by Thomas E. Serena MD, FACS, FACHM, FAPWCA
"The average isn't average because its average. The average is average because its best." – J.B.S. Haldane
Thomas Serena MD, Helen Gelly MD, Greg Bohn MD, Jeffrey Niezgoda MD
Endorsed by The American College of Hyperbaric Medicine
The rise in specialized wound and hyperbaric centers across the United States has resulted in an increased need for physicians to oversee Hyperbaric Oxygen Therapy (HBOT). However, there are no published national standards or recommendations for credentialing physicians for this service. The American College of Hyperbaric Medicine (ACHM) has drafted this document to guide hospital credentialing committees in this process. It represents the consensus opinion of leaders in the field of hyperbaric medicine in the United States. It is important to note that although this document applies to both hospital-based and non-hospital affiliated centers, they have separate requirements.
Credentialing Challenges in Hyperbaric Medicine
Prior to 2010, the American College of Graduate Medical Education (ACGME) through the American Board of Preventative Medicine (ABPM) and Emergency Medicine (ABEM) offered a practice tract option for sub-specialty board eligibility. As of 2013, the practice tract option closed and board certification for allopathic physicians through the emergency medicine or preventative medicine boards now requires a one year fellowship. The vast majority of physicians currently practicing hyperbaric medicine have not completed a fellowship in Undersea and Hyperbaric Medicine (UHM) as recognized by the ACGME and are therefore not eligible to take the UHM sub-specialty board examination. Thus, fellowship programs alone cannot meet the current physician staffing requirements.
At present, there are only a few approved hyperbaric medicine fellowships. Even if sufficient fellowship positions were available, physicians in mid to late career who are currently practicing hyperbaric medicine would have to return to training programs in order to complete an ACGME recognized fellowship. Thus, while completion of an ACGME recognized fellowship represents the highest level of training in hyperbaric medicine, at this time, the Consensus Panel does not recommend that UHM sub-specialty Board Certification be required for HBOT privileges.
The change in the definition of hyperbaric physician supervision to include "other qualified healthcare professionals" has served to further complicate the issue. Podiatrists and Allied Health Professionals (nurse practitioners, physician assistants) are not eligible for fellowship programs in hyperbaric medicine. Therefore, the Consensus Panel does not recommend that subspecialty board certification be required for HBOT privileges for podiatrists, physicians' assistants or nurse practitioners. These Allied Health Professionals should be closely supervised by an appropriately qualified physician in accordance with national and local credentialing authorities. The independent practice of hyperbaric medicine by Allied Health Professionals is inappropriate.
It should be acknowledged that not all hyperbaric centers have the same capabilities. The capacity of a hyperbaric facility to care for a patient is determined by the training and experience of the supervising physician, the professional staff and the nurses and hyperbaric technicians, in addition to equipment available (e.g. ventilator support for critical care patients, the ability to provide "air-breaks", etc.). Thus, requirements for physician credentialing in any practice setting should be developed in conjunction with the policies of the facility, and should consider the acuity level of patients to be treated, the hyperbaric diagnoses that will be managed, and the type of chamber being utilized at the facility (monoplace vs multiplace). Hyperbaric physician credentialing requirements should be commensurate with the level of care and scope of practice of the providers as that facility.
Board certification in a related medical or surgical specialty is suggested. The Consensus Panel does recommend that the following guidelines are used judiciously to reflect the scope of practice of the individual clinical settings. To read the Consensus Panel guidelines in full, click here.
About The ACHM
The American College of Hyperbaric Medicine (ACHM) was formed by a group of physicians practicing the developing specialty of hyperbaric medicine who noticed the need for a national professional organization dedicated to serving as a medical specialty society. The ACHM has worked to develop an image of hyperbaric oxygen therapy as a distinct medical specialty, often requiring full-time practice.
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The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.