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.
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?)
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
- 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?
- EMRA Critical Care Committee
- ACEP Critical Care Section
- SCCM Emergency Medicine Section
- Association for Emergency Medicine-Critical Care Medicine Program Directors (AEMCCMPD).