From the Society

Hospitalists trained in family medicine seek critical care training pathway

SHM committee works on intensivist certification proposal to ABFM


A nationwide shortage of intensivists has more hospitalists stepping into the critical care arena, but not all with the level of preparation and comfort of David Aymond, MD, a Louisiana-based hospitalist trained in family medicine (HTFM).

Dr. Aymond gained his ICU experience in a fellowship with the University of Alabama, where hospitalists also “were responsible for ICU patients,” he said. Years later, as an employee of both small and large hospitals with busy ICU services, and a faculty member for a family medicine residency with a busy ICU, Dr. Aymond moves seamlessly between roles.

In August, SHM’s Family Medicine Committee surveyed HTFM members on their professional needs and interests. The respondents (127) ranked a certification pathway in critical care medicine from the American Board of Family Medicine (ABFM) as a top priority.

“It was eye-opening to learn how many [HTFM] are not only caring for patients in the ICU, but also are requesting additional training,” said Dr. Aymond, a member of the SHM Family Medicine Committee. “A critical care pathway would provide them with a level of expertise already available to physicians in internal medicine, emergency medicine, and surgery.”

With 71% of HTFM reporting that they round on ICU as the attending physician, the strong endorsement (78%) for critical care certification is not surprising.

“I am currently practicing as a full time intensivist and take consults from other providers, yet I only have a certificate from fellowship, no formal board certification in critical care,” noted a survey respondent.

Other participants stated, “it makes perfect sense to have a pathway to critical care if both family medicine and internal medicine coexist as hospitalists,” that certification is “imperative at rural and underserved hospitals,” and also “helpful for those …who work in larger hospitals and take care of critically ill patients.” More than half of those surveyed want the Family Medicine Committee to work with ABFM to create the pathway.

The majority (87%) of the HTFM survey respondents are certified by the ABFM, and 8% have attained Recognition of Focused Practice in Hospital Medicine. Common pathways for additional credentialing include SHM’s Fellow of Hospital Medicine program (38%), a fellowship in hospital medicine (19%), and certification in hospice and palliative care (15%). More than 38% reported “other qualifications,” such as years of work experience, certification by the American Osteopathic Board of Family Physicians, and prior training in internal medicine.

The survey also found that certification differences in internal medicine and family medicine hospitalists, which may have posed employment obstacles in the past for HTFM, are not as much of an issue.

“The critical care pathway is the bigger concern,” Dr. Aymond said.

SHM’s Family Medicine Committee will be working on a proposal to ABFM to create the training pathway in the coming months. Dr. Aymond wants intensivists to know that this not an attempt to encroach on their professional domain, “but an opportunity to fill the existing professional gap.

Family medicine physicians are already providing critical care services, so a pathway to obtain formal training makes sense,” he adds. “If a family medicine doc completes the fellowship and takes it back to a residency program [the residents] will be more prepared for their potential careers in hospital and ICU medicine and much more comfortable with high-acuity patients.”

Claudia Stahl is SHM’s content manager.

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