Emergency Ultrasound: Why an Ultrasound Fellowship Might Be Right for You

Why an Ultrasound Fellowship Might Be Right for You

Joshua Guttman, MD FAAEM FACEP FRCPC and Lekha A. Shah, MD

The COVID-19 pandemic in combination with the reduced demand for emergency medicine attendings and greater supply of EM residency graduates exacerbates the difficulty of obtaining a desirable position. Finding an emergency medicine position in your chosen location was once a virtual guarantee. But it has become increasingly difficult for some EM graduates to find a satisfactory position these days.

Completing a fellowship gives you expertise beyond that of a general EM graduate. ED directors and chairs are more likely to hire a fellowship graduate and preferentially retain those graduates in the event of a layoff if your fellowship background provides value to the ED. WHILE EDS MIGHT HAVE A “POCUS CHAMPION” FILL THAT ROLE, AN ED DIRECTOR MAY RATHER HIRE QUALIFIED FELLOWSHIPTRAINED EPS THAT HAVE COMPLETED FORMAL US TRAINING RATHER THAN A GENERAL EP WHO HAS TO FIGURE OUT THESE ANSWERS IN REAL-TIME.”

ED ultrasound fellowships have enjoyed a steady increase in popularity over the past two decades. The first fellowship was founded in 1994; in 2020, there were 135 fellowship programs accepting 212 fellows. While there are many fantastic fellowship opportunities through emergency medicine, the breadth of an ultrasound fellowship makes it a great choice for those with a wide range of intended practice.

The use of POCUS is generally popular among emergency physicians (EPs), especially among those trained in its use during residency. Most emergency physicians recognize the value of this tool for both diagnostic and procedural performance. The ability to quickly “look inside” a patient to answer a focused clinical question expedites care without subjecting them to ion- manufacturers, these companies provide izing radiation or expensive comprehensive grants and equipment for research purposes. imaging. With POCUS, you no longer need As a fellowship-trained POCUS expert, you to wonder whether a patient has a pericardial would be an instinctive choice for developers effusion based on EKG, physical exam and to assist with product development. While X-ray; you can simply know the answer in mere research experience in ultrasound fellowships seconds. For this reason, virtually all EDs have varies, all fellowships require mentored scholPOCUS machines in the clinical area. arly work. For EPs interested in an academic career with a focus on education, ultrasound fellowships provide significant opportunities to hone teachFOR EPS INTERESTED IN AN ACADEMIC CAREER WITH A FOCUS ON EDUCATION, ULing skills. POCUS is popular with all levels of TRASOUND FELLOWSHIPS PROVIDE SIGNIFIlearners who are keenly receptive to ultrasound CANT OPPORTUNITIES TO HONE TEACHING teaching. All POCUS fellowships provide the SKILLS.” opportunity to improve bedside teaching skills and deliver formal didactics (e.g., lectures, For those interested in community emergency workshops, curriculum development, etc.). All medicine or administration, there is ample opEM residencies have a mandatory POCUS portunity to lead an ultrasound program. The rotation that necessitates teaching by POCUS goals for a community EM group is usually experts. These experts are generally given to credential the group for POCUS, improve protected time as faculty. For POCUS faculty patient safety, and provide ongoing quallooking to advance beyond resident education, ity assurance. Revenue generation from an ultrasound fellowship graduate may easily POCUS studies is a key driver for these EDs. transition to become a POCUS educational Community EDs hire ultrasound fellowshiplead for a medical school and other clinical trained EPs to fill this role, often giving paid departments (e.g., critical care, hospitalist, pri- administrative time for those tasks. Some mary care, etc.). Some graduates have chosen community health systems additionally hire to transition to roles within residency leadership >> (e.g. program director). Even those who simply prefer to teach a variety of learners (from first year medical students to seasoned faculty) benefit from POCUS education. There will be a role for you at an academic program.

For EPs interested in an academic career in research, POCUS provides unlimited scope since novel POCUS applications are constantly emerging. Some widely used POCUS applications require a stronger body of evidence to validate their current usage. Aside from diagnostic accuracy, POCUS provides other benefits to ED flow – reduced length of stay, time to diagnosis and cost savings. As artificial intelligence (AI) becomes more common, private companies are looking to integrate AI with POCUS. They need POCUS researchers to provide feedback as they refine their products for the market. Along with ultrasound

system-wide POCUS directors with significant allotted time for ultrasound tasks. This administrative role helps mitigate the risk of burnout, which is prevalent in community EPs. POCUS fellowships provide focused education on billing, quality assurance, credentialing, and machine selection. While EDs might have a “POCUS champion” fill that role, an ED director may rather hire qualified fellowship-trained EPs that have completed formal US training rather than a general EP who has to figure out these answers in real-time. Beyond the ED, becoming a POCUS lead creates connections across multiple specialties within the hospital. Other specialties recognize EM as the leader in POCUS and welcome EP assistance as they develop their own POCUS policies and education.

Ultrasound fellowships have occasionally been criticized for not being accredited. Fortunately, this is changing. As was discussed in a previous issue of Common Sense, the American Board of Emergency Medicine (ABEM) is starting a focused practice designation (FPD) in Advanced Emergency Medicine Ultrasonography (AEMUS). To this end, ABEM has spearheaded the creation of the Emergency Medicine Ultrasound Fellowship Accreditation Council (EUFAC), which is accrediting fellowships which adhere to rigorous standards in fellow education.

While all EM fellowships provide wonderful opportunities, we believe that ultrasound fellowships, in particular, are suited to a broad range of EM graduates looking for varied practice opportunities, whether in academic or community EM. We urge you to consider a fellowship to increase your employability, job security, and long-term career satisfaction in EM.

Joshua Guttman, MD FAAEM is the emergency ultrasound fellowship director at the Emory University Department of Emergency Medicine. Lekha Shah, MD is the pediatric emergency medicine ultrasound fellowship. 

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