Emergency Ultrasound Section Forum
From: Chris Moore, MD, FACEP <email@example.com> [mailto:firstname.lastname@example.org]
Sent: Thursday, October 22, 2015 8:59 PMTo: Emergency Ultrasound SectionCc: Moore, ChristopherSubject: ultrasound fellowship certification
A recent survey was sent out from ABEM through ACEP and SAEM seeking opinions about potential pathways to certification for emergency physicians with fellowship training in ultrasound. I am not sure what the volume or content ofresponse to this survey was. However, I anticipate there will be discussion about this in the week to come and wanted to offer my perspective. As a disclosure I am a member of the CUTF (Clinical Ultrasonography Task Force),nominated by SAEM/AEUS, though the views expressed here are solely my own.
About five years ago the ACEP EUS community voted to proceed with subspecialty certification through ACGME for fellowship training in ultrasound, and ABEM formed a task force (the CUTF) to pursue this goal. While there was initially some thinking that there may be multispecialty support for this (hence the term Clinical Ultrasonography instead of simply Emergency Ultrasound), what I have heard from ABEM is that this support has not materialized at this point. In addition, at a meeting last April of SCUF (Society of Clinical Ultrasound Fellowships, derived from eusfellowships.com) an informal poll following a presentation by leaders in the EMS community about their experience with ACGME fellowship certification found that a minority of emergency physicians (at the SCUF conference) supported continued pursuit of ACGME subspecialty status (of note while the EMS speakers described increased paperwork, they also voiced overall support for having pursued ADGME accreditation). From what I can tell the information about wavering support by the EUS community circulated back to ABEM and the perception was that the EUS community was divided/ wavering and potentially withdrawing support for ACGME subspecialty certification application. I am not sure about the current overall sentiment of the EUS community for or against this - however it is my personal belief that the EUS community should try to present a united front, whatever that may be; and that this coming week may be a key time to figure this out one way or the other.
In my opinion, to not continue to wholeheartedly pursue ACGME subspecialty certification at this point would be a mistake. While there is a very real possibility that even with our best efforts it will not succeed with ABMS, I believe we should try. ACGME represents the gold standard in acceptance by all specialties, and should we achieve this our status as leaders and experts in point-of-care ultrasound would be difficult to question. If it does not succeed, we will be able to revisit our approach, and will know either way that we attempted to try for the best possible recognition of skills.
Many people are concerned about the potential effects on reimbursement, and salaries, for emergency ultrasound fellows if fellowships were to become ACGME certified. It is true that an ACGME fellow cannot be reimbursed for the skillthey are being trained in for fellowship. While there is variability between institutions on how this manifests in practice, most people who are knowledgeable about this that I have consulted believe this should be interpreted that while a CU/EUS fellow could not be reimbursed for an ultrasound they perform during fellowship, care of an emergency patient can be reimbursed.Therefore it is unlikely that ACGME subspecialty certification will significantly affect the ability of CU/EUS fellows to work clinically and bill as an attending for routine emergency care. It is likely true that CU/EUS fellows when ACGME certified would adapt to the fellow salary schedule of the institution rather than be paid as junior attendings (with salaries that are currently higher than many ACGME fellows but lower than attendings for the same hours). This is a potential temporary hardship for fellows, but would also reduce the temptation for abuse on the part of institutions that may seek to recruit fellows simply as lower priced attending coverage.
For those who have already put in the time and effort to be fellowship trained in ultrasound, I would also remark that there would be a pathway for entry into true subspecialty status certification. To complete this path and be subspecialty certified I think would more completely validate the work that you have done than a Certificate of Added Proficiency, which may be made available with qualifications that are less than those of true EUS fellowship training.
There are a lot of people and a lot of organizations involved in this and I don't have particular leadership role in this, but I feel compelled to make my views known as someone who cares deeply about recognizing and continuing to maintain the quality of point-of-care ultrasound within emergency medicine.
There will not be another opportunity for EPs to pursue ACGME subspecialty status in point-of-care ultrasound. If we falter here the window will be closed. I would hate for short-term (particularly short-term financial) concerns to derail what is potentially the highest quality path for emergency ultrasound in the US. I encourage all members of the community to consider the potential pathways and implications and to voice this to leadership.
Many of you are probably already at WINFOCUS, many more will likely be at ACEP next week - hopefully see you there and look forward to discussion,
Christopher L. Moore MD
Associate Professor, Department of Emergency Medicine
Yale University School of Medicine
I agree with Minardi! Full disclosure, my opinion is that we should definitely push forward with attempting to get subspeciality certification.
I think Clinical Ultrasound as a field, and many of the individual CU stakeholders have a lot to potentially gain from subspecialty certification.
It's hard to know what would happen with certificate of focused expertise, especially given the lack of experience with this system.
The ABMS/ACGME/RRC pathway is kind of a known entity, and I think we've been so exposed to the warts/problems potentially associated with this system because we've been investigating it.
I think we all know if we opted for CFE instead it would come with it's own problems. The difference is that we don't necessarily know now what those problems might be. The first one that obviously comes to mind is who/what organization would have ownership of certification.
I think it would be really helpful if some people who have concerns and/or are opposed to subspecialty certification could list out what parts of subspecialty certification are deal breakers. What are the problems with subspecialty certification that people just can't get past?