Q - Can an emergency medicine physician become board certified in critical care medicine?
A - While there is not yet an ABEM examination for emergency medicine physicians in critical care, it is anticipated that this will change in the next few years. The number of emergency medicine physicians formally trained in critical care has continued to increase over the last decade.
As of 2011, The American Board of Internal Medicine (ABIM) & American Board of Emergency Medicine (ABEM) approved of co-sponsorship of IM-CCM. Following approval by ABMS, this co-sponsorship would allow EM residents to train in 2-year IM-CCM fellowships and then be eligible for certification in IM-CCM.
Our current EM-CCM fellowship has always worked together with the IM-CCM fellowship within the MCCTP and will continue to remain tightly connected in terms of fellow selection, curriculum, and mentorship.
An alternative route is available for US emergency medicine physicians who complete an emergency medicine residency and then two years of critical care fellowship training. The European Society of Intensive Care Medicine allows US physicians who meet the above requirements to take their European Diploma in Intensive Care (EDIC) exam, the official standard of critical care competence for the European Union. Although the ESICM has a relationship with the US based Society for Critical Care Medicine and its examination is widely regarded as equally rigorous as its American ABIM exam, this should not be construed as formal board certification in the US.
The history of access to board certification for emergency physicians can best be discussed through members of the ACEP Section of Critical Care Medicine or EMRA Critical Care Committee.
Q - Do Critical Care fellowships accept EM residents?
A - Some do, some do not. A variety of critical care fellowship programs have accepted emergency medicine residents. The ACEP CCM Section website has a more recent list of the CCM fellowships willing to accept EM physicians, and the EMRA Critical Care Committee maintains and updates this list programs. The MCCTP at the University of Pittsburgh Medical Center is housed within the oldest, largest, and first fully independent, academic Department of Critical Care Medicine in the US, and has accepted EM physicians into its fellowship program since 1976. It is a best to start looking as early as possible during residency: one year before your anticipated graduation would not be too soon, and many EM residents are identifying interest in fellowship over a year in advance.
Q - How long is the EM-CCM fellowship?
A - At the Multidisciplinary Critical Care Training Program in Pittsburgh, we encourage all EM-CCM fellows to complete two years of training.
Q - Will I be able to get a job in critical care after fellowship?
A - Yes. Many emergency medicine physicians are currently employed as intensivists in both private and teaching hospitals, some even as medical directors of ICUs. The demand for intensivists continues to increase, as well documented by the COMPACCS (Committee on Manpower for Pulmonary and Critical Care Societies) study published in JAMA (2000) and Critical Care Workforce Senate report (HHS, 2006). The Leapfrog Group, a consortium of Fortune 500 companies and healthcare consumers, has set as a healthcare priority to have all intensive care units staffed by trained intensivists. The Leapfrog Group considers emergency medicine physicians with critical care training to be intensivists.
Q - Will emergency medicine training prepare me well enough to be a strong critical care fellow?
A - Yes. While other specialties bring their strengths into fellowship programs, your familiarity with handling critically ill patients at their initial presentation, experience with managing multiple patients at once, and training in the diagnosis of potential disasters from a sea of undifferentiated complaints will serve you well during fellowship. The core curriculums of emergency medicine and critical care medicine have a significant amount of overlap, particularly in the areas of resuscitation, technical skills needed for critically ill patients (i.e., intubation, central lines, chest tubes), and exposure to both surgical and medical emergencies. We all recognize that nobody comes to a fellowship with nothing to learn.
Q - How will a critical care fellowship enhance my career as an emergency physician?
A - Training in critical care enhances your ability to manage critically ill patients and also understand the spectrum and process of critical illness. EM-CCM physicians are well positioned to serve as educators, researchers, and administrative leaders. EM-CCM physicians often find themselves serving as leaders in the ED in the care of the critically ill, such as early protocolized resuscitation for sepsis, early hypothermia for cardiac arrest, and continued care for ICU patients waiting for beds. With the increasing problems of overcrowding and boarding of inpatients, sicker patients will be in the ED for longer periods of time, requiring follow up and continued titration of care.
Working in both the ED and the ICU allows you to explore areas of interdisciplinary collaboration for clinical administration, patient care research, and graduate medical education. We hope that physicians dually trained in EM and CCM will serve as leaders to improve the continuity of care for the patient as they travel between the various arenas of health care, whether it is through research, education, or clinical leadership.