Academic Critical Care/Cardiac and Anesthesia

[MDAforthewin]

I'm going to bulletpoint these questions for ease of answering.

1)In academics, I know that pure anesthesia can be 3-4 days a week and a pure critical care doc would be working 7 on 7 off. What if you wanted to do a 50 split of gas and critical care in an academic position? Does the even happen in academia?

2) Does anyone have any info on what cardiac trained academic gas would have as a schedule? What would be your split of hearts cases vs. general anesthesia?

3) If you go academic critical care with 7 on 7 off do departments let you pick up extra shifts on your off weeks or perhaps do some OR shifts?

4) New psuedo trend is to be a triple threat of cardiothoracic, critical care and anesthesiology. Sounds impressive to have all of that specialization but what are these doctors doing in practice? Are they any more employable/profitable than a single fellowship or no fellowship at all in academics?

Lots of questions. Forgive my ignorance. Thanks as always. Love the info on this board.

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[core0]

I'm going to bulletpoint these questions for ease of answering.

1)In academics, I know that pure anesthesia can be 3-4 days a week and a pure critical care doc would be working 7 on 7 off. What if you wanted to do a 50 split of gas and critical care in an academic position? Does the even happen in academia?

2) Does anyone have any info on what cardiac trained academic gas would have as a schedule? What would be your split of hearts cases vs. general anesthesia?

3) If you go academic critical care with 7 on 7 off do departments let you pick up extra shifts on your off weeks or perhaps do some OR shifts?

4) New psuedo trend is to be a triple threat of cardiothoracic, critical care and anesthesiology. Sounds impressive to have all of that specialization but what are these doctors doing in practice? Are they any more employable/profitable than a single fellowship or no fellowship at all in academics?

Lots of questions. Forgive my ignorance. Thanks as always. Love the info on this board.

I can only tell you how we do it.
For critical care full time is 26 weeks per year. For anesthesia they submit how many weeks they want to do and the unit medical director and anesthesia medical director work on the schedule. Most anesthesia CCM work 10 weeks per year or so. This is no different than surgery does it.
The CT/CCM/anesthesia split time between the heart room and the CTICU. Weeks in the ICU depend on need and anesthesia need.
Not sure how the rest works.

 

[ProwlerturnGas]

When I was in academics….I did 18 weeks per year CCM, the rest of my time was OR and "academic" days.

 

[smgilles]

I'm going to bulletpoint these questions for ease of answering.

1)In academics, I know that pure anesthesia can be 3-4 days a week and a pure critical care doc would be working 7 on 7 off. What if you wanted to do a 50 split of gas and critical care in an academic position? Does the even happen in academia?

2) Does anyone have any info on what cardiac trained academic gas would have as a schedule? What would be your split of hearts cases vs. general anesthesia?

3) If you go academic critical care with 7 on 7 off do departments let you pick up extra shifts on your off weeks or perhaps do some OR shifts?

4) New psuedo trend is to be a triple threat of cardiothoracic, critical care and anesthesiology. Sounds impressive to have all of that specialization but what are these doctors doing in practice? Are they any more employable/profitable than a single fellowship or no fellowship at all in academics?

Lots of questions. Forgive my ignorance. Thanks as always. Love the info on this board.

I am Fellowship trained in Cardiac Anethesia and Critical Care and I work in an academic setting. My split is 50:50 CVICU and Anesthesiology with a majority in the cardiac hallway.

1. I do 7 days or nights in the CVICU from 6a - 6p or 6p - 6a. It's more like 5a - 7p or 5p - 7a (98 hours/week) if you count sign out with the other intensivist. I then have the next 7 days as non clinical time. I do 13 weeks a year of this, so I have 13 weeks of non clinical time. The other 26 weeks is OR time (M - F), with infrequent cardiac Anethesia call from home. My vacation and trip time comes out of my OR time.

2. Every week I am in the OR I will spend one of those days out of the cardiac hallway doing noncardiac cases.

3. You will be so beat down from Critical Care that you are not going to want to pick up extra OR shifts unless you really want too. When you work ~100 hours/week in the unit managing 25 critically ill cardiac patients you are not going to want to relieve your colleagues out of the OR from their 40 hr/week schedule.

4. Being triple boarded is not for everyone and it really sub specializes you. You better make sure it is what you are interested in because Cardiac Anesthesia and CCA are much more demanding than general Anesthesiology. It will really only work for you in large tertiary/quaternary referral centers (ECMO, VADs, Centrimags, Lots of TEE, etc.).

 

[secants]

What do you do during your 13 weeks of non clinical time? Are you paid the same (salaried) as the general anesthesiologists doing OR cases at your center?

 

[smgilles]

What do you do during your 13 weeks of non clinical time? Are you paid the same (salaried) as the general anesthesiologists doing OR cases at your center?

Yes, we are all paid the same (Critical Care vs Cardiac Anesthesia vs Regional Anesthesia vs Pediatric Anesthesia vs General Anesthesia). Everyone gets the exact same salary. My nonclinical 13 weeks are spent working on research that interests me or committees and meetings.

 

[secants]

I'm curious, is there any extra earning potential available in academics such as picking up more shifts or doing more call?

 

[BuzzPhreed]

My nonclinical 13 weeks are spent working on research that interests me or committees and meetings.

I'd be spending that 13 weeks in Fiji.

 

[smgilles]

I'd be spending that 13 weeks in Fiji.

I never said where I work on my research or hold meetings

 

[IlDestriero]

I'm curious, is there any extra earning potential available in academics such as picking up more shifts or doing more call?

It depends on how the group is structured. Some pay for call or late shifts and specialty call separately. Some offer incentive compensation for productivity, etc.

 

[scudrunner]

Does anyone ever negotiate a signing bonus or student loan payment?

 

[psychbender]

For the triple-boarded crowd here, would your practice/group/hospital allow someone who only completed a CCM fellowship to split time between the CVICU and CVORs like you do, if they came from a fellowship with a strong emphasis on TEE and post-op cardiac care?

 

[smgilles]

For the triple-boarded crowd here, would your practice/group/hospital allow someone who only completed a CCM fellowship to split time between the CVICU and CVORs like you do, if they came from a fellowship with a strong emphasis on TEE and post-op cardiac care?

We would let you cover the CVICU but not CV ORs.

 

[IlDestriero]

We would let you cover the CVICU but not CV ORs.

It seems like something that one could get on the job training for if they already have a solid anesthesia background with adequate cardiac experience and proven echo skills from the CICU..

 

[psychbender]

It seems like something that one could get on the job training for if they already have a solid anesthesia background with adequate cardiac experience and proven echo skills from the CICU..

That was my thought, as I had six months of cardiac during residency, and do hearts now as an attending in a moderate volume military MEDCEN, but I wanted to get a real-world response from those actually out in practice.

 

[pgg]

We would let you cover the CVICU but not CV ORs.

That surprises me. An echo-boarded anesthesiologist wouldn't be assigned to the CV ORs? Do you just have a lot of people doing those cases already?

 

[B-Bone]

I believe smgilles works at Mayo, and they have a bounty of CV folks. If I remember correctly, they even have CV/echo boarded people who don't even do cardiac.

 

[bigdan]

I think it will vary, depending on all the factors you'd predict.

If you're an academic place with an active CT fellowship program, it's not surprising that they'd want CT trained folks.

For sure, there a "less academic" and private practices that would love to have an ICU guy/gal doing hearts with them...there's at least one ICU guy on SDN that does hearts at his busy private practice.