NEUROCRITICAL CARE – SPECIAL INTEREST GROUP (NCC-SIG)

Interview with ABA President Brenda G. Fahy, MD


Questions Answered Regarding the New Neurocritical Care Subspecialty Certification

By Ines Koerner, MD
Chair, Research Committee
Oregon Health Sciences University
Portland, Oregon

Brenda G. Fahy, MD
Brenda G. Fahy, MD

Dr. Fahy is the President of the ABA and serves on its Assessments, Research and Critical Care Medicine Examination Committees. She also serves as a Professor and Associate Chair of Anesthesiology at the University of Florida. She is the medical director of Critical Care Medicine-Anesthesiology Clinical Services at Shands Hospital at the University of Florida. She also serves as program director for the Combined Critical Care Adult Cardiothoracic and Critical Care Medicine Fellowships. Her research interests include studies in the critically ill patient population and multidisciplinary translational research teams, as well as educational studies.

The American Board of Medical Specialties (ABMS) recently approved the American Board of Psychiatry & Neurology’s (ABPN) request to offer a subspecialty certificate in Neurocritical Care. As a co-sponsor, the American Board of Anesthesiology (ABA) will offer the subspecialty certificate to ABA diplomates. There will be a practice pathway for neurologists, neurosurgeons, anesthesiologists, and emergency medicine physicians who have a Neurocritical Care fellowship or who possess sufficient practice experience. ABPN will administer the first certifying exam in 2021, and the ABA will award certificates to ABA diplomates who take and pass that exam. Details are available on the ABA website.

Can you tell us more about the new subspecialty certification in neurocritical care that ABA sponsors? Why was this new pathway created?

The new neurocritical care subspecialty is currently co-sponsored by the ABA, the American Board of Psychiatry & Neurology (ABPN), the American Board of Emergency Medicine (ABEM) and the American Board of Neurological Surgery (ABNS). There will be a practice pathway for neurologists, neurosurgeons, anesthesiologists, and emergency medicine physicians who complete a neurocritical care fellowship or who have sufficient practice experience. The six-year practice pathway will run from 2021 (the first year in which the exam will be offered and someone could register to take it under the practice criteria) until 2026 (the last year they could do so).

The ABA joined ABPN in pursuing this subspecialty certification because of the rapidly expanding body of knowledge in neurology. The growth of treatment options in this subspecialty necessitates additional training and knowledge to master them. As anesthesiologists, many of us play a pivotal role in treating critically ill patients with neurological conditions. This new subspecialty will help physicians who focus their careers on neurocritical care to earn a credential that distinguishes them as having unique expertise in this area.

What does the new exam look like? Is this a written exam with multiple choice questions, or is there an oral examination?

The new exam will be computer-based and will include multiple-choice questions. The exam will have a content outline that includes the core competencies that are fundamental to neurocritical care practice.

How does ABA influence the content of the exam? Are anesthesiologists involved in writing the exam questions?

The ABA appoints two of its diplomates to serve on ABPN’s Neurocritical Care Examination Committee, which will develop the new exam.

I am an anesthesiologist and ABA diplomate who works in a neuro ICU, but am not fellowship trained. Can I sit for the exam in 2021 and become ABA certified in neurocritical care?

Yes, if you meet the “grandfathering” criteria. Anesthesiologists who did not complete a neurocritical care fellowship, but who have sufficient experience may take the new Neurocritical Care exam. You can review the grandfathering//practice pathway eligibility criteria on our website.

I finished a UCNS-accredited neurocritical care fellowship this summer. Should I pursue UCNS certification in 2019, or wait until the ABA sponsored exam in 2021?

Whether you pursue UCNS certification or not is up to you. Being UCNS certified will qualify you to take the new ABPN Neurocritical Care Exam when it is offered. When you pass the new exam, you will be ABA-certified in Neurocritical Care.

However, you are not required to take the new exam and, if you hold a UCNS certificate, you would continue to be boarded by the UCNS for the duration of your certificate.

Will I need to maintain both UCNS and ABMS certifications to work as a neurointensivist?

Qualifications for employment are set by employers, not the ABA.  However, I can tell you that pursuing this new subspecialty certification is voluntary. No one will be required to take the exam. You will need to contact UCNS for information about that certification.

Will there still be a path for anesthesiologists to do a combined anesthesiology/critical care and neurocritical care fellowship that leads to dual board eligibility in two years, similar to what currently exists with UCNS?

The ABA does not develop or manage physician training, so I cannot answer this question. The UCNS may be able to provide insight.  

Can I be certified in neurocritical care if my clinical practice is exclusively in critical care?

Anesthesiologists who practice exclusively in critical care medicine would not meet the criteria for subspecialty certification in neurocritical care. Physicians pursuing this subspecialty will need to spend anywhere from 17% to 50% of their time in the practice of neurocritical care depending up on their years of practice in this subspecialty. 

I will start an UCNS-accredited neurocritical care fellowship this summer. Will the structure of my fellowship be affected by this change? Will I be eligible to sit for both the ABA and the UCNS exam?

I cannot say whether the new subspecialty certification has impacted UCNS training programs or speak to their exam eligibility requirements. According of the current criteria, completing a UCNS, CAST or other non-accredited fellowship in neurocritical care will qualify anesthesiologists to sit for the new ABPN exam. Additionally, physicians who are UCNS certified will be eligible to take the new ABPN Neurocritical Care Exam.

Will the new ACGME-accredited two-year neurocritical care fellowship allow me to use elective time to complete an embedded non-accredited neuroanesthesia fellowship? Some UCNS-accredited fellowships currently offer this option.

It is up to the training programs to determine how they will manage their training programs and is not something that the board would dictate.

Does this new subspecialty certification mean that certification in anesthesiology-critical care will no longer qualify me to take care of neurosurgical patients in the ICU?

The goal of the new certification in neurocritical care is to distinguish physicians who have trained in this subspecialty and/or who spend a significant portion of their practice attending to critically ill patients with neurological conditions. However, the certification is voluntary and is not intended to displace physicians who do not pursue this certification, but are caring for critically ill patients with neurological problems.

Does the six-year limit on grandfathering apply to maintenance of certification, i.e. will those who are grandfathered to initial certification need to complete a fellowship to maintain certification beyond the six-year limit?

During the six-year grandfathering period, physicians who have not completed a neurocritical care fellowship, but who practice neurocritical care and meet the eligibility requirements may take the new exam. Once they are certified, these diplomates will participate in MOCA to maintain that certification in addition to maintaining any other certificates they have.

After the six-year grandfathering period ends using the current criteria, anesthesiologists seeking to qualify for neurocritical care certification will need to complete either:

  • One year of a general ACGME-accredited anesthesiology, medical or surgical critical care fellowship AND one year of an ACGME-accredited neurocritical care fellowship

OR

  • Two years of an ACGME-accredited neurocritical care fellowship.
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