|Glenn P. Gravlee, MD
Cardiothoracic Anesthesiology Fellowship Accreditation Re-revisited
History: The SCA submitted a proposal for cardiothoracic anesthesiology fellowship accreditation to the Accreditation Council for Graduate Medical Education (ACGME) in 2000. This proposal was rejected for a variety of reasons, the most important of which was lack of sufficient educational focus upon the characteristics that distinguish a cardiothoracic anesthesiology fellowship from an anesthesiology residency program. Undaunted, SCA responded to ACGME's constructive suggestions and in 2002 resubmitted its proposal, which appeared to address the previous deficiencies. That proposal was also rejected, in this instance ostensibly because cardiothoracic anesthesiology was not considered sufficiently distinct a subspecialty to warrant fellowship accreditation.
Why persist? One would think that SCA would have learned its lesson and that it would give up on this project, but your Board of Directors (BOD) has sent a clear signal to "re-resubmit," and that is our plan. Our rationale is that we believe that fellowship accreditation is in the long-term best interest of both anesthesiology as a specialty and of cardiothoracic anesthesiology as a subspecialty. The BOD believes that this action will benefit the education of cardiothoracic anesthesiologists by more clearly delineating the broad base of clinical, didactic, and research activities that constitute optimal fellowship training. Additionally, ACGME accreditation is the gold standard for graduate medical education, so why shouldn't over 70 programs enjoy the prestige associated with achieving that benchmark? Smaller subspecialties have achieved this status, e.g., endovascular surgical neuroradiology, spinal cord injury medicine, and others. Finally and most importantly, SCA's BOD maintains that our patients will be the ultimate beneficiaries of fellowship accreditation.
How Will Fellowship Accreditation Affect SCA Members?
I would like to divide this topic into academic and private practice domains, while realizing that there is overlap between them.
Academics: The bad news is that accreditation means more paperwork (in this day and age, read this as computer work). This is a price that must be paid for ACGME accreditation, the payoff being increased program prestige and the knowledge that a widely accepted standard has been met. Depending upon the specifics of a program's location and the dynamics of ACGME funding pass-throughs within a given teaching institution, the possibility exists that additional graduate medical education funding will become available as a result of fellowship accreditation.
Private Practice: Bear in mind that what SCA seeks is fellowship accreditation (a programmatic issue) and NOT subspecialty board certification in cardiothoracic anesthesiology (an individual practitioner issue). Also bear in mind that the ABA believes that "A Board certified anesthesiologist is a physician who provides medical management and consultation during the perioperative period." (ABA Booklet of Information, April 2003, paragraph 1.02D, page 3), and that ABA primary certification does not suggest or confer restrictions on subspecialty areas of anesthesiology practice.
We Want Your Suggestions
Please visit the SCA Web site (www.scahq.org) and click on "Fellowships" and then again on the proposal and on the proposed program requirements. We welcome your comments and suggestions, which can be directed to me (firstname.lastname@example.org) or to the Chairperson of our Fellowship Task Force, Alan Jay Schwartz (email@example.com).
Glenn P. Gravlee, MD