I am really torn as to which to pick. Anesthesia with a CC fellowship or pulm/cc after IM. Im an M3 and I have rotated through both and really loved both. I was wondering if anyone had any insight that might help me out choosing? Can you guys help me with the pros/cons of each approach. My ultimate goal is to be an attending in an MICU. I know either way I can do it but Im just hoping for some good advice. Thanks everyone.

I am really torn as to which to pick. Anesthesia with a CC fellowship or pulm/cc after IM. Im an M3 and I have rotated through both and really loved both. I was wondering if anyone had any insight that might help me out choosing? Can you guys help me with the pros/cons of each approach. My ultimate goal is to be an attending in an MICU. I know either way I can do it but Im just hoping for some good advice. Thanks everyone.

If you really want to round in a MICU, then the most logical path would be the IM/Pulm/CC route. It is not unheard of for an Anesthesiologist/CC to round in a MICU, but they tend to round in SICU for the most part.

I would do your basic training (IM or Anesth) based on what you really love the most. They are rather different specialities.

kg

You want to be a FULL TIME intensivist?

if that's what yu want ...then im/pulm/cc

not full time either way.... if I do pulm/cc I really like consults and office too. For Anes I like the OR as well. What Im hoping for is 3 weeks/month of OR or office/consults and 1 week of ICU/month.

bottom line...

you have to decide which you like better.....OR or office.

You want to be a FULL TIME intensivist?

if that's what yu want ...then im/pulm/cc

I've seen very few of these. Most have office practices or pulm/consult services.

I've seen very few of these. Most have office practices or pulm/consult services.

Full time intensivists are the wave of the future. For me, I plan on doing pulm/cc for a few key reasons:

1)I would probably kill myself sitting in the OR for hours on end with little to do what with my ADD and all. (Quick story: Coolest surgery I've ever seen was a repair of a total anomalous pulmonary venous return at Joe DiMaggio Childrens Hosp here in FL... 12 people in the room, video monitors so everyone could see, full bypass, etc. The anesthesiologist? Sitting in the corner playing solitare on his Treo.)

2)All kidding aside, most importantly, I want to be an intensivist, so IM would clearly prepare me better (though I do like SICU/trauma patients.. they're so young and heal so well!)

3)Once I'm old and decrepit, having made sufficient money working myself half to death for 30+ years, I can open up a sleep lab, work a couple of hours a day telling a bunch of obese people they have OSA, and then hit the golf course!

(Although, reading the FAQ, doing ID then CCM might be interesting too; certainly easier to get the original fellowship, I would think)

-E

Full time intensivists are the wave of the future. For me, I plan on doing pulm/cc for a few key reasons:

1)I would probably kill myself sitting in the OR for hours on end with little to do what with my ADD and all. (Quick story: Coolest surgery I've ever seen was a repair of a total anomalous pulmonary venous return at Joe DiMaggio Childrens Hosp here in FL... 12 people in the room, video monitors so everyone could see, full bypass, etc. The anesthesiologist? Sitting in the corner playing solitare on his Treo.)

2)All kidding aside, most importantly, I want to be an intensivist, so IM would clearly prepare me better (though I do like SICU/trauma patients.. they're so young and heal so well!)

3)Once I'm old and decrepit, having made sufficient money working myself half to death for 30+ years, I can open up a sleep lab, work a couple of hours a day telling a bunch of obese people they have OSA, and then hit the golf course!

(Although, reading the FAQ, doing ID then CCM might be interesting too; certainly easier to get the original fellowship, I would think)

-E

full time CCM will only be the wave of the future...IF someone (doesn't matter who) steps up to the plate and PAY for it....

As it stands right now....it is NOT the wave of the future.

1)I would probably kill myself sitting in the OR for hours on end with little to do what with my ADD and all. (Quick story: Coolest surgery I've ever seen was a repair of a total anomalous pulmonary venous return at Joe DiMaggio Childrens Hosp here in FL... 12 people in the room, video monitors so everyone could see, full bypass, etc. The anesthesiologist? Sitting in the corner playing solitare on his Treo.)

Funny, I thought anesthesia was one of the bastions of ADD-types, along with EM. The Anesthesiologist was playing solitaire because he is ADD. ;)

are there alot of anesthesia groups that also share time in the ICU and OR? how common is this?

are there alot of anesthesia groups that also share time in the ICU and OR? how common is this?

single digit percentage rate.....low single digit percentage rate

but i guess they do exist. with all this talk of perioperative medicine/critical care being incorporated in the specialty i hope this percentage increases. but as milmd stated, someone must pay for it.

Full time intensivists are the wave of the future. For me, I plan on doing pulm/cc for a few key reasons:

1)I would probably kill myself sitting in the OR for hours on end with little to do what with my ADD and all. (Quick story: Coolest surgery I've ever seen was a repair of a total anomalous pulmonary venous return at Joe DiMaggio Childrens Hosp here in FL... 12 people in the room, video monitors so everyone could see, full bypass, etc. The anesthesiologist? Sitting in the corner playing solitare on his Treo.)



Well that's probably just cause that particular anesthesiologist had no interest in watching the surgery, meaning he could have been watching the video monitors along with everyone else if he was interested. Just cause he wasn't interested, you're saying you wouldn't have been if you're were the anesthesiologist? Or are you saying the anesthesiology training itself makes all anesthesiologists uninterested in what's going on across the curtain? Neither makes any sense whatsoever. Speaking for myself, one of the reasons I actually chose this field was BECAUSE i love watching the surgeries. To each his/her own. . .

Most private hospitals and even academic hospitals usually have the IM intensivist running the ICU. If critical care is really your main interest, do IM/CC/Pulmonary. However, if your interest is more intervention, then anesthesia may be more of your liking. Personally, as an anesthesiologist, I think anesthesia is more versatile as a specialty, and you usually are compensated better.

Most private hospitals and even academic hospitals usually have the IM intensivist running the ICU. If critical care is really your main interest, do IM/CC/Pulmonary. However, if your interest is more intervention, then anesthesia may be more of your liking. Personally, as an anesthesiologist, I think anesthesia is more versatile as a specialty, and you usually are compensated better.

I think the IM/CC/Pulmonary track is a lot more versatile than anesthesiology. You could do general IM (boutique/concierge medicine, primary care, clinics, hospitalist medicine, nursing home, ER, etc), pulmonary medicine (interventional pulmonary procedures, clinics, occupational medicine, allergy, pulmonary function lab director, etc) and CC. With anesthesiology background, you are pretty much limited to working in SICU, OR or interventional pain management.

Touche. Though I agree with your assessment, most of the IM intensivists that I know usually end up spending most of their time in the ICU and sleep and PFT labs. I think doing general IM is not what they want to do after receiving all that extra certification and education.

also just by saying "OR" you encompass a wide breadth of possibilities: cardiac, neuro, ortho, peds, ob, trauma. Can anesthesiologists not do sleep medicine? I'd think that of all specialties anesthesia one would be the most expert on this subject. . .

also just by saying "OR" you encompass a wide breadth of possibilities: cardiac, neuro, ortho, peds, ob, trauma. Can anesthesiologists not do sleep medicine? I'd think that of all specialties anesthesia one would be the most expert on this subject. . .
Pulmonary seems to have grabbed onto the sleep medicine thing the most (because most sleep apnea is obstructive, and not central). Although one would think anesthesiologists would deal with the obstructive processes better (hey, it is the airway afterall), it appears that anesthesiologists were slow to nurture the subspecialty. Pulmonology saw a need and picked it up.

I am really torn as to which to pick. Anesthesia with a CC fellowship or pulm/cc after IM. Im an M3 and I have rotated through both and really loved both. I was wondering if anyone had any insight that might help me out choosing? Can you guys help me with the pros/cons of each approach. My ultimate goal is to be an attending in an MICU. I know either way I can do it but Im just hoping for some good advice. Thanks everyone.

since you're pretty early in your career, you might entertain another option given your interests. how's about IM then cardiology with cath? i know of a number of interventionalists who attend in the cardiac ICU (strictly because they like to, 'cause cath pays better). so you can get your procedural time in an OR environment and also get ICU time as well. just a thought.

Pulmonary seems to have grabbed onto the sleep medicine thing the most (because most sleep apnea is obstructive, and not central). Although one would think anesthesiologists would deal with the obstructive processes better (hey, it is the airway afterall), it appears that anesthesiologists were slow to nurture the subspecialty. Pulmonology saw a need and picked it up.

Does that mean that an anesthesiologist can't join in though? Are groups pretty exclusive that way? I guess i dont really know what would keep an anesthesiologist from practicing sleep medicine if that's the path he/she chooses. Is there a requirement for IM boards? Or they just wont get hired? What about research? I kind of see it as something either one can carve a career into, but I could be missing something.

Does that mean that an anesthesiologist can't join in though? Are groups pretty exclusive that way? I guess i dont really know what would keep an anesthesiologist from practicing sleep medicine if that's the path he/she chooses. Is there a requirement for IM boards? Or they just wont get hired? What about research? I kind of see it as something either one can carve a career into, but I could be missing something.
It would be difficult for an anesthesiologist to join in. I think pulmonary has a stronghold on it, primarily because of OSA's complications (like pulmonary hypertension).

Sleep labs are normally run by Neurologists. Internal medicine folks can do a fellowhsip in Sleep Medicine, but it is a fellowship run by Neurons.

Pulm /CCM: ICU for really sick people who need a medicine doctor. Who do you want taking care of your grandad? AKA full code geriatrics.

Anesthesia - Surgical ICU: ICU for surgical complications and trauma-burn patients. Those young people who heal so well / stupid people tricks.

While I threw out some GROSS generalizations about the patient types, there is some truth behind those justifications. MICU and SICU have different cultures. If you really are thinking about critical care, take a look at those cultures and decide which group you fit. Surgerizers and Fleas have very different outlooks and personalities.

You're only an M3, decide which specialty you want before sub-specialty.

Good luck.

i actually really love the SICU - however at my hospital, it was run by trauma surgeons, not anesthesiologists. how common is it for anesthesiologists to run SICUs? critical care is one of the reasons I'm looking at anesthesia, and I want to be sure I can do it when I graduate from residency ...

i actually really love the SICU - however at my hospital, it was run by trauma surgeons, not anesthesiologists. how common is it for anesthesiologists to run SICUs? critical care is one of the reasons I'm looking at anesthesia, and I want to be sure I can do it when I graduate from residency ...

At our hospital our attendings are trauma, anesthesiology, or even EM :love: . Either trauma or anesthesia attendings CAN run it, but there are much more trauma/critical care specialists than anesthesiologists in critical care (make less $$ than in the OR).

If I decide to return to the SICU it will be more difficult since I will be an EM doc.... :(

Ok this is the point I am at. Its february and my school is telling me that I should have everything set up for 4th year by may 1 so that means I really have to decide pretty soon. A question I had that I was hoping someone could answer. I would feel bad asking any of the pulmonologist I know, but how much of an income can I expect? I know alot will depend on the type of practice. Anesthesia I have a fairly decent idea. If the numbers are close I will probably choose pulmonary even though its arguably more work and longer hours. Thank you guys you have been helpful.

Ok this is the point I am at. Its february and my school is telling me that I should have everything set up for 4th year by may 1 so that means I really have to decide pretty soon. A question I had that I was hoping someone could answer. I would feel bad asking any of the pulmonologist I know, but how much of an income can I expect? I know alot will depend on the type of practice. Anesthesia I have a fairly decent idea. If the numbers are close I will probably choose pulmonary even though its arguably more work and longer hours. Thank you guys you have been helpful.

Internists who specialize in CC make 180s to 250s according to AAMC Faculty salary survey 2004 :luck:

Interesting discussion, as usual.

But back to the point - I'm not sure how well an MS3 can predict precisely what he/she wants to be doing in 20 years, let alone 2. I would focus on the basics as others have said - do you prefer the OR, or the hospital floors and units? Do you want to be an anesthesiologist or internist? If you like pulm/cc, you might end up liking cardiology or GI more during your intern year. Or maybe you'll do your CA-1 year and realize that you really like pediatric anesthesiology. Critical care is but one sub-specialty off of each residency. I know I've gone from being pretty serious about critical care and debating between IM and anesthesiology to realizing that I don't want to spend the bulk of my time in the OR and that I really prefer floor medicine to now thinking that I really like cardiology and maybe pulm/cc.

hey guys i just wanted to say thanks for all your help and advice. I have decided to go the anesthesia route and do a CC fellowship after.

Sleep labs are normally run by Neurologists. Internal medicine folks can do a fellowhsip in Sleep Medicine, but it is a fellowship run by Neurons.

Pulm /CCM: ICU for really sick people who need a medicine doctor. Who do you want taking care of your grandad? AKA full code geriatrics.

Anesthesia - Surgical ICU: ICU for surgical complications and trauma-burn patients. Those young people who heal so well / stupid people tricks.

While I threw out some GROSS generalizations about the patient types, there is some truth behind those justifications. MICU and SICU have different cultures. If you really are thinking about critical care, take a look at those cultures and decide which group you fit. Surgerizers and Fleas have very different outlooks and personalities.

You're only an M3, decide which specialty you want before sub-specialty.

Good luck.


Both MICU and SICU = VERY sick people. I never once took care of a young person in our SICU (youngest was 25). This may be due to the fact that we have shock trauma but even there a lot of the patients who were young were still very, very sick. Most of the patients in the SICU were older, sick and laying in the SICU for at least a week at a time ... no one was healing well. These patients have the same problems as those in the MICU however, they have had recent surgery. Most have multiple medical conditions and are on a vent.

I would suggest doing both a MICU and SICU month - I did it and loved them both. Do an anesthesia month too so you can decide if you want to do that for three years of residency. Reason I love anesthesia ... it's the MICU/SICU all the time. You are constantly taking care of a patient in a critical care setting. Best part about it - you are only taking care of one person at a time.

Best of luck!

Are the salaries of both types of intensivists equivalent (ie, do intesivists that are anesth. trained earn the same as those that are IM trained)?

Strong Choice Celsus. Having done an internal medicine residency and most of an anesthesia one, I can say I am much happier as an anesthesiologist. The work is fun, immediate, intense at times, more procedural and can be more personally rewarding. As far as ICU goes, you will be much more comfortable handling airways and lines with an anesthesia background and you may actually get to treat patients who get better and leave the ICU!:thumbup: