Can an emergency medicine resident become board certified in critical care medicine?
There are five pathways to subspecialty board certification in critical care for diplomates of the American Board of Emergency Medicine (ABEM). These are cosponsored with the American boards of Internal Medicine (ABIM), Surgery (ABS), Anesthesiology (ABA), and the United Council for Neurologic Subspecialties (UCNS). All require a two-year fellowship followed by formal examination.
The ABIM and ABEM also offer a joint certification pathway for candidates who have completed six years of accredited training in internal medicine, emergency medicine, and critical care medicine. This fellowship provides board eligibility in all three disciplines.
For more information about the pathways to board certification, please click the corresponding link below.
An historical alternative route is available for US Emergency Physicians who complete an EM residency followed by two years of critical care fellowship training. The European Society of Intensive Care Medicine (ESICM) allows US physicians who meet these requirements to take their European Diploma in Intensive Care (EDIC) exam, the official standard of critical care competence in the European Union. Although the ESICM has a relationship with the US-based Society for Critical Care Medicine and their examination is regarded as equally rigorous as the US counterparts, this does not lead to formal board certification in the US.
Do Critical Care fellowships accept EM residents?
Critical care fellowships are typically housed within a department of internal medicine, surgery, anesthesiology, or neurology. Many of these fellowships now accept applications from EM diplomates, especially since formal pathways to board certification are now in place. EM-based critical care fellowships also exist, but may not lead to board certification.
At the indivicual fellowship program level the quick answer is: some do, some don't. The ACEP CCM Section website has a list of the CCM fellowships willing to accept EM physicians (compiled in 2002 - update in progress). The Emergency Medicine Residents Association has an adapted list of these programs that are particularly interested in applications from emergency medicine physicians.
How long is a critical care fellowship?
In order to become board certified in critical care, two years of additional critical care training is required, regardless of the co-sponsoring board. Shorter fellowships are available, but without the substantial advantage of board eligibility.
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 is a growing need for intensivists. 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. 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. Trainees of all specialty backgrounds bring unique strengths to critical care fellowship programs, and your familiarity with critically ill patients from their initial presentation, experience with managing multiple patients simultaneously, and training in "sniffing out" the potential disasters from a sea of undifferentiated complaints will serve you well during fellowship. There are several areas of overlap between the core curricula for emergency medicine and critical care, particularly in the areas of resuscitation, technical and procedural skills, and exposure to both surgical and medical emergencies. Everyon comes to fellowship with something to contribute and somthing to learn. All 25 members of the first cohort of EM diplomates who sat for the IM-CC board certification exam passed on the first attempt.
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 thrive in hybrid roles 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 critically ill and injured patients. With the increasing problems of overcrowding and long emergency department lengths of stay, 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 ICU can be a 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.