ICU Hospitalist Competence and certification
6 Posts
For non-tertiary care hospitals, most hospitalists have been tasked with covering and/or running the ICU. Thus, these "ICU hospitalist" are placed under a tremendous amount of pressure (and risk) caring for these highly complex and critically ill patients. Do any of you have any requirements prior to hiring in regards to ICU hospitalists competency? Any ICU course requirement? Any ongoing competency requirements?
I am interested in a couple of things.
#1. Convince the ABIM to allow IM residents, that have not completed a fellowship, to participate in a critical care fellowship for only 1 year. I know David Aymond has been trying to get something like this done for FP docs.
#2. Create some sort of a nationally recognized class/certification in ICU/Critical Care that hospitalists can complete and turn in with their medical staff privileges so they can be labeled as certified "ICU hospitalist." Essentially this would be a subspecialty of Hospital medicine. Would need the medical staff of hospitals to recognize this and expect this when credentialing hospitalists to care for patients in the ICU. We have other specialties that have something similar such as general surgery, cardiology, wound care certification, etc. Let's face it, Hospitalist and Intensivists in the ICU are now starting to overlap and hospitalists in non tertiary care centers are the leaders in the ICU.
#3. Create a ACGME, ABIM approved Hospital Medicine fellowship post IM residency training for maybe 1-2 years that contains extensive ICU training along with all the other aspects of hospital medicine.
I am interested in a couple of things.
#1. Convince the ABIM to allow IM residents, that have not completed a fellowship, to participate in a critical care fellowship for only 1 year. I know David Aymond has been trying to get something like this done for FP docs.
#2. Create some sort of a nationally recognized class/certification in ICU/Critical Care that hospitalists can complete and turn in with their medical staff privileges so they can be labeled as certified "ICU hospitalist." Essentially this would be a subspecialty of Hospital medicine. Would need the medical staff of hospitals to recognize this and expect this when credentialing hospitalists to care for patients in the ICU. We have other specialties that have something similar such as general surgery, cardiology, wound care certification, etc. Let's face it, Hospitalist and Intensivists in the ICU are now starting to overlap and hospitalists in non tertiary care centers are the leaders in the ICU.
#3. Create a ACGME, ABIM approved Hospital Medicine fellowship post IM residency training for maybe 1-2 years that contains extensive ICU training along with all the other aspects of hospital medicine.
10 Replies
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23 Posts
I am a Full time nocturnist, first year attending who has had 6 to 7 months of critical care in residency. I currently work in a medium size community hospital (less than 200 bed) with a 12 bed ICU. I have help from EICU. I would love a 1 year critical care fellowship for those of us who do not want to be intensivist but need to manage and stabilize patients. I have a CRNA (sometimes anesthesiologist) and an EM doc on with me at night who I usually ask for help if something is out of the scope of my practice. One thing in particular I have wish I could get better at would be procedures and ultrasound.
12 Posts
I am entirely concur with Steve on dire need of one-year ICU fellowship for hospitalists on all stages of career. Would go for it myself.
On other hand, if somebody have two years to spend immediately after residency and go to fellowship, it would rather be traditional critical care fellowship.
On other hand, if somebody have two years to spend immediately after residency and go to fellowship, it would rather be traditional critical care fellowship.
6 Posts
Trisha Pascall-Lopez:
I am a Full time nocturnist, first year attending who has had 6 to 7 months of critical care in residency. I currently work in a medium size community hospital (less than 200 bed) with a 12 bed ICU. I have help from EICU. I would love a 1 year critical care fellowship for those of us who do not want to be intensivist but need to manage and stabilize patients. I have a CRNA (sometimes anesthesiologist) and an EM doc on with me at night who I usually ask for help if something is out of the scope of my practice. One thing in particular I have wish I could get better at would be procedures and ultrasound.
Yes, competency in procedures and ultrasound, I believe, would enhance some confidence in caring for these ICU patients. It would also limit the amount you would have to depend on the ER or CRNA for procedures. The bread and butter procedures of central lines, intubations, and arterial lines are procedures that in my opinion are essential for ICU care. The less time wasted relying and waiting on ER or CRNA could affect how quickly someone is treated in the ICU.
2 Posts
Like Trisha Pascall-Lopez above, I took on extra critical care rotations during residency for my electives to get as much experience and training as possible before transitioning to attending. I do think it was sufficient for the level of ICU patients I am caring for in a small hospital (94 beds). Also, I did an elective rotation in anesthesia to get extra experience doing intubations / lines which has proven invaluable.
Steve, I'm all for ensuring we have plenty of training but when we start creating further certifications that take a year or two that eventually become requirements for physicians, we need to keep the broader picture in mind. It already takes 11 years to produce a hospitalist md whereas hospitalist pa/np timelines are much shorter with more on-the-job experience later helping them fill their knowledge gap. I like your desire to help us have more training and certification but would hope we can do it in a more on-the-job way with shorter workshops and such instead of making the road to ICU hospitalist even longer.
A great option might be say a 4 week course spread out over four 1 week sessions every 3 months over the course of a year covering advanced topics and procedures with a certification for completing it. That way, existing hospitalists could fit it in and it wouldn't have the negative financial implication for physicians to spend another year at fellowship income vs. attending income. Also, a fellowship would mostly only apply to new hospitalists whereas this approach would be much more accessible for hospitalists at all stages of their career.
Steve, I'm all for ensuring we have plenty of training but when we start creating further certifications that take a year or two that eventually become requirements for physicians, we need to keep the broader picture in mind. It already takes 11 years to produce a hospitalist md whereas hospitalist pa/np timelines are much shorter with more on-the-job experience later helping them fill their knowledge gap. I like your desire to help us have more training and certification but would hope we can do it in a more on-the-job way with shorter workshops and such instead of making the road to ICU hospitalist even longer.
A great option might be say a 4 week course spread out over four 1 week sessions every 3 months over the course of a year covering advanced topics and procedures with a certification for completing it. That way, existing hospitalists could fit it in and it wouldn't have the negative financial implication for physicians to spend another year at fellowship income vs. attending income. Also, a fellowship would mostly only apply to new hospitalists whereas this approach would be much more accessible for hospitalists at all stages of their career.
6 Posts
Thanks very much for the reply and recs. I agree with all you are stating. Fellowship income vs attending income is a big difference and would definitely limit the amount of docs that would like to proceed into a fellowship. If SHM and this critical care SIG can come up with a course/certification that all medical staff credentialing departments acknowledge, then we would not need hospitalists to transition into a critical care fellowship. We can keep them within a so called 'sub-speciality' of hospital medicine....ICU hospital medicine. That is the challenge. How do we create a culture as to enable all hospital credentialing committee's trust and grant critical care privileges to ICU hospitalists (that are competent of critical care) to care for this critically ill patients. This will address the critical (no pun intended ) shortage of board certified critical care docs across the country.
2 Posts
I think it would be a step in the right direction if ABMS would allow hospitalists to sit for critical care board exams to attain “testamur” status. At this time completion of a fellowship is required just to sit for the exam. I think if a hospitalist is so inclined, he or she should be allowed to demonstrate his or her knowledge by passing this exam. The exam is already standardized and recognized on a national level. It is strictly knowledge-based and does not assess procedural skills, but I think taking and passing this exam should count for something.