Procedural certification in different Pulm/ICU procedures

[ILikeMilk]

So when I'm done with fellowship, how many of each of these procedures would I need to be able to do them in practice? EBUS, PleurX, Perc Trachs, PEGs in the ICU, Navigations, Cryobiopsies (Or is this IP only?). Who sets the numbers, is it the board or the institution? And if the latter, what are some approximate numbers I should have? Currently a 2nd year and just planning out how many procedures I need to leech to get my numbers. Not saying I would want to do each of those, like I don't have much of an interest in PEGs, but I'm just curious. Thanks in advance!

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[chessknt]

There is no definite answer since every hospital is different. Academic centers tend to require much higher numbers or restrict them to certain specialties (eg trach/peg), community hospitals may require only a few (I was credentialed for airways as an IM resident based on completing an ACLS course at one hospital for reference)

 

[Doctor Bob]

The accrediting body for the fellowship determines how many procedures you need to complete before finishing fellowship in order to graduate. Sometimes this number is "whatever your PD requires to declare you competent", sometimes it's an actual number.

The hospital you go to work at will have their own number in order to be eligible for privileges in that procedure. Or some places, for your first job out of fellowship, will accept the competency list that your program provides in lieu of actual numbers. It's extremely varied.

Best plan... get as many numbers as you can during training regardless of whether you plan on doing the procedure after fellowship.

 

[CCM-MD]

Varies from hospital to hospital.

 

[jdh71]

So when I'm done with fellowship, how many of each of these procedures would I need to be able to do them in practice? EBUS, PleurX, Perc Trachs, PEGs in the ICU, Navigations, Cryobiopsies (Or is this IP only?). Who sets the numbers, is it the board or the institution? And if the latter, what are some approximate numbers I should have? Currently a 2nd year and just planning out how many procedures I need to leech to get my numbers. Not saying I would want to do each of those, like I don't have much of an interest in PEGs, but I'm just curious. Thanks in advance!

In general you can apply for whatever privilege you want. You’ll probably get it too, UNLESS there is a service that has a stranglehold on the particular procedure at the institution. The chair of medicine at the institution will approve, approve with conditions or deny. In the community there isn’t a strong interest in preventing doctors from practicing as long as it reasonable. You might also not want to apply for all of it either, especially if the environment won’t support YOUR potential complications. To be honest I don’t really know why you’d want to do anything other than bread and butter critical care *management* procedures and anything with a bronch. You’re likely not adding enough production to your totals by doing trachs and pegs every once in awhile for instance to make the time you might take to do them worth it. Best to just see patients. Also something else to consider once you touch them you own them. Put that trach in? Be prepared to see them in clinic about it until it’s gone. You’ll end up with some of this anyway because of the people doing these procedures refusing to follow their own work.

 

[CCM-MD]

I do my own trachs and I am not IP. Need supportive surgeons. Not financially worth it, see below. I just enjoy doing them.

Elective tracheostomy = 5.56 wRVU
Critical care time 30-74 minutes = 4.5 wRVU