surg onc board certification

[maverick_pkg]

have heard rumors that surg onc is gonna get board certified with its own boards? anyone else heard that?

what impact do u think it will have - probably make the fellowship more competitive? how about jobs?

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[Winged Scapula]

have heard rumors that surg onc is gonna get board certified with its own boards? anyone else heard that?

what impact do u think it will have - probably make the fellowship more competitive? how about jobs?

This has been talked about for several years now. It is certainly a possibility, but probably several *more* years away. There has been resistance as Surgical Oncology was seen (by non-surgical oncologists) as a specialty that didn't need to be one (much akin to how Breast or MIS is seen). However, the SSO feels that times are changing.

Last year at SSO, the new SSO Board Certification Task Force was introduced and a representative from Vascular Surgery (don't recall his name) talked about the process. One of the major stumbling blocks is the issue of grandfathering in members. Basically, the rep from Vascular said that once they gave up the idea that everyone who was doing X amount of Vascular, Vascular Trained and ACS certified could also be Vascular Certified (ie, "grandfathered in"), they got Certification. Thus, only someone who was trained after X date could be Certified. So his recommendation was that the SSO also give up the idea of Certification - this is, of course, not very attractive to current practitioners as they could not be certified.

From Raphael Pollock, former SSO President:

How board certification in surgical oncology will be implemented is the next order of business. The Directors of the American Board of Surgery, which includes several members of the SSO Executive Council, has unequivocally indicated that the time is ripe to begin this process in earnest. Several of us represent the SSO as members of the Surgical Oncology Advisory Council of the American Board of Surgery, and we are developing a multi-step action plan that will require much concerted effort by all of us to be successful. This process will take several years at a minimum, and will require our fellowships to be accredited by the American Council of Graduate Medical Education (ACGME). Once we have ACGME accreditation, the American Board of Surgery will be able to work with the SSO to develop board certification in surgical oncology. This past year we created a Board Certification Task Force, led by James Goodnight, to advise the SSO Executive Council while providing a direct communication link for you, the members of our Society.

The fellowship is already competitive mostly because of the low number of positions. I'm not sure that it would become significantly more competitive unless an Integrated Track were designed - there are lots of non-BC fellowships out there and it doesn't seem to stop people from applying (ie, people will choose the field because they love it).

 

[thedrjojo]

As a MS interested in Surg Onc, I have an interest in this topic...

One of the attendings I have worked with during 4th year rotations (will not name names) who has a position with the SSO was talking like it was something that would happen very soon, and that, just like Wing's post, that only newly trained Surg Onc Fellows could get certification (meaning that no grandfathering). Also like Winged said, the main resistance is that Surg Onc has so much overlap with many other fields, Gen Surgery as well. Many General Surgeons in practice feel comfortable and still will occasionally do a Whipple Procedure, will do gastrectomies, will do colectomies, will do lumpectomies, thyroidectomies... Surg Onc is a fellowship more for the purpose of making academic surgeons who are proficient in Oncology (since about 75% of fellows in SurgOnc enter academics) and providing training for Surgeons to be at the forefront of the Cancer treatment team, not about giving the fellows training in doing the actual procedures (they gain proficiency and volume and independence, but all general surgery residents are expected to know how to do a Whipple as they can be asked it on the oral boards). This is different with some other fellowship specialties... residents are not expected to be able to know how to do a Liver Transplant... or know Plastic Surgery procedures, and while I am not entirely sure on this so I might be talking out my arse, I don't think it is a requirement to do CABG, valve repairs/replacements. Now, with the new board in Vascular Surgery, did they decrease the requirements of Gen Surg residents in vascular (like, are gen surg residents responsible for an Open AAA? Aortobifem?).

SSO has no intention at this time, as far as I am aware, for making a SurgOnc residency... they intend on it being a fellowship after GenSurg, for the foreseeable future.

 

[surg]

The presidential address given this year by Dr. Michelassi this year at the SSO was on this topic. I also happened to talk to the chair of the ABS recently which corroborated the information as well.

The certificate for "advanced surgical oncology" was approved by the ABS and now goes to the ABMS for approval. This will require approval by the other boards. Some other boards may register opposition (expected is ortho for the overlap in Sarcoma, and possibly oto for the overlap in Thyroid and head/neck cancers). This will then be worked out.

Assuming that this is all worked out, the certificate would only apply to new graduates of ACGME accredited fellowships. It is expected that most of the current SSO fellowships will apply for ACGME approval, although with many of the programs being at free-standing cancer centers, it is unclear what hoops they will need to jump through to qualify. There will be no "grandfathering" meaning that all of us who have already finished SSO fellowships will be out in the cold. Interestingly enough, one other issue will be that when these programs become ACGME approved, that means they have to adhere to ACGME rules of work-hours, supervision, etc. and also NO billing for their fellows. A number of programs supplement salaries, or get partial funding for their fellowships currently by billing for their fellows as surgical assistants or even having them cover certain types of calls or cases (such as port/line placement) on their own.

Look for more details when the SSO presidential address shows up in the Annals of Surgical Oncology in a few months.

 

[Dr.LeoSpaceman]

I wonder if the idea of earlier tracking in general surgery plays any role in this. While interviewing at OSU, Dr. Ellison seemed fairly convinced that the ABS would move to an 4 years of initial training, after which you would take the written boards. You would then move on to complete your training in a specific general surgery track. If that's the case, I would think a board certified surg onc fellowship is almost a necessity.

 

[maverick_pkg]

Thanks a lot guys. That was really helpful

 

[thedrjojo]

The presidential address given this year by Dr. Michelassi this year at the SSO was on this topic. I also happened to talk to the chair of the ABS recently which corroborated the information as well.

The certificate for "advanced surgical oncology" was approved by the ABS and now goes to the ABMS for approval. This will require approval by the other boards. Some other boards may register opposition (expected is ortho for the overlap in Sarcoma, and possibly oto for the overlap in Thyroid and head/neck cancers). This will then be worked out.

Assuming that this is all worked out, the certificate would only apply to new graduates of ACGME accredited fellowships. It is expected that most of the current SSO fellowships will apply for ACGME approval, although with many of the programs being at free-standing cancer centers, it is unclear what hoops they will need to jump through to qualify. There will be no "grandfathering" meaning that all of us who have already finished SSO fellowships will be out in the cold. Interestingly enough, one other issue will be that when these programs become ACGME approved, that means they have to adhere to ACGME rules of work-hours, supervision, etc. and also NO billing for their fellows. A number of programs supplement salaries, or get partial funding for their fellowships currently by billing for their fellows as surgical assistants or even having them cover certain types of calls or cases (such as port/line placement) on their own.

Look for more details when the SSO presidential address shows up in the Annals of Surgical Oncology in a few months.

Michelassi alone almost had me wanting to go to Cornell for Residency. He did a great job of selling that residency on the interview day. It will be interesting to see how this pans out over the coming years... hopefully it gets ironed out within 7 years for a potential start of my fellowship If it is ACGME approval needed, will that surplant the SSO approval of SurgOnc fellowships, or will the both now be needed to approve? If that is true, it might actually increase the number of programs, because I know the SSO has a current hold on any new programs being recognized, and I know at least Mt. Sinai of places who currently have non-SSO fellowships who at least claims to want SSO recognition and, according to the PD of the Gen Surgery program, will get SSO recognition once the hold is released and new programs are accepted. Also, does that mean that the SSO match, which is currently run in conjunction with HPB (first time this year, don't know how it worked out), will then be run by ERAS/NRMP, or can they keep the match process independent?

 

[surg]

On tracking: there are a number of powerful people who believe in tracking, including many on the ABS board. Still a number of hurdles to overcome before that becomes a reality, many of which are logistics. Baseline hurdles include, whether you allow transfer between programs to get to tracks that you want to be in but aren't offered at your institution (not currently allowed for the vascular integrated track or CT integrated track, but is allowed for those transferring to plastics before finishing general surgery), whether tracked people get a general surgery certificate, which tracks are available, how early do tracks start, etc. We also need some time for some of us to mourn the official passing of "general surgery" as a widespread baseline for all specialists. (Not going to open the debate here, it's as much an emotional thing as an actual thing to acknowledge what has been happening with fewer and fewer of us truly practicing the entire breadth and depth of general surgery and won't ever go back).

As far as SSO, don't have a source within that committee (actually come to think of it, I do, but never put it together until just as I typed that, so I haven't asked him about it specifically), who knows. Just as an FYI, the "hold" on SSO fellowships was lifted I believe since Louisville got their fellowship about 2 years ago, along with Brigham/MGH which were the first new fellowships in a while. I know of a number of places with programs in the works. These developments could put this on hold again, although I'd note that the ACGME is likely to not adhere to any limits, and thus this could lead to an explosion of programs with every large general surgery residency going after one, OR it could lead to a contraction as the free standing centers have trouble meeting ACGME requirements from an institutional side (even if they meet RRC requirements for a specific program, you have to have a sponsoring institution that meets ACGME criteria overall) or have funding issues (if you can't bill for your fellows, and there is no more Medicare money to get extra slots, then where does the 100K+ you need to train a fellow each year come from?). Not sure if there are rules on the match, but since Urology ran their own match for a while (albeit with a blow-up that led to using NRMP later), I assume that if desired, SSO could continue to run the match. Don't feel like combing through the rules to find out though.

 

[Winged Scapula]

The SSO embargo on new programs is only for Breast Fellowships; it has been lifted for Surg Onc training.