Ultrasound in CCM fellowships

[nymbarra]

I am interested in the use of ultrasound in critical care.

Would it be possible to obtain RDMS and/or RDCS certification during CCM fellowship? Is this common, or do those that have it, obtain it while as attendings? Or separately in an ultrasound fellowship?

Any thoughts would be greatly appreciated.

Thanks!

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[deuist]

I've wondered the same thing. Since the ACGME only requires 12 months of your fellowship be spent in the ICU, could you spend the next 12 months doing ultrasound? I've also wondered if you could use the second year to study echocardiography and take the echo boards instead of RDCS. Since I'm only an EM-1, I've got a while to go before investigating it more.

How you found out anything since you first posted this message? What do CCM fellows do with their second year?

 

[Stitch]

I'm peds, but this is an area of interest to me as well. I feel ultrasound is useful for more than just lines, and there's definitely some research going on. One of the adult CCM guys next door is pretty enthusiastic about it as well and is trying to publish on a number of topics, though I don't know specifics. There was also a recent course in Chicago on critical care ultrasound use.

If adult fellowships function similar to peds ones in terms of time, I interviewed at a number of places willing to let me get certified in ultrasound during my research months. The issue tends to be billing, and you really need your radiologists on board with it. They often view it as stealing money out of their pockets.

 

[deuist]

That's odd that you would need permission from the rads department. RDMS' application only states that you need 800 scans in one area of the body (e.g., abdomen or vascular). It mentions nothing about needing a radiologist's signature. In fact, the emergency medicine ultrasound fellowships are taught completely in house without any input from the radiology department. I imagine that you could set up shop in the ICU and belly scan every child that comes in without performing it as a formal procedure and billing them.

 

[Hamhock]

That's odd that you would need permission from the rads department. RDMS' application only states that you need 800 scans in one area of the body (e.g., abdomen or vascular). It mentions nothing about needing a radiologist's signature. In fact, the emergency medicine ultrasound fellowships are taught completely in house without any input from the radiology department. I imagine that you could set up shop in the ICU and belly scan every child that comes in without performing it as a formal procedure and billing them.

must be reviewed by a RDMS

first question you must answer: why RDMS vs. becoming proficient without a technician's certificate?

HH

 

[deuist]

While you are correct that proficiency is key, RDMS is a national standard that hospitals recognize for credentialing. Also, I think that you can bill for bedside ultrasounds as a physician if you are RDMS certified.

 

[Yodelayheehu]

You can actually bill for diagnostic or procedural studies without an RDMS, it's up to your hospital/department as to what proficiency requirement you need. You just have to generate appropriate documentation. In some markets you have to produce a picture for the medical record, in others you don't. Radiology often weighs in on this though and may stonewall you, but there is AMA policy stating impeding the use of US by other services for financial reasons (which it usually is) as an ethical violation you can take up with them.

I am not sure an RDMS does much for you, since in CCM most studies are point of care and focused to answer a question instead of composing a complete diagnostic study. Most of what I use the machine for is echo as opposed to looking for gall bladders and DVTs. The ACCP offers an expensive course where you can get certification (you will HAVE to go to Hawaii this year for the last part of the course) if you want something on paper. However no one I know requires this certification to bill, it's usually up to your department and hospital.

If you are interested in echo, I think a few places offer echo fellowships for non-cardiologists but I am not up to date with the folks who are offering this now.