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Emergency Ultrasound

Welcome the New Chair -The Year Ahead

By Matt Fields, MD, FACEP

Dear EUS Community,

I am extremely honored to be your section chair for 2016-2017! I look forward to working with you all to continue the tradition of excellence and productivity our section has produced for decades. Hats off to John Bailitz on an incredible 2015-2016!

For the upcoming year I have a number of goals, but the ones I want to start with are the big “C” words - Certification, Credentialing and Collaboration. When I was finishing fellowship I was troubled by the fact that after I graduated I really had no document that explained the year of training I had just received. Within EM, people knew about ultrasound fellowships and trusted the word of my fellowship director (despite his thick British accent). But outside the EM world there can be confusion. I was recently discussing this issue with an applicant who pointed out that in this way ultrasound fellowship actually more resembles an “apprenticeship” than a fellowship. When I thought of that word I could only think of two things: the dark ages and the reality TV show of our president-elect - neither of which should describe our specialty.

Ultrasound fellowships have existed for over 15 years and as a community we have produced a massive amount of education, research and policy literature. We have sophisticated guidelines that the entire world looks to. We have overcome impossible hurdles from external entities and sometimes our own colleagues. Ultrasound fellowship training is intense and those who pursue it deserve a level of recognition that is commonly and easily understood across the field of medicine.

In order to achieve certification of fellows and credentialing of fellowships, we rely on another “C” word - collaboration. We have waited for years on ABEM to move forward with recommending Clinical Ultrasound as an ACGME accredited fellowship. We continue to work with ABEM in this effort. Meanwhile we are actively working with other groups including the Society of Clinical Ultrasound Fellowships (SCUF) and the Academy of Emergency Ultrasound (AEUS) to create the framework and tools that will be necessary to actuate the process. ABEM has promised to make a decision on the future of the CSQCC – Certificate of Special Qualifications in Continuing Certification (this was previously called the certificate of focused expertise - CFE) in February of 2017. While we hopefully anticipate movement in the direction of some form of certification, we will ensure progress with all of the above efforts. My hope is that we can all agree on a future vision together and quickly.

When I’m speaking about certification I want to be clear that I am only speaking about the advanced ultrasound training that is typically acquired during fellowship. Our section and the Emergency Ultrasound guidelines (2001, 2008 and 2016), have always maintained that the residency training or a practice pathway leading to credentialing in core modalities is implicit certification and therefore no EP should ever need to obtain additional certification for the routine use of emergency ultrasound. I bring this up for two reasons: 1) To make sure we are all on the same page and 2) to draw your attention to a new organization who is attempting to provide certification for core emergency ultrasound modalities - The Alliance for Physician Certification (APCA) - a division of the American Registry for Diagnostic Medical Sonography (ARDMS).

ARDMS has created APCA solely for the purpose of certifying physicians in point of care ultrasound. Many of us have interacted with ARDMS to achieve RDMS or RDCS credentials. Going forward these credentials will now be renewed through APCA. In addition, APCA is launching a “POCUS Academy” (apca.org/pocus) which plans to certify emergency physicians in core ultrasound modalities. This “Academy” appears to be nothing more than a profit-driven merit badge system. When I first heard of it, I ignored it, because I believed that it did not pose any threat. While I still believe that to be true, I have also become more aware of the fact that, sadly, many people within emergency medicine aren’t familiar with the guidelines and are confused by these concepts. My fear is that if we are not active in educating our EM colleagues on why an entity like APCA is bad for our specialty then some will sign up for these certificates. If this happens one could imagine that hospital credentialing committees may request this for other providers and insurance companies could demand it for reimbursement. I think this seems far-fetched, but I think we should do everything we can to make sure it doesn’t. I think we should all educate our colleagues within our institutions of these principles. Feel free to use the following speaking points: 

  • The ACEP Emergency Ultrasound Guidelines (2001, 2008, 2016) maintain that the residency training in ultrasound (or a similar practice pathway leading to credentialing in core ultrasound modalities) is implicit certification and therefore no EP should ever need to obtain additional certification for the routine use of emergency ultrasound. 
  • The American Medical Association House Resolution 802 states that “ultrasound imaging is within the scope of appropriately trained physicians.” 
  • The APCA POCUS Academy appears to be a profit-driven merit badge pathway that is unnecessary. It is not endorsed by the ACEP Emergency Ultrasound Section.

On a different note, I would also suggest that those of us with RDMS and RDCS credentials should strongly consider not renewing them. With the creation of APCA, ARDMS is clearly attempting to insert a level of control into our specialty and profit from it. I don’t think ARDMS should continue to be supported by us. Ignoring the POCUS Academy should be easy, but as we move towards certification of fellowship type training I hope we will also supplant things like “RDMS” with letters supplied by our own certification body. I’m excited to get started working towards this and our other section goals! I anticipate it will be a fun and productive year!

Matt Fields
ACEP Emergency Ultrasound Section Chair 2016-2017


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