Anesthesia Critical Care fellowship: basic questions

[TortuousVein]

When during your residency do you apply - and find out if you've obtained a position? Is there a centralized application process?

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[twoliter]

I did not apply to Critical Care, but you apply winter of your CA2 year. I'm not sure exactly when programs start accepting applications, but the Match is in May of your CA2 year (or at least it was this past year). So just based off what I remember my classmate doing, apply winter, interview spring, match May.

 

[cognitus]

Can you still work in the OR if you're certified in Critical Care? Is that common? Also, what's the salary for CC attendings?

 

[Femtochemistry]

Can you still work in the OR if you're certified in Critical Care? Is that common? Also, what's the salary for CC attendings?

Yes, most people do OR and CCM. A fellow in my class that graduated recently is doing 100% CCM. I would take a shot and say most gas-ccm people do about 30% CCM and 70% OR...as the OR pays more. Salary varies a lot from region to region, academics vs. PP, and how much OR-to-CCM you are doing.

 

[nimbus]

We've hired a few adult CCM fellows over the years and they all do 100% OR.

We have a handful of pediatric anesthesiologists who also do peds ICU.

 

[seinfeld]

I do about 3o% CCM. The biggest problem many CCM trained people have is finding a practice like mine where you can do Critical Care and Anesthesia seamlessly all within one group. Hence why some CCM trained people end up doing only OR or only CCM.

 

[G-Man82]

I do about 3o% CCM. The biggest problem many CCM trained people have is finding a practice like mine where you can do Critical Care and Anesthesia seamlessly all within one group. Hence why some CCM trained people end up doing only OR or only CCM.

What do you think about job prospects for us? I'm just now at the beginning of my CCM fellowship, but it seems like if you want to practice both CCM and OR Anesthesiology you have to stay academic, aside from the seemingly rare position that you have. I think at the SOCCA meeting back last October, they had mentioned that more and more jobs in CCM are starting to open up for interested Anesthesiologists. I haven't started my job search yet, so I don't know how true that is.

My Anesthesiology dept here is pretty large, very large in fact, and we manage 2 ICUs within the department, and have attending coverage for another as well, and it seems like there's a push to expand. But this is still academics, which I don't mind. It would be nice to know if PP jobs did exist though.

 

[Ezekiel2517]

Yes Anes/CCM PP gigs do exist. Typically usually found in larger groups. To name a few, a couple of the large groups in the Boston area, a large group in seattle, the big ass group in Houston, a big group in San Antonio, some groups in the southeast. There will be more. Why? Leverage.

 

[Morzh]

We have a handful of pediatric anesthesiologists who also do peds ICU.

Doesn't that require completing both an anesthesiology and pediatric residency plus the requisite fellowship(s)?? Or can do you do peds ICU with a traditional pediatric anesthesiology certification?

 

[urge]

Doesn't that require completing both an anesthesiology and pediatric residency plus the requisite fellowship(s)?? Or can do you do peds ICU with a traditional pediatric anesthesiology certification?

There are some Anes Ped CCM spots.

I found this on a quick Google search:

http://www.hopkinsmedicine.org/anesthesiology/educational/fellowships/ped_critical_care.shtml

A two year fellowship in Pediatric Critical Care Medicine is available from an American Board of Pediatrics approved residency for individuals who are also board certified in Anesthesiology. The Sequential Anesthesiology Residency and Pediatric Critical Care Medicine Fellowship at Johns Hopkins currently is as follows:
Year 1
Anesthesiology residency year 1
Year 2
Anesthesiology residency year 2
Year 3
Anesthesiology residency – 5 months anesthesia training, doing pediatric cases exclusively; 7 months elective: 4 months research, 3 months Pediatric Intensive Care Unit (PICU)
Year 4
PICU fellowship: 20 weeks PICU, remainder research
Year 5
PICU fellowship: 20 weeks PICU, remainder research

 

[nimbus]

Doesn't that require completing both an anesthesiology and pediatric residency plus the requisite fellowship(s)?? Or can do you do peds ICU with a traditional pediatric anesthesiology certification?

Yes the folks I'm talking about have peds, PICU, anesthesia, +-peds anesthesia.

 

[seinfeld]

The best way to find out is to call groups in a particular area and ask if they or any of the other groups in the area do CCM.

 

[nycitygas]

Plenty of groups do critical care-the problem is finding them. My recommendation is do your fellowship in the location where you want to live. Most programs will have a connection into the local group that does CCM. It'll be alot easier getting a job at that big group in Seattle coming from UW or Oregon than from the East Coast unless you have a connection.

I got my job through a connection (a co fellow knew they were hiring) They have a direct pipeline/connection with the local CCM group however so it would have been much easier/less stressful had I been local for fellowship.

Academic CCM market used to be hot...not so much anymore. There is a ton of interest in academic positions lately (fueled by the tight market and AMCs ). In several markets, straight CCM pays better than anesthesia (well, at least for new grads). I don't recommend doing it full time though because it's a recipe for burn out and you do not want to lose your OR skills.

The market for ccm is good enough these days that lots of groups are willing to take Anesthesia and ER folk. Plenty of opportunities for growth in the future. So far I'm happy with my choice of fellowship but time will tell if it was worth it.

 

[michigangirl]

There are some Anes Ped CCM spots.

I found this on a quick Google search:

http://www.hopkinsmedicine.org/anesthesiology/educational/fellowships/ped_critical_care.shtml

A two year fellowship in Pediatric Critical Care Medicine is available from an American Board of Pediatrics approved residency for individuals who are also board certified in Anesthesiology. The Sequential Anesthesiology Residency and Pediatric Critical Care Medicine Fellowship at Johns Hopkins currently is as follows:
Year 1
Anesthesiology residency year 1
Year 2
Anesthesiology residency year 2
Year 3
Anesthesiology residency – 5 months anesthesia training, doing pediatric cases exclusively; 7 months elective: 4 months research, 3 months Pediatric Intensive Care Unit (PICU)
Year 4
PICU fellowship: 20 weeks PICU, remainder research
Year 5
PICU fellowship: 20 weeks PICU, remainder research

Sorry just seeing this. To be clear-- this is only for folks who have completed a Pediatric Residency. So, three years of pediatrics then this five year program. Then if you want peds anesthesia training you do an additional year. 9 years minimum. Not including pedi heart fellowship, etc.

 

[Random Anesthesiologist]

For those in CCM... How did you decide that you ultimately wanted to do it? What was it that hooked you?

I spent a lot of time in the SICU last year, more of a private or community place and loved it. I'm on an ICU rotation at an academic place now and don't have the same warm fuzzy feelings. I thought I wanted to do this... Now I'm not so sure...

 

[deleted171991]

Same here, Random Resident. I loved MICU in my intern year. Absolutely hated every single month of SICU in my residency (mostly run by surgeons who used residents only for scutwork). But I love internal medicine, and I want to feel like a physician, not a stool sitter or a firefighter. And, long term, my guess is that at least 50% of anesthesiologists will end up either replaced by experienced CRNAs, or working at CRNA-level hourly rates. Unless the patient is ASA 4 (and possibly 3 for some procedures), we have made anesthesia safe enough to be practiced even by monkeys. It's just a matter of time. Just look at primary care physicians, except that those guys had the advantage of having their own patients, and their APRNs are way less militant. CCM is an escape route, an insurance for the future. It would also allow me to get my specialty diploma recognized in my home country, if ever needed.

I work in a renowned academic place, as an attending. For years, I have witnessed the decay of the status of the department in the eyes of the hospital and the surgeons. As a group, we get almost no respect from many of the surgeons. Even when we are respected, few of them treat us as equals. We push our patients' stretchers to the OR alone, even if working as solo attendings, making us look worthless in the eyes of the OR staff. We make up our own fluids, put on our own monitors, are being more and more ignored by the OR staff in the room (today I had 2 circulators in the room, and none of them moved a finger to help). Meanwhile everybody kisses the surgeons' butts up to their cecums. Some surgeons will interrupt our preop interviews like we don't exist. They would give us instructions about the kind of anesthesia they want, down to the level of "I want an LMA, not an ETT". Again, we are talking about board-certified attendings here. (As a resident or CRNA, these thunderstorms happen way above your head, so you don't know how good you have it.) The hospital admins overrule us when we occasionally cancel cases of well-connected surgeons, so we end up taking risks we shouldn't. If we are a minute late with getting the patient to the OR in the morning, a hospital middle manager will page us and treat us like kindergarteners, while the department will cut a part of our day's pay. And the list can go on. To quote Rodney Dangerfield, we mostly "don't get no respect". And it's not even worth complaining, because nothing changes except being branded as a troublemaker by your own department.

I will be doing CCM because I want to feel like a doctor again, not a valet for surgeons or periop monkey for CRNAs. I am not a prima donna, but I can't stand being treated like a doormat either. If that means being the primary attending for the patient, so be it. Even if it means never going back to the OR, or ending up in another academic place (which I'd hate, because I am a hard worker, not a CV padder or brown noser). The rest of the generic reasons you can find in similar recent threads.

Anesthesia incomes are going down. CCM salaries are going up. After the two intersect, private groups will suddenly become very interested in taking over ICUs. Same goes for the PSH, which might end up being paid better than some OR anesthesia.

 

[Random Anesthesiologist]

Thanks for that insight. I think the amount of scut is skewing my view too. I'm also finding, and this is true with anesthesiology too, the more I study, the less I feel I know, and it can seem overwhelming at times. I'm on cardiac ICU right now and feel like a ***** most of the day!

I never really entertained pain medicine thoughts before, but I do now. I should revisit this post at the end of this month and see how I feel.

 

[deleted171991]

I am not sure I was clear enough: I am not practicing critical care now. I will be doing a CCM fellowship soon.

Any job that doesn't feel overwhelming at first will be taken over by midlevels.

 

[nycitygas]

Nice! Where are you going?

 

[nycitygas]

Congrats! PM me when you start-I have alot of CCM resources (Questions reviewbooks, questions) on pdf I can send your way

 

[Sirach38]

This maybe a very dumb question so please excuse my ignorance but, if a CCM trained anesthesiologist is unable to find a mixed private practice where they can practice both in the ICU and in the OR, could they potentially take a private practice job doing exclusively OR work and then get hired at his local academic institution to do one week per month of ICU work? With the limited PP split OR/ICU positions it seems like one could find a PP OR gig and then pick up some ICU shifts at the local university without having to practice academic anesthesia....

 

[nycitygas]

Well what you can do is take a mommy track OR job 7am-3pm and then moonlight on the weekends and at night in the ICU. PM and Weekend shifts in the ICU are always easy to come by.

I went into CCM thinking at worst I could get a 7on 7off ICU job and moonlight in the OR on my week off. The locums market is pretty ****ty these days which makes that impossible unless you're willing to do only Gi anesthesia.

 

[TortuousVein]

Which would you consider the best critical care fellowships in the east or midwest?

 

[chocomorsel]

I feel your pain FFP and would like to do an ICU fellowship for the same reason. Although I am in a place where I certainly get more respect than average, I do get tired of surgeons being dinguses at times, acting like we are just twiddling our thumbs between cases as we are not moving fast enough for their liking, yelling at me when the patients move, (hello that **** happens when patients are getting neuromonitoring with no paralysis) or yeah, interrupting your preop exam.
I know I am not gonna last in this too long and if for sure I have to start supervising, then it will be time for me to go back and train to be a CCU person. That's what got me interested in this field in the first place.
I would go back to my medical school where the ICU experience was really good unlike residency which was horrible. I did get accepted to an ICU fellowship right after residency but ended up getting dropped when my license didn't come thru in time and they found out about my troubles in residency.
Oh well, it is still part of my plan. Or just say **** it and start a medspa.

 

[amyl]

I just signed up to start ccm fellowship next summer. I wanted back into academics and a top institution and wanted a fellowship. I loved cardiac but Everyone says cardiac will be dead in a few years and it just didn't feel right for me for a couple reasons... And 90% of those surgeons are truly crazy. I'm too tell it like it is to be successful in pain. Don't like regional or ob enough to do only that n peds isn't for me. I like the bigger cases I guess. Ccm seemed like a good fit... It's kind of like an extension of the OR with the sickest patients. I just signed to go back to academics, be staff for a year, run the preop clinic, then do the fellowship and then stay on as staff with probably 25-50% Icu. Really excited to work with residents... Supervising will be weird after doing all my own cases! great academic gig imho bc I won't loose my ob skills and will get to do liver transplants, etc. money isn't everything - I found out the hard way - but I'm glad I came here and broke myself in as a new attending on the front lines where all the patients are Asa 3 or 4 and I had zero backup - just me. They say you learn more your first year as an attending than you did all of residency. For me it was true the first couple months... Here is often **** storm after **** storm - happy I came and saw but happy to go too

 

[amyl]

Chocomorsel... I use remi infusions in neuromonitoring no paralysis cases... They never move. I'm down w the Medispa thing. Recently took a course in Botox and filler bc I was interested and wanted to do my friends etc. come back to tx and we can open it together

 

[amyl]

Not all fillers are irreversible less is more, agreed.

 

[chocomorsel]

Oh yeah, all those rich folk with old money, oil money, new money from my home state, yeah, we could make some money. I have thought about it since residency. Let me save up some.

 

[secants]

I just signed up to start ccm fellowship next summer. I wanted back into academics and a top institution and wanted a fellowship. I loved cardiac but Everyone says cardiac will be dead in a few years and it just didn't feel right for me for a couple reasons... And 90% of those surgeons are truly crazy. I'm too tell it like it is to be successful in pain. Don't like regional or ob enough to do only that n peds isn't for me. I like the bigger cases I guess. Ccm seemed like a good fit... It's kind of like an extension of the OR with the sickest patients. I just signed to go back to academics, be staff for a year, run the preop clinic, then do the fellowship and then stay on as staff with probably 25-50% Icu. Really excited to work with residents... Supervising will be weird after doing all my own cases! great academic gig imho bc I won't loose my ob skills and will get to do liver transplants, etc. money isn't everything - I found out the hard way - but I'm glad I came here and broke myself in as a new attending on the front lines where all the patients are Asa 3 or 4 and I had zero backup - just me. They say you learn more your first year as an attending than you did all of residency. For me it was true the first couple months... Here is often **** storm after **** storm - happy I came and saw but happy to go too

What type of ICU will be you be running? Is it the 7-7 schedule? How's the transition of getting back into the medicine work environment of rounding and writing notes after working as an anesthesia attending?