“Carving out” your own CCM fellowship??

[Doc Doc Doc Goose]

I have heard distant fables of residents or fellows that essentially made their own fellowship or “combined residency” at a particular program that did not/does not actually have that official fellowship or combined residency program.

For example, an individual convincing their home program to allow them to “create” their own EM/IM residency just for them, though the program doesn’t officially have an established combo EM/IM residency. I recognize such examples are likely (very?) rare and case-by-case basis with many factors and variables involved. Nonetheless, I was wondering:

Let’s say you’re an EM resident (or even EM/IM resident) that desires to persue a CCM fellowship. However, your home program does not have such a fellowship; only a Pulm/CC program (obviously through IM) is established. Since the rotations, training sites, etc. are already in place in terms of critical care training, how feasible would it be for the EM (or EM/IM) resident to “carve out” a CCM fellowship for themself? What would this entail in terms of acquiring funding , certification, etc? Is this remotely possible or just a mythical unicorn?

Any insight would be appreciated!

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[FiO2@21]

I thought EM residents could go the IM route for CCM fellowship?

 

[Doc Doc Doc Goose]

I thought EM residents could go the IM route for CCM fellowship?

They can do the two-year, IM-based CCM fellowships. But they cannot do the three-year Pulm/CCM fellowships; these are only for IM residency grads. And the EM guys can’t just apply to these and say oh I’m only doing the CCM portion; it’s a separate program entirely.

My question pertains specifically to creating a fellowship at a hospital/program where one doesn’t currently exist.

So lets say I’m an EM resident at Awesomeville Médical Center; I want to do a CCM fellowship; I don’t want to have to move for fellowship (because of spouse, kids, etc), but there is no CCM fellowship established at AMC currently; there is a Pulm/Crit fellowship for the guys who did IM residencies established. Is it possible to/how hard would it be to make a fellowship for myself at AMC??

This hypothetical may very well have further confused you. And for that I apologize.

 

[CCM-MD]

Currently the ABIM has an exception that allows Pulm/CCM programs to occasionally have fellows pursuing CCM only, without having to create a separate program. It’s on their website, so theoretically what you are wanting to do is possible right now. There were ~30 IM-CCM programs when I finished, there are now ~50 a few years later - so it is also possible that that by the time you are looking, the institution you are wanting to train at, may have an IM-CCM fellowship.

 

[Katheudontas parateroumen]

I would think carving out own CCM fellowship would be tough. I had seen someone carve out a clinical ultrasound fellowship from EM using department funds. I don’t have much details. This was at UC Irvine.

 

[deleted547339]

They can do the two-year, IM-based CCM fellowships. But they cannot do the three-year Pulm/CCM fellowships; these are only for IM residency grads. And the EM guys can’t just apply to these and say oh I’m only doing the CCM portion; it’s a separate program entirely.

My question pertains specifically to creating a fellowship at a hospital/program where one doesn’t currently exist.

So lets say I’m an EM resident at Awesomeville Médical Center; I want to do a CCM fellowship; I don’t want to have to move for fellowship (because of spouse, kids, etc), but there is no CCM fellowship established at AMC currently; there is a Pulm/Crit fellowship for the guys who did IM residencies established. Is it possible to/how hard would it be to make a fellowship for myself at AMC??

This hypothetical may very well have further confused you. And for that I apologize.

Its doable but challenging. I spoke with a couple programs about this while I was a resident and uniformly got a no.

 

[Doc Doc Doc Goose]

Its doable but challenging. I spoke with a couple programs about this while I was a resident and uniformly got a no.

All of them turned you down? But you still give me some hope.

Reasons why they turned you down?? Funding?? General view towards EM docs doing CCM?

 

[WheezyBaby]

My understanding (which is superficial) is that it is a fair bit of effort for a program director primarily surrounding having a curriculum drafted and funding secured. I imagine doing a CCM spot in an existing PCCM program would be easier than some other de novo programs, but don't know that for sure

 

[Doctor Bob]

Urgh.
There are so many logistic headaches here.
First off, a program is allowed a certain number of training spots based on the information they provide to the ACGME (for example, 6 per year for a total complement of 18 at a PCCM program). ACGME grants that number of spots in order to ensure that each trainee isn't overworked or underexposed.
If a program was inclined to try and make a 2 year track for you, then one year they could only take 5 PCCM people, and then when they moved into their third year they'd have a deficit (which could cause coverage trouble depending on how the units are covered). A program with an already-established CCM track would have either figured out this schedule, or applied to the ACGME for a class-complement increase.
Ok, funding is the next issue. If it wasn't already planned for in their budget, then some department would have to eat the cost of an additional fellow. Not an insurmountable problem, but at nearly 100k per fellow per year of cost to the department it's not a snap of the fingers to make happen either. And assuming you want an accredited program (what's the point of going through a CCM fellowship if you can't sit for boards at the end), you can't work for free, or pay your own salary (ie: moonlight as a budgetary offset).
Now... all of this assumes that the PCCM program has put a CCM track into the program structure that ACGME approved; not all programs do, especially if they don't plan on ever having a CCM track (because it's extra paperwork and why do extra paperwork when you don't have to). It would be a simple process to get a sub-track like that approved by ACGME but... again... administrative hassle for the program and would be far far more work than is worth just as a favor to a specific person.

Just apply to places that have a CCM track in place. Any IM-CCM program can take EM if they want to. If they don't want to then... well... that facility certainly won't go through the hoops of making a track for you.

 

[MelMcT2009]

I have heard distant fables of residents or fellows that essentially made their own fellowship or “combined residency” at a particular program that did not/does not actually have that official fellowship or combined residency program.

For example, an individual convincing their home program to allow them to “create” their own EM/IM residency just for them, though the program doesn’t officially have an established combo EM/IM residency. I recognize such examples are likely (very?) rare and case-by-case basis with many factors and variables involved. Nonetheless, I was wondering:

Let’s say you’re an EM resident (or even EM/IM resident) that desires to persue a CCM fellowship. However, your home program does not have such a fellowship; only a Pulm/CC program (obviously through IM) is established. Since the rotations, training sites, etc. are already in place in terms of critical care training, how feasible would it be for the EM (or EM/IM) resident to “carve out” a CCM fellowship for themself? What would this entail in terms of acquiring funding , certification, etc? Is this remotely possible or just a mythical unicorn?

Any insight would be appreciated!

This was what I tried to do. My mentor is EM/IM/CC trained and really really tried to help me get it done. We had the Pulm/Crit PD on board, but when it came down to funding and who would be paying my salary, it just didn’t work out.

 

[Doc Doc Doc Goose]

This was what I tried to do. My mentor is EM/IM/CC trained and really really tried to help me get it done. We had the Pulm/Crit PD on board, but when it came down to funding and who would be paying my salary, it just didn’t work out.

What’d you end up doing???

 

[chocomorsel]

Good luck OP. You need to just move. What you are trying to accomplish is damn near impossible.
If you want the fellowship badly enough you are most likely gonna have to move.
If you are able to “carve out” your own fellowship let us know.
Kids are resilient. They will survive. Spouses job may be an issue but you need to discuss if this fellowship is worth it for your family in order to make the move and possibly disrupt spouses career for a bit.

 

[MelMcT2009]

What’d you end up doing???

Applied to IM-CC through ERAS and accepted an offer at my top choice.

Was really a better move for my family anyway. Husband will be much happier with our new location than he would have been sticking around another two years at our current place so it worked out

 

[Doc Doc Doc Goose]

Good luck OP. You need to just move. What you are trying to accomplish is damn near impossible.
If you want the fellowship badly enough you are most likely gonna have to move.
If you are able to “carve out” your own fellowship let us know.
Kids are resilient. They will survive. Spouses job may be an issue but you need to discuss if this fellowship is worth it for your family in order to make the move and possibly disrupt spouses career for a bit.

Appreciate it. The move is out of the question. I guess I just don't "want it bad enough." I'll just stay hopeful that my program adds itself to the IM-CC Program List in time for application time. If not, oh well. If it's meant to be, it will be.