Adapted from ACEP's Critical Care Section
Can an emergency medicine resident become board certified in critical care medicine?
Internal Medicine
Residents from Emergency Medicine can now do a 2 year internal medicine critical care fellowship and get certified through ABIM. There is also a grandfathering track.
Surgery
Residents from 2012 on can get certified through ABS. It is a 2 year fellowship, but one of the years will be a rotating surgery experience. No grandfathering (grandmothering?)
Anesthesia
Finally, an agreement has been reached. All of the details are here:
Do Critical Care fellowships accept EM residents?
Definitely and we are very desirable to these programs. For more information on this question and a bunch of others, go to the Association for Emergency Medicine-Critical Care Medicine Program Directors (AEMCCMPD).
How long is a critical care fellowship?
All certification-track fellowships are two years in length. The advantages of a two-year fellowship are that it: 1) allows more training and diversity in your education, 2) puts you on an equal standing with other intensivists, and 3) gets you certified.
Will I be able to get a critical care job after fellowship?
Yes. Many emergency medicine physicians are currently employed as intensivists in both private and teaching hospitals, some even as medical directors. In addition, the field of critical care in general is facing a time of tremendous growth. The COMPACCS (Committee on Manpower for Pulmonary and Critical Care Societies) study published in JAMA demonstrated that there would be a growing need for intensivists in the near future. The Leapfrog Group, a consortium of Fortune 500 companies and healthcare consumers, has set three healthcare priorities for improvement in quality care, one of which is that all intensive care units be staffed by trained intensivists. In fact, the Leapfrog Group considers emergency medicine physicians with critical care training intensivists. With these powerful demographic and economic pressures, we anticipate a promising job market for critical care physicians, regardless of their base specialty.
Will emergency medicine training prepare me well enough to be a strong critical care fellow?
Yes. While other specialties bring their strengths into fellowship programs, your familiarity with handling critically ill patients at their initial presentation, experience with juggling multiple patients at once, and training in “sniffing out” the potential disasters from a sea of undifferentiated complaints will serve you well during fellowship. If you look at the core curriculums of emergency medicine and critical care, you will find that to a large degree our areas of knowledge overlap, particularly in the areas of resuscitation, technical skills needed for “crashing” patients (i.e., intubation, central lines, chest tubes), and exposure to both surgical and medical emergencies. Remember that nobody comes to a fellowship with nothing to learn.
How will a critical care fellowship enhance my career as an emergency physician?
Having a “niche” will always help your career, by keeping your interest level high, allowing greater research and administrative opportunities, and by making you a highly sought after expert in your field. Emergency toxicologists, pediatric emergency specialists, sports medicine emergency specialists, and hyperbaric emergency specialists exist, thrive, and add to the strength and breadth of emergency medicine. There is certainly room for emergency critical care specialists!
A recent NEJM paper demonstrated the importance of aggressive, early care for critically ill patients in the emergency department. By training in critical care, you will not only enhance your ability to manage critically ill patients, but will also be well positioned to coordinate the expanding role of emergency medicine in the care of the critically ill. With the increasing problems of overcrowding and long emergency department times, sicker patients will be in the emergency department and under your direct supervision, whether we feel prepared to care for them or not. Another possibility is the staffing of observation units by physicians with training in both emergency medicine and critical care.
Finally, working in both the emergency department and the intensive care unit may help prevent “burnout”, by offering a change of pace and different challenges on a daily basis. The more cerebral and controlled environment of the unit can be an interesting counter-balance to the frenzied and chaotic pace of the emergency department. Many of us find the combination of these two environments to be tremendously rewarding.
Which programs do you recommend?
These are the fellowships which I recommend for ED residents because they actively want as opposed to begrudgingly accept ED residents:
- Shock Trauma Center (Baltimore) [Surgical and Medicine]
- Indiana University [Anesthesia]
- University of Pittsburgh {Anesthesia and Medicine]
- Henry Ford
- Cooper
- Beth Israel (Boston)
- University of Alabama
- University of Michigan [Anesthesia and Medicine]
- University of Iowa
- Stanford
- University of Washington (anesthesia track and recently began also training via the IM route)
- University of Nebraska
- UC San Diego
- Geisinger
- Emory
- Hennepin
Resuscitation Fellowship
Want to master resuscitation and ED Critical Care, but never want to work in an ICU? Consider Stony Brook's 1 year advanced training in resuscitation.
My friend, Seth Manoach, adds the following:
Stanford Anesthesia has always actively welcomed ER guys, and now, in their Pitt style multi-disc track they put out the welcome for us but say to apply under medicine
Hopkins Anesthesia's director has said the same thing, they actively welcome ED applicants
Also Wash U St. Louis Anesthesia, actively welcomes and has had a two year track for EM people since the deal talk started
And Ali Dabaja writes in to say:
You should add the 2-year track at University of Florida through Anesthesia; they actively recruit EM
What about Neurocritical Care?
These folks came through for us. Many of have certified. The window for grandfathering will be closed as of 2014?
How about passing the certification exams?
This excellent post discusses the British exam.
Where can I find additional resources?
- EMRA Critical Care Committee
- ACEP Critical Care Section
- SCCM Emergency Medicine Section
- C3MED
- Association for Emergency Medicine-Critical Care Medicine Program Directors (AEMCCMPD).
How about some relevant references?
- Bill Chiu wrote an article in J. Trauma
- Wesserman on ED Critical Care Fellowships
- White Paper on Where we should be Going1
- Prepping Residents to Apply to Crit Care 1
- Prepping Residents to Apply to Crit Care 2
- EMCCM Job Listings
Hi, Im a second year Emergency Medicine Resident in Mexico. I know that to be able to practice medicine in the United States, I have to pass the Board examination. Nevertheless, I know a lot of physicians down here that go to the United States for a Fellow training. Do you know if it is at all possible to do that in ICU training?
Tx for your time, you have a GREAT project here!
Fernando
Fernando,
if a program likes you, they’ll train you.
hi
how can have the critical care fellowship programme?
thax
Hi, Thanks for all the information on your website – it’s a great resource. The answer to the first question on this page about our ability to be boarded in critical care doesn’t say that we are able to, though the last question (and link) says we can. I just want to confirm that we are now indeed able to get boarded through internal medicine (even without the EM/IM/CC pathway you mention), correct?
how can have the critical care fellowship programme?
thax
Dr ALOSERT
I finished the egyptian board of emergency medicine & i would like to join a critical care fellowship?
Thanks for your time
This blog was VERY informative. Thank you very much. I am extremely interested in a Critical Care fellowship after ER and to find out that there are one year programs out there is an even bigger joy. Im currently a 3rd year medical student in NY and doing medicine as my second career. Im a non traditional and have always enjoyed ICU but ER as well. To know that I can potentially combine the two in 4 years is AMAZING to me. thank you for the info
Hi Jijoe – would strongly urge you to do a 2 year CCM Fellowship – reasons are numerous, pragmatic, and educational – also 1 extra year pales in comparison to the rest of your career – even if this is your 2nd career! – Best, David H
Agree!
I am working in critical care medicine for last 7 years in india. I did post graduate diploma in anaesthesiology and indian diploma in critical care medicine . Kindly advice me how can i go about in pursuing a fellowship in critical care medicine in usa or uk.
I am a 4th year EM resident in NYC and just received word that an Anesthesiology 1-year critical care fellowship is looking for EM applicants. I was wondering if it makes a difference whether certification is via Anesthesia vs Internal Medicine. Also wondering if it matters if I only do 1 year of fellowship vs doing a 2 year fellowship. As I am from a 4-year EM 1 year would be more ideal. I just want to know how these two things would impact my job prospects once I graduate.
You should add the 2-year track at University of Florida through Anesthesia. They actively recruit ED physicians.
Hopkins through anesthesiology are actively recruiting EM folks, they had at least one EM fellow each year for the past 3 years.
Your info on Neurocritical Care is not complete. I’m EM trained and currently a 1st year fellow at Wash U in St. Louis in the Neuro ICU. Neurocritical Care is still recruiting EM grads to fellowship and offering certification. Here’s a link:
http://www.ucns.org/go/subspecialty/neurocritical/certification
Hi Scott,
Do you know how many EM trainees there are in the USA and how many of them do critical care fellowships (in medicine, surgey and anesthesiology programs)?
Thanks,
Steve
Hey Scott,
I’m an EM grad currently in a trauma and surgical CC fellowship. We’ve been told that ABS has given us the green light for board certification, and that at least some of us currently in fellowship will be board eligible. The ‘prelim’ year is still being worked out, but another pathway for EM trained intensivists it open.
Hi,
I passed a 3 year program in emergency medicine in Iran and i have 3 years of experience in a teaching hospital there. is it possible for me to take part in an intensive care fellowship program? what should i do?
Hi,
graduating 3rd year EM resident looking at CC fellowships, do you know if there is a difference in job or position availability based on the type of CC fellowsip you do? That is, if I get a surgical CC fellowship, will they still hire me to work in an ICU, not as a surgeon?
Thanks,
jim
MICUs will generally want you to be medicine boarded
Agree with Rob Alundai: Neurocritical Care is also a very valid option for EM physicians willing to train in critil care and looking at a non-segregating fellowship with a definite board certification as Leapfrog recognized intensivist. Of course, it is with an additional nich in neurologic and neurosurgical critical care specialization, which does not appeal to everyone, but something to consider, because actaully, the future of critical care is sub-sub-sub-specialization. And it is actually a shorter training for them if they completed EM residency and EM/CCM fellowship (NB: EM/CCM fellowship, not necessarily EM/IM/CCM track), as UCNS allows you to sit… Read more »
Hi, Im currently a 3rd year resident in EM in Mexico, ECFMG certificate holder, am I eligible for fellowship trainig and if so, will I be able to practice in the US?
I am a final year Emergency and Critical Care Nursing Masters student from three consortium Universities of Helsinki Metropolia University (Finland), University of Oviedo (Spain), University of Algarve and Institute Polytechnic of Santarem (Portugal). Is it possible for me to take up fellowship training?
I have liked one of the course unit for Crisis Resource Management (CRM); an adaptation from the Aviation Industry as applied in Health and wish this could be taught at undergraduate level to enhance teamwork concept.
Hi! Finished EM at UCLA, now in my first year of CCM at Montefiore — a program that loves, welcomes, nurtures EM grads. It is the essence of multidisciplinary CCM as the same faculty and fellows run/staff ALL ICUs in 3 hospitals except the CCU. That is — SICU, NSICU, CTICU, MICU. We also run the codes for the whole hospital (except for the ED of course). I highly recommend the program for EM grads!
Hi, I have done 3 years post-graduation (MD paediatrics) and 3 years senior residency (paediatrics) after MD. Now I have been working in paediatric critical care for last 3 years as an assistant professor. I have total experience of 5 years in the PICU but that does not label me an intensivist. I can do most procedures in PICU ( Subclavian vein catheter insertion, Peritoneal Dialysis, pericardiocentesis). I am extremely interested in improving and learning new skills. Similarly I am very interested in research, statistics and can do most statistical tests on a software. Is it possible for me to… Read more »
You haven’t said where your training was done Sudha.
I did MBBS, MD and senior residency from Lady Hardinge Medical College, Delhi, India. Now I am working at PGIMER, DR.RML Hospital, Delhi. Any kind of short/long term training would be of great help. Thanks.
Sorry, my friend. I have no knowledge of the idiosyncrasies of foreign med folks applications to US fellowships.
Hello,
I am writing from Georgia. I graduated Ivane Javakhishvili Tbilisi State University, faculty of medicine in 2012 (studied for 6 years). I work in intensive care unit for 3 years as junior doctor. I am not in residency program. Can I get diploma in given specialty, according to length of service, experience ?
With respect,
Vakhtang.
Hi
I am a hospitalist(Categorical IM trained) have been doing this for 5 yrs. I have been working in open ICUs and have half of my patients in ICU. I am reasonably comfortable with procedures-wont say I am an expert..Looking to do a critical care fellowship. I do want to continue doing hospitalist work(more admin) while doing ICU work after fellowship. Anyone done similar thing.
Kindly advise
Is there a vailable online degree course in critical care medicine ?
no, but we do one for Resuscitation. not a degree–just pure learning. resusleadershipacademy.com
Hey Scott,
Please consider adding University of Washington to the above list. We have a long tradition of talking EM folks via the anesthesia track and recently began also training via the IM route.
It’s a great multidisciplinary program with training in medical, surgical, trauma, cardiothoracic, and neuro ICUs at 3 different hospitals (county, quarternary referral, VA) with a catchment areas of 5 states.
Best,
Nick Johnson
UW EM-CCM Fellow
Can you specify on the above list of fellowships which pathway each takes EPs ( medicine, anesthesia, surgery)
Thanks
Cat Parker
EM PGY 2
U of Missouri
I was blessed to graduate from Stanfords program in 2015 after being an ER doc since graduating residency in 1998. It is/was the BEST decision I ever made. ER docs are a perfect fit for ICU. If you even think about it then DO it! No other fellowship gets you out of ER!! And, burnout is real!!!
Greg, it looks as if you had a gap between graduating residency and starting your fellowship. How long was it? Did you find it hard to get in after being out of residency for so many years? Were you more less desirable as a candidate to programs? Thanks
I didn’t know that a majority of emergency medicine physicians are employed as intensivists. My sister is interested in getting a job as a intensivist, so I’ve been looking online for some more information about this career path. I’ll share your article with her.
If you ever update this post please consider adding Geisinger Medical Center to your recommended centers. I recently took over as PD of the CCM fellowship and Associate Editor for REBELEM…. We would love to have well qualified EM Physicians join us! Thanks
Frank l
Hello Dr. Weingart.
I am a faculty in one of the EM residency training program. I would like to pioneer ED Critical Care fellowship program in the Philippines. Can you please help me as one of the faculty and for one i want to use your edited book ED Critical Care as the main reference.
Our first batch of EM will be on December 2021. i want to give them some options to proceed after their residency. Please check our hosptial online Eastern Visayas Regional Medical Center, Tacloban City. It is the referral center for 5 million population.
More power.