Another barrier excludes physicians who are not certified in internal medicine from being counted as key faculty in internal medicine–based critical care training programs. "In my program, we have anesthesiologists and surgeons who are teaching our fellows, and there’s no good reason they shouldn’t be counted as key faculty," he said.
He and Dr. Brian Wessman, who also spoke at the meeting, cited another ACGME barrier, this one blocking the pipeline of emergency medicine physicians. Internal medicine–based critical care medicine training programs must limit the proportion of emergency medicine trainees to 25% of their programs.
Emergency medicine physicians are the ideal candidates for critical care medicine because their training already includes exposure to undifferentiated critical care patients and development of a "robust procedural acumen applicable to critical care," said Dr. Wessman, an emergency medicine physician and codirector of the critical care fellowship program at Washington University, St. Louis.
There now are three paths to obtaining certification in emergency medicine/critical care medicine, he said. Medicine-based critical care programs limit trainees from emergency medicine to 25% of slots. As of July 2013, emergency medicine physicians could enter surgical critical care fellowships at three institutions. And beginning in the 2014 academic year, 10 anesthesiology critical care medicine fellowship programs will offer an emergency medicine/critical care medicine training tract.
"If you haven’t run across an emergency medicine intensivist yet, you will," Dr. Wessman said. "I think you will see our numbers grow exponentially now that there are ways for us to go forward, if we can remove some of the barriers."
None of the speakers had financial disclosures relevant to this topic. Dr. Pastores reported receiving research grants from Spectral Diagnostics and Bayer Healthcare. Dr. Michota reported financial associations with Boehringer Ingelheim, Daiichi-Sankyo, and other companies. Dr. Wessman and Dr. Auerbach reported having no financial disclosures.
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