Advice for EM/CC hopeful

[oceanillusion42]

Hey guys,

Realize the EM/CC thing has been addressed on here and I've read multiple posts but just had a few quick questions. Long story short I was completely sold on EM going into my third year... I've been an EMT for 7 years, thought I had everything figured out. Then I did 2 weeks in the ICU as part of my IM core and realized that the fun part of EM is seeing the 10% of the patients that are actually sick, and 100% of the patients in the ICU are actually sick and there's more codes, procedures, and fast thinking in the ICU than I'd thought, with the added benefit of getting to stick around and treat the patient. I enjoy taking care of sick people, so started thinking maybe CC is for me. That being said, the thought of completing an IM residency is scary to me.

I realize that you can do EM-CC, and in fact my home state of NJ is home to Cooper Hospital that has a CC fellowship that accepts EM docs. My question is really, are EM-CC docs able to find work in an ICU setting fairly easily? I'd be interested in doing some ICU and ED shifts, but is this sort of set up hard to come by?

Finally, if I did decide to pursue just the CC aspect (doing the IM residency), I'd be more interested in CC and and not the pulm.... is it uncommon to be a doc that makes a career out of 100% ICU?

Thanks for any help!

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[dotcb]

Disclaimer: I'm a practicing emergency physician who spent a lot of residency considering doing CCM fellowship, but ultimately chose not to. I still consider doing it from time to time, but am also very happy practicing EM.

Bottom line: You should do the residency of the field you'd be most happy practicing in the event you chose NOT to do a fellowship. A lot can change in 3-4 years. You could change your mind and decide not to do a fellowship. You should do the field you think is more fun or the residency you'd rather do.

Historically, ICU's have been staffed by surgical (surgery and anesthesia) and medical (pulm/CCM) intensivists. Surgeons have needed to be able to take their patients to the OR, and medical intensivists have had job descriptions which included pulm consults and pulm clinic. Things are slowly changing, and ICU coverage seems to be moving a bit more toward shift work.

Emergency physicians who have trained in CMM in years past have been able to find CCM jobs with a bit of legwork, and have been employed by progressive, forward-thinking departments who value their training as an asset. Institutions which are very traditional, have more turf battles, have been slow to adapt or recognize the change. Being eligible for board certification by medicine, surgery, and anesthesia will likely help to legitimize CCM training for EM in the future. In the meantime, if it turns out that you want a job at X institution, and they only employ anesthesia trained or pulm trained intensivists, you might just be outta luck. If you're willing to be flexible, it probably won't be that big a deal.

In addition, working out your schedule, juggling 2 departments, 2 sets of projects and literature, could be difficult but doable. Many people say that ultimately, most will just pick one field to practice. The pay is similar, ICU has a pager, less flexible schedule, night-time emergencies, etc. EM has its own downsides.

To summarize: You should do the field you think is more fun or the residency you'd rather do.

 

[oceanillusion42]

Thanks for your response. Yea EM has always been my real passion, so it stands to reason that I should pursue that as my residency and then explore the CC aspect more during my time in the MICU during residency and make a decision from there. One step at a time lol.