Are you implying that CC in IM is longer than Anes/Surgery because MICU patients are sicker?
I don't think there's any doubt that MICU patients are sicker than SICU. But more MICU patients die. I don't really think there's much to learn from sticking catheters and monitoring devices on people who are going to die anyway. In other words, unless your interventions make a difference in outcomes, it doesn't matter if your patient is sicker than mine. I could stick all sorts of monitoring devices on a nutritionally deficient patient with metastatic cancer... in surgery we call that a warm autopsy.
The real reason why CC from IM is longer than Anes/Surgery is because IM is 3 years, and some of that time is spent in outpatient clinics. During inpatient care, there are discrete floor and ICU teams. Compare that with Surgery which is 5 years and almost always has a mix of floor and ICU patients in each team. It doesn't make any sense to say that an IM graduate is at the same level of CC profiency as a Surgery graduate. It also doesn't make any sense to say that an EM graduate from a 3 year residency working 40-50 hours a week has the same level of proficiency as someone with 5 years of training at 80 hours a week.
CC fellowship after Surgery is really only 9 months of CC. This is standard. Is there any CC program that will take an EM graduate for 9 months of CC? As far as I know its 2 years minimum. I don't see why this is controversial. EM residents are just as bright as Surgery residents, they just aren't trained as extensively in CC during their course of residency training. That's not chest thumping, that's a fact.
If you're talking about those who have completed the recommended CC fellowship, one would think (and hope) that anyone would be well trained to run an ICU regardless of where they came from pre-fellowship.
Warning! Long post ahead! (sorry guys).
Filter07:
Thank you for your comments.
Full disclosure: Im an EM trained intensivist working in a (mostly) surgical ICU group but with a couple of others with different base specialties.
The varied training background of the ICU staff as a collective entity is an advantage for several reasons, and not just because most units outside of the US (and indeed, many community hospitals in America) take all comers, i.e. med/surg/neurosurg/cardiac etc. in one unit. It is also an advantage because folks from different backgrounds enrich journal clubs, case reviews, faculty meetings, educational sessions.... even the collective revenue streams and economics of the group in some cases. Our base-specialty biases become collective sources of wisdom for the whole group! Without another base-specialty to weigh in, theyre just biases. Anyway, in my opinion it makes the rest of the docs in the group better, and better doctors make healthier patients.
Filter, you seem to think you have considerable insight into the relative value of, among other things, residency in emergency medicine, surgery, anesthesia, internal medicine, and the attendant clinics, OR time, EM shifts, and floor/ICU months that go along with them vis-a-vis their relative value to a future career as an intensivist. Forgetting for a moment that you really only have limited exposure to one of these things (you're a 3rd year resident now right?) lets assume some of your observations are correct. One thing you have failed to grasp is that while we all come from some base specialty, what makes a great intensivist is the willingness to approach the job AS AN INTENSIVIST and not simply an anesthesiologist or trauma surgeon rounding on ventilated patients.
I have worked with talented (and not so talented) intensivists from all of the backgrounds relevant to our discussion here. Their relative skills were, without exception, a direct result of their commitment and effort at learning critical care rather than their 3, 4, 5 (or more!) years of residency. One intensivist with a trauma surgery background I worked with during fellowship wasn't a great mentor and colleague because he spent more time taking care of critically ill patients in his general surgery residency then I did in my emerg residency (though he might have (shrug)); rather, he was a great intensivist because he had a voracious appetite for expanding his critical care knowledge base, a drive to continually evaluate his own practice as well as that in the unit we worked in, a willingness to teach
and be taught, and a drive to approach working in the ICU AS AN INTENSIVIST.
Anyway, I choose not to identify one base specialty as the "best" prep for critical care. I came from EM. In my opinion, my emerg training, while certainly being of great utility, contributed very little differential benefit compared to what I may have gleaned from another specialty in making me a (hopefully) capable intensivist. Of much greater importance was the fact that I started reading extensive critical care literature even as an intern, and sought out the sick of the sick during every shift, rotation, clinic, and floor month (who do you think got to the rapid responses in the month when I was a general medicine intern, me or the IM resident? LOL). Hell, maybe your point about doing 55 hours a week in EM vs. 80 in surgery (more like 110-120 even with the work hours where I trained) played into my makeup as an intensivist-wannabe affording more time to read around my cases! LOL.
Interestingly, as an exercise, I made a list of my "top 10" mentors among all those I trained under or worked with in the ICU. The list: 1 EM, 2 anesthesia, 2 trauma surgeons, 1 transplant surgeon, 1 cardiothoracic surgeon, 1 cardiologist, 1 pulmonolgist, and an ID specialist.
Pretty cool, eh?!? What a group to pull inspiration from! Yup, 4 of 'em were surgeons and only one was EM. But it isn't a reflection of their backgrounds.... it reflects their commitment to critical care
Do what you love. If you want to do critical care, pick whatever base specialty you would otherwise see yourself working in when you're not in the unit. Rest assured, no base specialty will give you the definitive leg up or leg down insofar as being a great intensivist. It *might* have a bearing on your ability to get a job in a certain place (I'm not naive about this - it is harder in EM, though rapidly improving) but it isn't because of the lack of skills based on your choice of base specialty that will keep you out - its the long-standing prejudice against certain intensivists based on the perceived ads/disads of their base specialty. Which is why I feel an obligation to not flame the probably well-intentioned, talented, but slightly biased 3rd year surgery resident in this case, but to influence through persuasion not hubris.
Take care my surgical friend. May your call be painless this weekend --
