TSA Bulletin - July 2012

The last several years have seen expansion of opportunities in a variety of subspecialty areas and development of training programs combined with other specialties for anesthesiologists. The American Board of Anesthesiologists (ABA) continues to offer subspecialty certification in pain medicine and critical care medicine; however, they have also expanded certification opportunities for anesthesiologists in a variety of areas in which our clinicians may have additional expertise. These subspecialty areas include hospice/palliative medicine, sleep medicine, and pediatric anesthesiology, as well as the emergence of opportunities for combined residency training programs. I hope to review and summarize some of the recent changes in training and certification that we have seen as a specialty over the past few years.

Hospice and palliative medicine certification is sponsored by the ABA and several other specialty boards to recognize physicians who have subspecialty level knowledge of end of life care and symptom control when a cure is not possible. The practice pathway for eligibility has expired this year with the 2012 exam being the final opportunity to become certified without a fellowship training period. The exam is currently offered every other year and is overseen by the American Board of Internal Medicine.

Sleep medicine certification recognizes physicians with expertise in the multidisciplinary treatment of patients with sleep problems and specific sleep disorders. The exam is currently offered every other year and the next exam is in October 2013. This will be the final opportunity for anesthesiologists with expertise and current practice in this area to “grandfather” eligibility for this exam without previous fellowship training.

Combined training that occurs simultaneously within two specialties has recently been extended by the ACGME into the specialty of anesthesiology. A small number of programs have already established combined training programs in Anesthesiology and Pediatrics. These programs will consist of five, not six, years of training and will allow the physician to be fully qualified and certified in each of the specialties with the benefit of reducing their overall training by one year. Residency programs that desire to pursue this pathway must be approved by the American Board of Pediatrics and the ABA prior to recruiting residents.

Similarly, the ABA and the American Board of Internal Medicine have recently announced the opportunity for programs with combined training in anesthesiology and internal medicine. The trainee will be able to reduce the overall combined training period by one year, thus finishing the program in five, not six, years. Physicians completing these programs should be competent for practice in either specialty and will be eligible for certification in both specialties.

In October of 2013, the ABA will offer its first subspecialty exam for pediatric anesthesiology. The exam will be offered annually in the years to follow. The “grandfathering” period for non fellowship trained pediatric anesthesiologists will end after the 2015 exam.

In addition, plans are under way for American Board of Medical Specialties (ABMS) subspecialty certification in Medical Informatics. Further information on this certification will be available at the ABA website as it becomes available.

In addition to ABA certifications, many anesthesiologists are also seeking certification in perioperative transesophageal echocardiography. The National Board of Echocardiography (www.echoboards.org) oversees the certification process for anesthesiologists seeking certification in TEE. There has been a recent change in the types of certifications available with the addition of the new Examination of Special Competence in Basic Perioperative Transesophageal Echocardiography (Basic PTEeXAM). This exam is intended to provide anesthesiologists who utilize TEE as a monitor during general anesthesia an opportunity to demonstrate their competence with this technique. Anesthesiologists who perform more extensive TEE exams for diagnostic purposes or to direct or assess cardiac surgical interventions may pursue Advanced PTE Certification which consists of the Advanced PTEeXAM. Practitioners who pass the exam, but do not meet eligibility requirements for certification, will be granted “Testamur” status, which recognizes their completion of the examination process. A summary of the current certification process in TEE is as follows:

Basic PTEeXAM-Testamur—obtain medical license, complete and pass the Basic PTEeXAM

Basic PTEeXAM-Certified—pass the above exam, complete primary certification in anesthesiology, complete 50 personally performed & supervised TEE studies and review 100 studies for a total of 150 studies

Advanced PTEeXAM-Testamur—obtain medical license, complete and pass the Advanced PTEeXAM (much more rigorous exam)

Advanced PTEeXAM-Certified—pass the above exam, complete primary certification in anesthesiology, perform 300 echo studies (echo studies done during residency do not count towards the total), and complete a one year fellowship dedicated specifically to the perioperative care of surgical patients with cardiovascular disease (unless training in anesthesiology was completed prior to June 30th 2009).

Currently, fellowships in cardiothoracic anesthesiology and critical care medicine through the ABA are considered adequate for eligibility for the advanced PTEeXAM certification; however, the critical care pathway may be more challenging since the education and exposure to echocardiography may vary between programs. Future plans for formal board certification in cardiac anesthesiology through the ABA may also impact the future of this certification process.

In the field of pain medicine, there are many additional certifying boards that do not fall under the ABMS umbrella recognized by the Texas Medical Board (TMB). The details of these certifying boards is beyond the scope of this summary and would require much additional discussion. A small number of these non ABMS boards are quite rigorous in their vetting process and have become an additional standard for interventional pain physicians. There is current political activity underway to petition the TMB to recognize a small number of these as ABMS equivalent for physician advertising purposes.

As with primary board certification, all of the above certifications require maintenance of certification that occurs every ten years. The ABA website (www.theaba.org) is an excellent source of detailed information. While this summary is not all encompassing, I hope that it has given you a better understanding of the changes that have occurred in the certification process as well as a glimpse into the possible new training programs on the horizon.