Adapted from ACEP’s Critical Care Section
Can an emergency medicine resident become board certified in critical care 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.
A deal is in the works; it seems it will a 2 year fellowship, but one of the years will be a rotating surgery experience. This is being worked out.
A deal is in the works here as well. It will be one year if you did a 4 year program and 2 years if you did a 3 year EM program.
Do Critical Care fellowships accept EM residents?
The quick answer is some do, some don’t. The April 1999 issue of Academic Emergency Medicine contains a list of the critical care fellowship programs that accept emergency medicine residents. The ACEP CCM Section website has a more recent list of the CCM fellowships willing to accept EM physicians (compiled in 2002). The Emergency Medicine Residents Association has an adapted list of these programs that are particularly interested in applications from emergency medicine physicians for critical care training. The Multidisciplinary Critical Care Training Program at the University of Pittsburgh Medical Center, the oldest, largest, and first fully independent, academic Department of Critical Care Medicine in the US, has accepted emergency medicine physicians into its fellowship program for 25 years and is actively recruiting more. It is a good idea to start looking as early as possible; one year before your anticipated graduation would not be too soon.
See below for a list of programs that want EM applicants and gear their programs to us.
How long is a critical care fellowship?
Some programs are designed to provide a one year experience; other 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) allows you to sit for the European Diploma. The drawback of course is the need for an extra year of training. Because no standard exists for emergency medicine physicians seeking critical care training, there is no “right” answer. At the Multidisciplinary Critical Care Training Program in Pittsburgh, we encourage all emergency medicine critical care fellows to complete two years of training.
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)
University of Pittsburgh
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 has now unfortunately closed as of this year.