Emergency physicians in critical care: where are we now?

Samantha S Strickler; Daisi J Choi; Daniel J Singer; John M Oropello

doi:10.1002/emp2.12105

Emergency physicians in critical care: where are we now?

J Am Coll Emerg Physicians Open. 2020 Jun 2;1(5):1062-1070. doi: 10.1002/emp2.12105. eCollection 2020 Oct.

Authors

Samantha S Strickler¹, Daisi J Choi², Daniel J Singer³, John M Oropello⁴

Affiliations

¹ Department of Emergency Medicine and Department of Anesthesia Division of Critical Care Medicine Emory University Atlanta Georgia USA.
² Department of Emergency Medicine, Weill Cornell Medical College Cornell University New York New York USA.
³ Department of Emergency Medicine Lincoln Medical Center Bronx New York USA.
⁴ Department of Surgery Icahn School of Medicine at Mount Sinai New York New York USA.

Abstract

Objective: Prior to 2011, emergency physicians who completed critical care (CC) fellowship were unable to obtain board certification in the United States. Three pathways for CC board certification have since been established. This study explores the training, practice, and perceived challenges of emergency medicine/critical care fellows and emergency medicine/critical care physicians in the United States.

Methods: Anonymous institutional review board-approved survey distributed via email through an online survey engine from April to December 2016. Participants were recruited through national organizations and independent interest groups. Emergency physicians who were in CC fellowship or had completed a CC fellowship and were in practice in the United States participated voluntarily.

Results: Of the 162 respondents, 152 were included (92 physicians, 60 fellows). Eighty-nine percent ranged from 31-50 years old. Among fellows, 90% desired a dual discipline practice. Among physicians, 63% split their time between the emergency department and ICU. Seventy-one percent of physicians reported working in academic institutions. Among physicians engaged in a dual practice, mean full-time equivalent (±SD) devoted to the ED was 0.37 (±0.22), mean full-time equivalent for ICU was 0.47 (±0.22), and mean full-time equivalent for protected academic time was 0.28 (±0.19). Emergency medicine/critical care fellows and emergency medicine/critical care physicians identified numerous challenges associated with duality.

Conclusions: Since the advent of critical care board certification for emergency physicians in the United States, there has been an increasing number of emergency physicians pursuing CC fellowships and achieving CC board certification. Emergency medicine/critical care physicians are venturing into a variety of practice models, demonstrating that the employment landscape remains plastic. Not unexpectedly, emergency medicine/critical care fellows and emergency medicine/critical care physicians are encountering challenges intrinsic to their duality.

Keywords: accreditation; board certification; critical care; emergency medicine; employment barriers; training.