Since the inception of emergency medicine in the 1960s and its subsequent establishment as a medical specialty in 1979, the emergency physician has long been seen as the “jack of all trades, master of none.” From this we have grown to the “master of resuscitation,” and further to “the master of nearly anything,” through a host of both board-prepared and certificate fellowship programs.

Many emergency physicians find themselves drawn to the intensive care unit (ICU) as a hospital-based specialty where we can use our resuscitative skills and broad knowledge base to continue the care of critically ill patients through their emergency department (ED) stay and into their recovery phase. There are four tracks by which emergency physicians can become critical care board certified—internal medicine, neuro-critical care, anesthesia, and surgery.

Surgical Track Fellowship

The surgical track fellowship is a two-year commitment where emergency physicians train  alongside surgeons to learn how to care for trauma, postoperative, and neurologically-injured patients. Emergency physicians in these programs also spend time training in the medical, neurological, and cardiovascular ICU. These programs provide board certification through the American Board of Surgery (ABS) and allow physicians the training and flexibility to work in any adult ICU.

Additionally, the training we receive allows us to integrate seamlessly into any trauma service. Several trauma systems in the United States have emergency traumatologists fully incorporated into their trauma service who spend their on-service weeks either on the trauma service (leading trauma alerts and rounding on the trauma floor) or the surgical ICU service. If our path leads primarily home to the ED, the comprehensive training we receive during these two years serves to elevate the level of management for critically ill patients in the ED and provide critical care education to learners.

Compared to the internal medicine track, the surgical pathway is particularly attractive to  emergency physicians. It does not require inpatient internal medicine prerequisites and gives more diverse training in the surgical and trauma realm, which improves job prospects.

The anesthesia pathway is the same length and provides diverse ICU training, but the application cycle opens quite early (November of applicant’s second year of residency) and it is challenging to obtain prerequisites unless the applicant knows that this is their desired career path at the beginning of residency. The Neurological Critical Care pathway relegates these graduates to work primarily in a neuro ICU. These are not insurmountable challenges, but they do make the surgical pathway more attractive to some applicants.