Critical Care Fellowship FAQ

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.

See here for additional info

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)
  • Indiana University
  • University of Pittsburgh
  • Henry Ford
  • Cooper
  • Beth Israel (Boston)
  • University of Alabama

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?

How about some relevant references?

Comments

  1. Fernando Marquez says:

    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

  2. Fernando,
    if a program likes you, they’ll train you.

  3. 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?

  4. ALOSERT says:

    how can have the critical care fellowship programme?
    thax
    Dr ALOSERT

  5. mahmoud fekry says:

    I finished the egyptian board of emergency medicine & i would like to join a critical care fellowship?
    Thanks for your time

  6. 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

  7. 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

  8. 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.

  9. 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.

  10. You should add the 2-year track at University of Florida through Anesthesia. They actively recruit ED physicians.

  11. Akram Al Nababteh says:

    Hopkins through anesthesiology are actively recruiting EM folks, they had at least one EM fellow each year for the past 3 years.

  12. Rob Alunday says:

    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

  13. Steve Pastores says:

    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

  14. 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.

  15. h reihani says:

    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?

  16. Jim Hall says:

    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

  17. 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 for Neurocrit Care boards after only 1 year of additional fellowship (usually consisting of 8mo neuroICU, 1mo stroke, 1mo neurophys, 1mo radiology, 1mo research/vacation).

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