of Cardiologists practicing that are not echo certified or have let their expiration lapse yet still perform echoes.

 

[sevoflurane]

To the OP ,

This person wants you to be certified by the NBE correct? Not just testamur?

I am a recent graduate, after 2009 so I don't fall into the practice pathway for certification from NBE. I passed the advanced perioperative exam as a resident. I have also passed the special competence in adult echo exam, Same test as a graduated cardiology fellow. I am an anesthesiologist, I do cardiac anesthesia. But I also read echo usually once per week. Sometimes it's for the OR cases, sometimes it is in the echo lab where we do both TTE and exercise/dobutamine stress echo. I have plenty of numbers to be certified, but I can't because because I didn't do a cardiac fellowship. I think it's bogus, and I would argue that my training rivals that of a cardiac anesthesia fellow.

If I was told this mandate, and my testamur status for advanced perioperative and adult comprehensive weren't enough I would be pretty upset. Sure hope a mandate like that isn't coming my way anytime soon.

Good job. I have a feeling you are well respected at your facility.

How about those who do the echo fellowship? I work with one of those guys. He is not certified because it's not a CT fellowship. I can tell you he is a bonafied badass in TTE, TEE and echo lab. He heads our CT department.

 

[Ignatius J]

Yes but they self-studied echo. If they didn't, they are not one of the best.

A lot did. Still, to my knowledge self-study cannot get certified above "Basic TEE", which is pretty dumb. You don't have to waste a year of your life studying pictures to say you are a good "cardiac anesthesiologist". Sorry, there is no magic drug they teach you to make to come off a 3 hour pump run in fellowship. There's no magical view that they teach you that unlocks the secret of why the CO is low. It's silly.

 

[DrBeaker]

A non certified person running an echolab? How long do you expect that to last?

As stated, I don't run the lab. The lab is staffed by anesthesiologists (long story). Most are certified via the practice pathway prior to 2009. Others like myself can't get certified.

To sevo: I did a non ACGME echo/cardiac fellowship. Performed and read lots of TEE/TTE. Staffed hearts.

 

[nimbus]

A lot did. Still, to my knowledge self-study cannot get certified above "Basic TEE", which is pretty dumb. You don't have to waste a year of your life studying pictures to say you are a good "cardiac anesthesiologist". Sorry, there is no magic drug they teach you to make to come off a 3 hour pump run in fellowship. There's no magical view that they teach you that unlocks the secret of why the CO is low. It's silly.

Wasn't really talking about certification. But the more cardiac you do, the more you realize how useful echo is. So whether they are fellowship trained or not, whether they are NBE certified or not, all the best cardiac guys I know are echo geeks to some extent. And all are at least testamurs.

 

[Twiggidy]

I personally don't think it matters how "bad ass" you are at something, if rules and regulations change then you have to fall in line. If you weren't prepared for that, then your bad. It's the biggest hypocrisy ever given that we're on here constantly screaming about CRNAs taking over anesthesia, but then when someone says "get certified so you can be the guy doing these cases", no people are like "what?! i don't need certification!"

Another point, there's a big difference betwee just getting 20 clips and getting 20 clips and being able to describe what's going on to the surgeon.

Again the whole essence of this thread is people wanting to get paid cardiac anesthesia money but no go through what it takes to be a cardiac anesthesiologist. I don't care how many hearts you've don't, if you didn't do a fellowship, you're not a cardiac anesthesiologist. Just like a general surgeon that happens to be skill enough to do a VATS isn't a thoracic surgeon.

Also yes, make a regional certification, make an OB certification, heck, there is peds certification now. Have some pride in the field and do what it takes to keep a hold on it.

 

[Twiggidy]

A lot did. Still, to my knowledge self-study cannot get certified above "Basic TEE", which is pretty dumb. You don't have to waste a year of your life studying pictures to say you are a good "cardiac anesthesiologist". Sorry, there is no magic drug they teach you to make to come off a 3 hour pump run in fellowship. There's no magical view that they teach you that unlocks the secret of why the CO is low. It's silly.

See that's just disrespectful, because if you think that year of cardiac is just "teaching people how to come off pump" then maybe you need to do a cardiac fellowship. That's like me saying that a peds fellowship is just a year of teaching how to intubating with 3.5 tubes and mask inducing babies.

 

[Twiggidy]

Why isn't anyone asking this in reverse? If any anesthesiologist with 2 thumbs can do cardiac, then why IS there a fellowship? Just as any goof can do OB so there's really aren't many fellowships, why even have cardiac anesthesiology fellowships?

 

[DrBeaker]

Twiggidy,

I get what you are trying to say. I am guessing you did a cardiac fellowship? Anyway, I'm just throwing it out there that there are people who haven't done a cardiac fellowship or an accredited fellowship but are excellent in echo and in the heart room. I won't say cardiac anesthesiologist since apparently I have to do a fellowship.

In cardiac fellowship, you do lots of complex cases and learn some echo. I also do complex cases, probably the same ones as in cardiac fellowship and I know a lot of echo. I would say more than most cardiac fellowship grads. I can assure you I can tell a surgeon what he wants to know. So I guess I disagree with your quantification of what makes a cardiac anesthesiologist. I'm sure there are plenty of cardiac fellowship trained people who barely know echo and can only as you say get 20 clips. So those guys get to be cardiac anesthesiologists?

 

[Man o War]

[

A lot did. Still, to my knowledge self-study cannot get certified above "Basic TEE", which is pretty dumb. You don't have to waste a year of your life studying pictures to say you are a good "cardiac anesthesiologist". Sorry, there is no magic drug they teach you to make to come off a 3 hour pump run in fellowship. There's no magical view that they teach you that unlocks the secret of why the CO is low. It's silly.

Yeah, this rubs me pretty wrong. This paragraph tells me you (or anyone who believes this)really don't get it, so maybe you shouldn't be doing hearts.

 

[Twiggidy]

Twiggidy,

I get what you are trying to say. I am guessing you did a cardiac fellowship? Anyway, I'm just throwing it out there that there are people who haven't done a cardiac fellowship or an accredited fellowship but are excellent in echo and in the heart room. I won't say cardiac anesthesiologist since apparently I have to do a fellowship.

In cardiac fellowship, you do lots of complex cases and learn some echo. I also do complex cases, probably the same ones as in cardiac fellowship and I know a lot of echo. I would say more than most cardiac fellowship grads. I can assure you I can tell a surgeon what he wants to know. So I guess I disagree with your quantification of what makes a cardiac anesthesiologist. I'm sure there are plenty of cardiac fellowship trained people who barely know echo and can only as you say get 20 clips. So those guys get to be cardiac anesthesiologists?

There are many guitarists out there working in guitars stores or wherever that are better guitarist than many of the people we pay to see on stage, but does that mean the person in the guitar store should be on stage? The guy on stage did what he had to do to get there, even if he's isn't the greatest musician.

 

[Twiggidy]

and the funny thing about this entire thread is that if by chance the did start requiring fellowships for OB anesthesia you wouldn't hear a single complaint...

people would be like.....

c'mon ...it's me....you knew a meme was coming.....

 

[Man o War]

I'll just say this- I did hearts for 10 years before I did my fellowship. I thought I was pretty good. My last year of residency was a focus on cardiac, and I had the numbers to sit for the exam but didn't. I showed up to fellowship feeling pretty confident in my skills, and that year truly took me to the next level. Talk about humbling. There is in fact a next level in cardiac.

 

[ryanjmy]

The best clinicians should do the cases. Doing a fellowship gives you an advantage but doesn't alway mean better skills. The CT surgeons are pretty good at weeding out the weak links. I've seen both non fellowship and fellowship trained guys banned from doing cases.

 

[Man o War]

and the funny thing about this entire thread is that if by chance the did start requiring fellowships for OB anesthesia you wouldn't hear a single complaint...

There are no fat stipends for OB🙂

 

[OB1🤙]

I think there are two kinds of cardiac cases: JV and Varsity. Straightforward good-EF CABGs and AVRs are JV cardiac.

Most competent anesthesiologists should be able to do JV cases, with a little brushing up if it's been awhile. Most community hospitals with low numbers should *only* be doing JV cases. As a fellowship-trained, advanced echo boarded guy, I think that these settings don't necessarily require advanced skills. I do think that taking the basic exam is probably a good idea, but not necessarily mandatory.

Yes, there will be times things go to crap. Yes, there will be incidental findings that a more "basic" person might miss that may alter surgery. That's the deal with the devil.

But I do think that shops doing Varsity cases need to have fellowship trained, advanced folks in there.

 

[pgg]

I'll just say this- I did hearts for 10 years before I did my fellowship. I thought I was pretty good. My last year of residency was a focus on cardiac, and I had the numbers to sit for the exam but didn't. I showed up to fellowship feeling pretty confident in my skills, and that year truly took me to the next level. Talk about humbling. There is in fact a next level in cardiac.

Posts like this make me look forward to fellowship. I can't wait to start discovering all the things I didn't know I didn't know.

 

[DrBeaker]

For one reason or another, my training institution did not have a cardiac fellowship. We do have a non ACGME fellowship heavily geared toward both echo and cardiac. I did and still do big complex cases. Transplants, VADs, ecmo, valves, you get it.

It would suck if a mandate like the OP's came along my way. But if it came down to it, I would probably do the accredited cardiac fellowship.

 

[Man o War]

Posts like this make me look forward to fellowship. I can't wait to start discovering all the things I didn't know I didn't know.

Don't know unless you go.....

 

[Ignatius J]

See that's just disrespectful, because if you think that year of cardiac is just "teaching people how to come off pump" then maybe you need to do a cardiac fellowship. That's like me saying that a peds fellowship is just a year of teaching how to intubating with 3.5 tubes and mask inducing babies.

I never said it is just teaching people to come off pump. I do think a lot of it is superfluous though.

 

[Ignatius J]

Why isn't anyone asking this in reverse? If any anesthesiologist with 2 thumbs can do cardiac, then why IS there a fellowship? Just as any goof can do OB so there's really aren't many fellowships, why even have cardiac anesthesiology fellowships?

I do think any board-certified anesthesiologist should be able to do cardiac cases. I think it is downright a complete lack of faith in residency training if you think it requires additional training to be competent in doing so. I think fellowships across all of medicine have jumped the shark in an effort to convince others that they have a feather in their hat. TEE can definitely be useful, but I don't think it requires sacrificing another year to learn at the expense of starting your practice. My two cents and that will be my last comment.

 

[sevoflurane]

Posts like this make me look forward to fellowship. I can't wait to start discovering all the things I didn't know I didn't know.

CT? I'm guessing yes.
Congrats dude. You're gonna rock that house.

 

[pgg]

CT? I'm guessing yes.
Congrats dude. You're gonna rock that house.

Yes, CT. Will have to hold off on accepting the congrats until December, when the Navy releases the board results that specify who can go where for fellowship, and when. But I like my odds.

I'm actually a 2009 residency grad and the practice pathway is open to me, but no way I could get the case volume without fellowship.

 

[sevoflurane]

Yes, CT. Will have to hold off on accepting the congrats until December, when the Navy releases the board results that specify who can go where for fellowship, and when. But I like my odds.

I'm actually a 2009 residency grad and the practice pathway is open to me, but no way I could get the case volume without fellowship.

Somehow, someway I had a gut feeling you'd be doing a fellowship in CT or be doing the PP. Good stuff and I have full confidence you will get released. 👍

 

[Man o War]

Yes, CT. Will have to hold off on accepting the congrats until December, when the Navy releases the board results that specify who can go where for fellowship, and when. But I like my odds.

I'm actually a 2009 residency grad and the practice pathway is open to me, but no way I could get the case volume without fellowship.

Congrats, you will love it. I had a great year despite getting knocked down to private and hazed accordingly🙂

 

[deleted126335]

Don't the cath lab cash cows need CT surgeons and CT-capable ORs around? If so, are those actual rules/regulations, or just limits that sensible people voluntarily embrace?

I haven't ever paid close attention to what the cardiologists can do with vs without a surgical plan B a couple floors away. But I sort of vaguely remember one medium sized community hospital where I used to moonlight talking about starting up a heart program specifically because it would allow the cath lab in the hospital to do a lot more. I don't think they ever did it.

Don't know if it is rule or common sense. I do know that it was not at all uncommon for small community hospitals without a CV surgery program to have diagnostic only cath labs in the 90s and early 2000s. The few of those that previously existed in our area have closed or added a CV surgery program.

 

[pgg]

Congrats, you will love it. I had a great year despite getting knocked down to private and hazed accordingly🙂

I've been there done that. Spent 3 years between internship and CA-1 year as the doc / medical officer with the Marines going back and forth to the Middle East, with responsibility and authority for 50 people in my section. Then one morning it was over, I woke up, went to the hospital, and was a dangerous newbie CA-1 ... and treated accordingly. 🙂

I have lots of practice humbly taking direction. 🙂

 

[Man o War]

I've been there done that. Spent 3 years between internship and CA-1 year as the doc / medical officer with the Marines going back and forth to the Middle East, with responsibility and authority for 50 people in my section. Then one morning it was over, I woke up, went to the hospital, and was a dangerous newbie CA-1 ... and treated accordingly. 🙂

I have lots of practice humbly taking direction. 🙂

Thanks so much for your service.

 

[pgg]

Thanks so much for your service.

My pleasure and honor.

 

[hooride]

The difference is that any dope can do OB, and many places have CRNAs running OB solo at night/weekends while they're home in bed. I cannot understand the appeal of an OB fellowship at all outside of someone wanting to an OB based academic career. Even then it's likely a waste of a year and a few hundred thousand dollars.

As a society, we may be better served having our brightest and most skilled anesthesiologists provide obstetric anesthesia care, where the stakes are high and two young lives are at stake. Perhaps then we can leave the redo TAVR in the 90-year-old demented nursing home patient to "any dope."

 

[caligas]

As a society, we may be better served having our brightest and most skilled anesthesiologists provide obstetric anesthesia care, where the stakes are high and two young lives are at stake. Perhaps then we can leave the redo TAVR in the 90-year-old demented nursing home patient to "any dope."

Or dare we not do that TAVR altogether?

 

[sleepallday]

I don't have a desire to do hearts anymore, so this discussion doesn't affect me much. But I would be pretty annoyed if my TEE privileges were revoked because of no fellowship. I would still like to use it for monitoring or the occasional IVC tumor case.
And what do some of you pro-fellowship guys say to do once regional becomes an ACGME fellowship, because it looks like its coming.

 

[sleepallday]

Again the whole essence of this thread is people wanting to get paid cardiac anesthesia money but no go through what it takes to be a cardiac anesthesiologist. I don't care how many hearts you've don't, if you didn't do a fellowship, you're not a cardiac anesthesiologist. Just like a general surgeon that happens to be skill enough to do a VATS isn't a thoracic surgeon.

I don't think people do cardiac anesthesia for the money. You can make more doing ortho or GI for the day. There just isn't enough fellowship trained people to cover all the cardiac cases without having to be on call all the time.

 

[Ignatius J]

I don't have a desire to do hearts anymore, so this discussion doesn't affect me much. But I would be pretty annoyed if my TEE privileges were revoked because of no fellowship. I would still like to use it for monitoring or the occasional IVC tumor case.
And what do some of you pro-fellowship guys say to do once regional becomes an ACGME fellowship, because it looks like its coming.

If you tell someone that you need something long enough, they will begin to believe you. I have no doubt we are a few years away from people with regional and OB fellowships talking about how much more qualified they are to perform in these areas.

 

[Man o War]

Or dare we not do that TAVR altogether?

That's coming. Along with performing joint replacements on 400 pound people, and really old folks. Some of the stuff we are allowed to do is kind of crazy if you think about it.

 

[GA8314]

I think there are two kinds of cardiac cases: JV and Varsity. Straightforward good-EF CABGs and AVRs are JV cardiac.

Most competent anesthesiologists should be able to do JV cases, with a little brushing up if it's been awhile. Most community hospitals with low numbers should *only* be doing JV cases. As a fellowship-trained, advanced echo boarded guy, I think that these settings don't necessarily require advanced skills. I do think that taking the basic exam is probably a good idea, but not necessarily mandatory.

Yes, there will be times things go to crap. Yes, there will be incidental findings that a more "basic" person might miss that may alter surgery. That's the deal with the devil.

But I do think that shops doing Varsity cases need to have fellowship trained, advanced folks in there.

We do JV cases at my place.

I don't have a desire to do hearts anymore, so this discussion doesn't affect me much. But I would be pretty annoyed if my TEE privileges were revoked because of no fellowship. I would still like to use it for monitoring or the occasional IVC tumor case.
And what do some of you pro-fellowship guys say to do once regional becomes an ACGME fellowship, because it looks like its coming.

I had super high volume regional. We did just about everything except for things which would require, literally, fluoro. Then, it's not even really regional, but rather chronic pain/interventional pain.

It would have been the dumbest f.cking thing for me to have done a regional fellowship. Currently, we do a TON of regional at my gig. I'll put my regional skills up against just about anyone. But, come on.....

Sick, complicated hearts, requiring expert level diagnostic TEE, and sick, complicated pediatric cases are a different story. I think we all agree on that. But, yikes on some of these others.....

 

[IlDestriero]

If they offered Regional or OB certification, they would certainly grandfather people into certification process, and you could, assuming you have the requisite volume, sit for the exam, similar to the TEE cert. Peds allowed grandfathering into the exam process for the first 3 years. That door just closed. I'm sure many people took the test, exaggerating their assertion that they practiced the full scope of peds anesthesia at least 1/3 of the time, etc., or whatever it was. Some got bent, but it really doesn't matter to me, as they won't be taking my job at a children's hospital anyway. Those questionably grandfathered in don't want anything to do with neonates and sick kids.

 

[seinfeld]

Tons of Cardiologists practicing that are not echo certified or have let their expiration lapse yet still perform echoes.

there are more TEE certified anesthesiologist in our hospital than cardiologists. I have had interventional cardiologists tell me when covering ICU hat they could have the ECHO tech come in but that i would have to read it as they were not privileged to read echo .