Emergency physicians now have a pathway for earning board certification in critical care medicine under an arrangement approved by the American Board of Medical Specialties.
At the end of September, the ABMS board of directors approved a plan to allow emergency physicians to be board certified in critical care medicine through a pathway cosponsored by the American Board of Emergency Medicine (ABEM) and the American Board of Internal Medicine (ABIM). The arrangement allows emergency physicians with additional training in critical care medicine to take advantage of the existing certification available through the ABIM.
Residents in emergency medicine who are interested in critical care medicine board certification would need to meet additional requirements that include 6 months of general internal medicine training. Three months of that training would need to be in an internal medicine–critical care medicine unit.
"I think in the past it’s been quite risky to do a fellowship not knowing if you’ll ever be board certified."
Emergency medicine residents who accomplish this additional training could be accepted into a 2-year internal medicine–critical care medicine fellowship program. Completion of that program will allow them to sit for the ABIM’s critical care medicine certification exam, according to the ABIM.
Emergency medicine residents will be eligible to enter critical care medicine fellowships in July 2012, said Dr. William F. Iobst, vice president of academic affairs at the ABIM. The certification pathway is available for critical care medicine only, not pulmonary critical care medicine, he said.
Emergency physicians who have already trained in an accredited 2-year critical care medicine program, under the umbrella of general surgery, anesthesia, or internal medicine, are eligible to sit for the ABIM critical care certification exam under a "grandfather" provision. These "grandfathered" physicians need to provide documentation that they spend a significant amount of their clinical time in critical care units. The "grandfather" option is expected to be available for 5 years, Dr. Iobst said.
"It’s an opportunity to recognize that there are a certain number of people who have been doing this who have not been eligible to seek certification," Dr. Iobst said. "The real goal here is to ensure that people are meeting a standard and can demonstrate that they are meeting a standard of practice."
Efforts to allow emergency physicians access to some type of U.S. board certification in critical care medicine have been underway for years. Prior to this agreement, the only option open to emergency physicians who completed a critical care medicine fellowship was certification through the European Society of Intensive Care Medicine.
As early as 2006, leaders in internal medicine and emergency medicine began meeting to come up with another option for these physicians. In March 2009, a task force of physicians from the ABIM and the ABEM held a day-long meeting and unanimously agreed that the two boards should cosponsor a critical care medicine subspecialty certification pathway for emergency physicians.
Dr. Debra G. Perina
Dr. Debra G. Perina of the department of emergency medicine at the University of Virginia in Charlottesville and a past president of the ABEM, said the creation of the pathway took time in part because the specialties and programs involved needed to mature. But today, it’s clear that emergency medicine training has evolved so that its competencies are consistent with entering internal medicine graduates, and it has a number of points in common with critical care training, she said.
The availability of the critical care certification is an exciting development, said Dr. Richard N. Nelson, president of the ABEM, and could encourage more emergency medicine residents to consider fellowship training in critical care medicine. "I think in the past it’s been quite risky to do a fellowship not knowing if you’ll ever be board certified," he said. "If you aren’t, then that would limit your employment opportunities."
Even with that risk, the ABEM estimates that about 150 emergency physicians have already completed critical care medicine fellowships. For those physicians, the availability of U.S. board certification could be a big benefit. "That opens the doors for these physicians to seek employment at different hospitals," Dr. Nelson said.
Allowing a greater number of physicians to be board certified in critical medicine will also benefit patients, said Dr. Nelson, who is also a professor and vice chair of the department of emergency medicine at Ohio State University, Columbus. And the addition of emergency physicians to the critical care workforce is a good fit, he said, especially as some emergency departments begin developing their own critical care units.
In some emergency departments, the units are a holding area for patients when traditional critical care units in the hospital are full. In other cases, these new ED-based units are used for patients who need critical care but are likely to be discharged in a short amount of time. Having a physician who is board certified in critical care medicine and emergency medicine would be "ideal" for that situation, Dr. Nelson said.