prankster

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I am currently a resident in an osteopathic (four year) emergency medicine program. Now that I am past the internship phase, I've started looking at fellowship opportunities. I found during my trauma surgery and ICU rotations that I have a strong interest in CCM. I have read into the fact that EM-trained critical care doctors cannot currently get board certified, which I am fine with. However, there are certain questions which I have not been able to find the answer to:

1) Would the fact that I am an osteopathic residency graduate preclude me from applying to allopathic CCM fellowships that take EM grads?

2) Does anyone know of any CCM fellowships that take osteopathic EM grads other than St. Luke's?
http://www.mystlukesonline.org/for-healthcare-professionals/resident-education/trauma-critical-care-fellowship-physicians/index.aspx

Thanks in advance.
 

Dwindlin

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I am currently a resident in an osteopathic (four year) emergency medicine program. Now that I am past the internship phase, I've started looking at fellowship opportunities. I found during my trauma surgery and ICU rotations that I have a strong interest in CCM. I have read into the fact that EM-trained critical care doctors cannot currently get board certified, which I am fine with. However, there are certain questions which I have not been able to find the answer to:

1) Would the fact that I am an osteopathic residency graduate preclude me from applying to allopathic CCM fellowships that take EM grads?

2) Does anyone know of any CCM fellowships that take osteopathic EM grads other than St. Luke's?
http://www.mystlukesonline.org/for-healthcare-professionals/resident-education/trauma-critical-care-fellowship-physicians/index.aspx

Thanks in advance.
Isn't this changing soon?
 

Dwindlin

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MTGas2B

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One of my fellowship colleagues was EM trained. He took a full time CCM position after fellowship. His contract said he was required to become board certified in CCM. He was excited about the possibility of ABIM board certification, but last I talked to him he hadn't heard any more on that becoming a reality.

The option he was actively pursuing was the European CCM boards, which he was eligible to take. His contract didn't I have heard of other EM trained folks doing the same.
 

jdh71

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One of my fellowship colleagues was EM trained. He took a full time CCM position after fellowship. His contract said he was required to become board certified in CCM. He was excited about the possibility of ABIM board certification, but last I talked to him he hadn't heard any more on that becoming a reality.

The option he was actively pursuing was the European CCM boards, which he was eligible to take. His contract didn't I have heard of other EM trained folks doing the same.
You can sit for IM CC boards BUT only after finishing a 2 year IM critical fellowship.

I know many docs attempt to use the European CC boards as a "back door" of sorts since the gas/surgery folks are being jerks about it, and it also seems that many hospitals are accepting this.
 

Coastie

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You can sit for IM CC boards BUT only after finishing a 2 year IM critical fellowship.

I know many docs attempt to use the European CC boards as a "back door" of sorts since the gas/surgery folks are being jerks about it, and it also seems that many hospitals are accepting this.
What are those folks doing, and why?
 

jdh71

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What are those folks doing, and why?
Gas and some Surg CC fellowships would allow EM trained people to spend a year with them, but their respective boards were not allowing them to sit for CC boards, and thereby denying them the "board certification"

EDIT: As to "why"? Your guess is as good as mine.
 

EMCritCare

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Gas and some Surg CC fellowships would allow EM trained people to spend a year with them, but their respective boards were not allowing them to sit for CC boards, and thereby denying them the "board certification"

EDIT: As to "why"? Your guess is as good as mine.
Despite several anesthesia CCM programs accepting EM residents as fellows (MGH, Brigham, Wash U, Johns Hopkins, UCSF) and years of intermittent ongoing discussions between the ABA and ABEM regarding access to the ABA CCM exam, the status quo persists.

The recent historical lack of anesthesiology resident interest in CCM fellowships led some anesthesia CCM program directors to view EM residents as warm bodies to staff the units and keep the programs going ("better to have an acceptable fellow rather than no fellow"). Other anesthesia CCM programs (Univ. of Florida) came to view EM residents as a good fit, and some PDs came to openly advocate opening the ABA CCM exam to EM folks. However, in spite of intermittent ongoing discussions for several years now, the best the ABA offered was the prospect of combined anesthesia/EM residencies leading to primary board certification in both. Hybrid residencies involving EM (EM/IM, EM/IM/CCM, EM/Peds, EM/FM) are already available, but they do not fundamentally address the need for direct access to CCM training and ABMS certification. EM/IM and EM/IM/CCM have already been held forth as abortive compromises in a similar vein from past negotiations between ABIM and ABEM.

As to why the ABA refused to allow access to their CCM exam for fellows with primary training in EM, I can only speculate. Some recent hearsay suggests that the most recent round of discussion between ABEM and ABA died in the wake of the agreement between the ABA and ABS to allow reciprocal recognition of CCM training for surgery trained fellows in anesthesia accredited programs wanting to sit for the surgical CC exam and anesthesiology trained fellows in surgery accredited programs wanting to sit for the anesthesia CCM exam.

While R. Adams Cowley Shock Trauma is the longstanding example of a surgical CC program willing to take EM residents as fellows and advocate for their access to the surgical CC exam, the leadership at the ABS level has historically been strongly opposed to allowing exam access. Although surgical CC programs have had recent fill rates better than anesthesia CCM programs, the cynicism involved in taking EM residents into surgical CC programs to fill the void left by surgeons who much prefer the OR to the ICU, while stalwartly refusing them access to the ABS exam, still staggers me. To add insult to injury, OB/GYNs who complete training in a surgical CC fellowship have been eligible to take the ABS exam for many years now.

While the surgical CC PDs have recently released a concensus statement openly advocating access to surgical CC certification for EM trained fellows, I am not holding out much hope on this front for the short to intermediate term. In the case of the ABS, I believe that the board of directors is just too conservative to work this out with EM and that the concurrent push for a unified acute care surgery/trauma surgery/surgical CC identity will only serve to hamper EM's progress in this matter.
 
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EMCritCare

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I am currently a resident in an osteopathic (four year) emergency medicine program. Now that I am past the internship phase, I've started looking at fellowship opportunities. I found during my trauma surgery and ICU rotations that I have a strong interest in CCM. I have read into the fact that EM-trained critical care doctors cannot currently get board certified, which I am fine with. However, there are certain questions which I have not been able to find the answer to:

1) Would the fact that I am an osteopathic residency graduate preclude me from applying to allopathic CCM fellowships that take EM grads?

2) Does anyone know of any CCM fellowships that take osteopathic EM grads other than St. Luke's?
http://www.mystlukesonline.org/for-healthcare-professionals/resident-education/trauma-critical-care-fellowship-physicians/index.aspx

Thanks in advance.
The OP's question is an interesting one. However, I think the medical students who replied failed to understand the intent of the question. The OP is not asking whether or not ABMS certification will be available to EM trained CCM fellows. He is not asking whether or not there are CCM fellowships that accept DOs.

According to my reading, the specific intent of the question is to figure out whether there are CCM fellowships willing to accept DOs who have completed primary residency training in an OSTEOPATHIC (non-ACGME accredited) residency program. Such candidates would not be boarded in EM by ABEM. They would only be eligible for the osteopathic EM boards (AOBEM). Discussing the implications of the proposed ABIM ABEM CCM co-sponsorship is meaningless for someone who will not be ABEM boarded.

Having said that, here are my thoughts/best guesses regarding the original questions.

1) Would the fact that I am an osteopathic residency graduate preclude me from applying to allopathic CCM fellowships that take EM grads?

Due to the fact that the allopathic CCM training landscape is currently in flux given the proposed ABEM ABIM CCM co-sponsorship, it is likely that ABEM board eligible MDs and DOs who complete training in an ACGME accredited allopathic EM residency will soon be eligible to sit for the ABIM CCM exam after completing an ACGME accredited 2 year IM CCM fellowship. In such programs, where the number of training spots is under ACGME oversight and the intent of PDs is usually to train people who are ABMS board eligible, it seems less likely that non-ABMS eligible DOs will be accepted. If there is strong interest from ACGME accredited EM program graduates in IM CCM fellowship spots (which is entirely plausible, but remains to be seen), the likelihood of acceptance at such programs is even lower.

However, just as ACGME accredited anesthesia CCM, surgical CC, and IM CCM programs accepted graduates of ACGME accredited EM programs in the past when there was no hope of ABMS certification in CCM, there is probably some degree of latitude based on the need for warm bodies/labor, quality of the individual applicant, the PD's own feelings on the issue, his/her ability to secure funding for the candidate, and his/her relationship with departmental leadership.

Having said that, my own guess is that a lack of completed prior residency training in an ACGME accredited program is probably going to be a deal breaker at the vast majority of ACGME accredited (anesthesia, surgical, IM) CCM programs.

2) Does anyone know of any CCM fellowships that take osteopathic EM grads other than St. Luke's?

The OP listed St. Lukes specifically because their website states that they will take AOBEM eligible or certified candidates. The program at St. Lukes is not an ACGME accredited surgical CC fellowship. St. Lukes is home to both ACGME and American Osteopathic Association approved EM residencies, which probably contributes to their willingness to take AOBEM eligible candidates into the trauma/CCM program.

At present, I am not aware of other places with similar set-ups. I would suggest looking into other non-ACGME accredited CCM programs which actively recruit EM candidates (IU's EM-CCM program, BIDMC's EM-CCM program, Univ. of Alabama' s EM-CCM program, North Shore LIJ's EM-CCM program, etc). These programs probably have more latitude in candidate selection, although again a lot of the factors listed above will still come into play. In addition, there is hearsay/speculation that some of these programs may choose to seek ACGME accreditation via merging with IM CCM training pathways at their respective institutions in order to access ABMS certification for ABEM eligible candidates. Some places, like BIDMC, will probably not take an AOBEM candidate regardless due to institutional attitude/environment.

One other possibility to look into is AOA approved programs in CCM and surgical CC. These programs exist and obviously would recognize completion of residency training within an osteopathic program, even if there is no osteopathic CCM exam which you can take as an AOBEM primary boarded candidate. Are the AOA approved CCM and surgical CC fellowships popular among osteopathic IM and surgery residents? Do they consistently fill? If not, you may be able to find a way in as an osteopathic EM residency trained candidate.
 
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EMCritCare

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As far as programs that would take Osteopathic grads, my program, University of Washington, would take DOs.
I have heard good things about CCM training at Univ. of Washington. EM residents have asked me about this programs, and I have not really been able to tell them much. Perhaps you can help shed some light.

1) Univ. of Washington has both ACGME anesthesia CCM and IM CCM fellowships. I have heard that EM candidates accepted for CCM training in the past came in via the anesthesia CCM program. Is this true?

2) Given the hoped for ABMS approval of the ABEM ABIM CCM co-sponsorship, is Univ. of Washington currently tracking its EM trained fellows into the IM CCM program, or planning on taking EM candidates via the IM CCM program in the near future?

3) While it is not surprising that Univ. of Washington would accept DO fellows who completed primary residency training in an ACGME (allopathic) accredited program, it is unique that they would accept DOs whose primary residency training was completed in an osteopathic (AOA accredited) program. To borrow from the IM training world, it is rather tough (but not unheard of) for DOs from AOA IM residencies to get into less desirable ACGME IM fellowships. The relative unpopularity of CCM amongst anesthesiology residents certainly allows for the parallel example of an AOA anesthesiology resident getting into an ACGME anesthesia CCM fellowship. However, I still wonder how an EM candidate from an AOA program would fare given the added wrinkle of applying to an officially unrecognized (neither ACGME/ABEM/ABA nor AOA/AOBEM/AOBA) subspecialty training pathway.

I guess the only way to find out would be to ask the PD.
 
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prankster

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Thanks everyone for their responses. CritCare, that's exactly what I was asking. My question was concerning the fact that I will be a grad of a non-ACGME residency and therefore won't have ABEM certification. I assumed that would make things tougher. I will look into AOA CCM programs and contact PD's of allopathic CCM programs and see what they have to say.
 
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prankster

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Just to expand on my original question, my goal is to practice CCM after doing a fellowship. I would also like to work in EM as well, but the point in doing the fellowship would be to be able to practice as an intensivist. Would doing a non-ACGME fellowship For ex IU or UAB make any difference in job prospects? Will not having board certification make a big difference?

I saw that St. Luke's is a one year fellowship, as is UAB (expandable to two yrs if you want to do an MPH). Considering that most if not all IM-CCM programs are two years, is one year enough to get a good grasp on CCM? Anyone have any experience or has anybody heard about the training at these non-ACGME programs?

Thanks.
 

EMCritCare

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Just to expand on my original question, my goal is to practice CCM after doing a fellowship. I would also like to work in EM as well, but the point in doing the fellowship would be to be able to practice as an intensivist. Would doing a non-ACGME fellowship For ex IU or UAB make any difference in job prospects? Will not having board certification make a big difference?

I saw that St. Luke's is a one year fellowship, as is UAB (expandable to two yrs if you want to do an MPH). Considering that most if not all IM-CCM programs are two years, is one year enough to get a good grasp on CCM? Anyone have any experience or has anybody heard about the training at these non-ACGME programs?

Thanks.
Would doing a non-ACGME fellowship make any difference in job prospects?

Yes, there are groups/institutions that will not hire/credential someone who did not complete an accredited fellowship and is not eligible for board certification in the US by a traditional route. However, given the current shortage of intensivists in the US and ever increasing demand for end of life care for babyboomers, there are places that do/will make exceptions based on local staffing needs, relative desireability of location, individual contacts/connections within the institution, etc. By the same token, there are CCM jobs where only board certification in pulm/CCM is acceptable due to the staffing model in place and being an EM trained intensivist will not be accepted regardless of future access to ABMS certification.

With regards to the graduates of IU and UAB, they have found jobs splitting time between ED/ICU and full time ICU jobs in some cases.
IU's recent graduates have been hired within the IU system (http://iu-iusm-emer.ads.iu.edu:8081/iuem/fellowships/em-critical-care/current-fellows).
UAB has had a graduate hired by VCU (Michael Abatazis, http://www.vcu.edu/mcved/faculty1.html). I believe that he splits time between ED/ICU.
In fact, the PD of the UAB EM-CCM fellowship is a DO (Amy Fellman, http://medicine.uab.edu/EM/Residency/61432/) who did her EM residency in an osteopathic program at Garden City Hospital.

Alumni from the St. Lukes trauma/CC fellowship have been hired by St. Lukes and seem to work in the ICUs there (Jennifer Axelband, DO; Tony Luizza, MD; Marc Portner, MD; http://www.mystlukesonline.org/for-healthcare-professionals/resident-education/allopathic-and-application/faculty/bethlehem-faculty.aspx).


Will not having board certification make a big difference?

The lack of traditional board certification (ABMS) does currently make a difference and will very likely continue to make a difference in the future, especially if ABMS allows ABEM to co-sponsor the ABIM CCM exam. In the past and present, given the lack of access to ABMS certification in CCM, EM intensivists used a few work arounds to satisfy hospital credentialing committees via alternative boards.

Many completed the written and oral CC boards in Europe (EUROPEAN DIPLOMA IN INTENSIVE CARE MEDICINE (EDIC, http://www.esicm.org/Data/ModuleGestionDeContenu/PagesGenerees/03-education/0A-european-diploma/11.asp). This exam is open to EM physicians. Some hospitals and academic medical centers will accept this as CC board certification for EM physicians.

Some used their CC fellowship time and/or actual post-fellowship practice time to apply for board certification in neurocritical care via the United Council for Neurologic Subspecialties (UCNS). The UCNS is a US organization that accredits fellowships and provides certification in various non-ACGME accredited programs/non-ABMS neuro subspecialties. EM intensivists could apply via the "practice track pathway" and sit for the UCNS neurocritical care exam (http://www.ucns.org/go/subspecialty/neurocritical/certification). To some extent, this may restrict one's hospital privileges/scope of practice, but it helps satisfy the need for some type of recognized board certification that is open to EM physicians. However, the practice track pathway will be closing soon.

Some recent EM residents have chosen specifically to go into UCNS accredited neurocritical care fellowships because the UCNS exam is open to EM physicians. Univ of Cincinnati EM has sent several recent graduates into the Univ of Cincinnati neurocritical care program. These folks have been able to take the UCNS neurocritical care boards and work in the neuroICU.

So, people were able to find work arounds for the lack of access to ABMS certification in CCM. Plus, as noted above, the overall shortage of intensivists and local factors can sometimes work in your favor.

Considering that most if not all IM-CCM programs are two years, is one year enough to get a good grasp on CCM?

It all depends on the program and the intensity/quality of the training. Some 1 year programs may compress the same number of actual primary ICU blocks done at some 2 year programs into a 1 year format. Obviously, this would affect the amount of time available for other rotations, electives, research, etc.

Anyone have any experience or has anybody heard about the training at these non-ACGME programs?

I have heard good things about the IU program.
 

MTGas2B

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1) Univ. of Washington has both ACGME anesthesia CCM and IM CCM fellowships. I have heard that EM candidates accepted for CCM training in the past came in via the anesthesia CCM program. Is this true?
Yes, but the two programs are somewhat paired up. Most the rotations for the Anes/CCM fellows are the same as the first year Pulm/CCM fellows.

2) Given the hoped for ABMS approval of the ABEM ABIM CCM co-sponsorship, is Univ. of Washington currently tracking its EM trained fellows into the IM CCM program, or planning on taking EM candidates via the IM CCM program in the near future?
Last few EM fellows to come through have been via Anes/CCM. As noted in my reply the program is closely related to the IM program. I don't know if they IM guys are looking at taking EM folks, but for my EM trained co fellow he said the IM CCM program direct would attest to the fact that the programs are indistinguishable.

3) While it is not surprising that Univ. of Washington would accept DO fellows who completed primary residency training in an ACGME (allopathic) accredited program, it is unique that they would accept DOs whose primary residency training was completed in an osteopathic (AOA accredited) program. To borrow from the IM training world, it is rather tough (but not unheard of) for DOs from AOA IM residencies to get into less desirable ACGME IM fellowships. The relative unpopularity of CCM amongst anesthesiology residents certainly allows for the parallel example of an AOA anesthesiology resident getting into an ACGME anesthesia CCM fellowship. However, I still wonder how an EM candidate from an AOA program would fare given the added wrinkle of applying to an officially unrecognized (neither ACGME/ABEM/ABA nor AOA/AOBEM/AOBA) subspecialty training pathway.

I guess the only way to find out would be to ask the PD.
Never heard about anyone trying this. I don't know what logistical/administrative issues surround making this work. Knowing my program director, on the Anes/CCM side, unless there was some administrative nightmare involved in taking fellow trained in an osteopathic residency, I don't see why he wouldn't take one. His email is on the program website.