Anesthesiology Critical Care Fellowship

[nycitygas]

Hey All, I'm currently debating what fellowship to do. I have a huge interest in CC but am not sure if I believe the hype about the job market. On my last ICU month, the ICU fellow i worked with told me most med groups that cover ICU tend to only hire pulm/cc so that they can cover pulm consults as well. Any recent CC grads have anything to say about the job market?

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[G0S2]

I am applying for CC. The US happens to be the only advanced health care country where pulm runs the ICUs in private practice. One of my CCM attendings showed us a slide about this. In the US it appears you will have to be in academics to be an anesthesia attending covering the ICU. There have been some instances, however, where a PP group of anesthesiologists have covered the SICU in private hospitals.

 

[nycitygas]

That's what I feared. I'm from texas originally as well and am looking to return home. Any programs in particular in texas that stand out?
My other interest is CT but not having done any yet I dont know. I always thought I would do pain until I did my second pain month and absolutely hated it although that could be because of the patient population we see.

 

[G0S2]

That's what I feared. I'm from texas originally as well and am looking to return home. Any programs in particular in texas that stand out?
My other interest is CT but not having done any yet I dont know. I always thought I would do pain until I did my second pain month and absolutely hated it although that could be because of the patient population we see.

Just 3 programs:

UT San Antonio (my home program)-new this year. 2 fellows. Rotations in SICU, MICU, Trauma ICU and PICU. 2 months TEE. Seems great but this is the first year. Great CC faculty.

UT Houston- seems great on paper with rotations in Trauma, MICU, Neuro and MD Anderson.

UTSW-know the least about this program but I bet if you just want a year of getting your ICU butt kicked, Parkland could do it.


I enjoyed my CT month but not enough to do a fellowship. It really provided more incite into the needs of the pt in the SICU.

 

[lazylikeapanda]

I'm a resident at UTSW. The critical care fellowship takes one fellow. The rotations includes time in the Parkland SICU, which is a busy trauma unit with trauma fellows around, but also MICU, the SICU at VA Dallas, which is sometimes busy. During the fellowship year there is an option to go down to Methodist Houston for CVTS-ICU in a semiprivate practice setting. The outgoing fellow was pretty happy with his experience, got a sweet gig in California. There are 5 critical care trained anesthesiologists that came from Mayo Clinic, UTMB, Jackson Memorial, and UTSW, so you'll get variety in approaches to management. Also while rotating at Parkland you get to train with some arguably great trauma/burn surgeons like Erwin Thal and John Hunt.

 

[CrazyJake]

I think currently most CC jobs are in academics, but there are exceptions you can find in PP and these can be some very sweet gigs if you luck out. A former resident at my program is covering his hospitals "mini-ICU" once a week, few days here and there and getting payed pretty damn well for it! Also, a week or so ago, an attending told me that shes heard/read that many Anesthesia group are looking to expand into ICU coverage for more recognition within their hospital and leverage if a managment or competing group woud try to buy them out.

I've been told that there will be a shortage of many specialties over the next 30 yrs (Anesthesia included), but critical care especially as baby boomers get older and frankly there just isn't enough doc's who are willing to do CC.

Critical care also gives you an alternative if you get burned out of the OR's, tired of surgeon B.S, are injured/sick and can't do procedures..etc.

I think it's worth considering and in 20 yrs could be a smart decision...

Looking forward to hearing from others. I'll try and ask our current critical care fellows what the outlook is like.

CJ

 

[nycitygas]

Thanks for the input guys. I'm going to go ahead and go with my gut and pursue CC. Even if I end up in straight anesthesia PP, the year of critical care training can only help. I'm going to try to focus on programs heavy on TEE, I think its still possible to get certification this way.

 

[G0S2]

Thanks for the input guys. I'm going to go ahead and go with my gut and pursue CC. Even if I end up in straight anesthesia PP, the year of critical care training can only help. I'm going to try to focus on programs heavy on TEE, I think its still possible to get certification this way.

It is as long as you are caring for CT surgery pts, which you will be.

 

[RussianJoo]

Are there combined CC/CT anesthesia fellowships out there? It seems like someone who did both fellowships would be prefect for CVTS-ICU's. You take care of them in the OR and then in the ICU once they're out of surgery.

 

[G0S2]

Are there combined CC/CT anesthesia fellowships out there? It seems like someone who did both fellowships would be prefect for CVTS-ICU's. You take care of them in the OR and then in the ICU once they're out of surgery.

Yes. Many.

 

[imfrankie]

Yes. Many.

I know the Brigham has one; where else?

 

[Bertelman]

I know the Brigham has one; where else?

Pretty sure Penn does. Short answer- pretty much any program that has both a CC and CT fellowship would probably be happy to have you stick around for 2 years of poorly paid work to complete both.

 

[Idiopathic]

when i interviewed at hopkins back in the day i seem to remember the program director being a big proponent of the split/combined fellowship (specifically CC/CT)

 

[RT2MD]

Wash U in St. Louis does:

http://www.anest.wustl.edu/educationtraining/fellowships/cardiothoracic/Default.aspx

"We also offer the opportunity to pursue a combined cardiothoracic/critical care fellowship. We encourage potential applicants to contact us and to discuss their specific needs and career goals. We will work with applicants to accommodate their individual needs wherever possible."

 

[nycitygas]

2 years of fellowship seems too much. Not sure if I have the energy for it and . I'm just starting my research now, looking for a program that will give me heavy TEE experience (and hopefully get boarded)
I took a look online, saw a few combos (anesthesia + critical care jobs) that seemed pretty sweet. The other straight intensivist were often 7 on 7 off-plenty of time to do anesthesia in the middle part time.

 

[RussianJoo]

Pretty sure Penn does. Short answer- pretty much any program that has both a CC and CT fellowship would probably be happy to have you stick around for 2 years of poorly paid work to complete both.

I was thinking more of combined fellowships that are maybe 1.5 years instead of two. What's the point of having the combined cc/ct fellowship if it's two years when you can just do a ct fellowship and then apply to a cc fellowship or vice versa.

 

[nycitygas]

I was thinking more of combined fellowships that are maybe 1.5 years instead of two. What's the point of having the combined cc/ct fellowship if it's two years when you can just do a ct fellowship and then apply to a cc fellowship or vice versa.

i think they are all two years (combined Programs)

 

[lushmd]

RJ, the 18 month combined CT/CCM fellowships are a thing of the past. Now that CT is an ACGME accredited fellowship, there's no way (that I'm aware of anyway) to reduce the length of doing both fellowships to less than two years.

 

[Bertelman]

I was thinking more of combined fellowships that are maybe 1.5 years instead of two. What's the point of having the combined cc/ct fellowship if it's two years when you can just do a ct fellowship and then apply to a cc fellowship or vice versa.

I don't know why people do what they do. I'm just telling you what's out there.

 

[RussianJoo]

well that sucks. thanks for answering my q's.

 

[amyl]

my program -- cleveland clinic -- has a guy doing a CC fellowship w TEE certification as part of it, (so some CT rotations so he gets his echo numbers and then some). i think it is going to be a 18 month fellowship. its a good idea i think and i think its going to work out great but he is the first. that said if you are looking for a 2012 gig we are full and then some. if you were thinking 2013 speak up soon because i think they are already working on those classes.... thats nothing official, just what i hear

 

[Mac4]

He will be CCM and TEE certified, but not CVT certified.

Realistically, I feel it is very difficult to do a 12 month CCM and be TEE certified. You are required to do 9 months of ICU to be board eligible. It leaves you three months to do electives/TEE. Unless you have dedicated CVT months (like at Duke), how can you do the complete 150 TEE exams? Remember you will be competing with your own CCM fellows, CVT fellows, residents... If you want to be TEE certified, do you best in residency and get a CVT fellowship spot.

 

[Bertelman]

He will be CCM and TEE certified, but not CVT certified.

Realistically, I feel it is very difficult to do a 12 month CCM and be TEE certified. You are required to do 9 months of ICU to be board eligible. It leaves you three months to do electives/TEE. Unless you have dedicated CVT months (like at Duke), how can you do the complete 150 TEE exams? Remember you will be competing with your own CCM fellows, CVT fellows, residents... If you want to be TEE certified, do you best in residency and get a CVT fellowship spot.

What is CVT certification?

And it looks like amy said it will be an 18 mo. fellowship.

 

[Mac4]

Sorry, I mean CVT credited fellowship.

 

[proman]

National Board of Echocardiography Perioperative Echo certification does not require a cardiac anesthesiology fellowship. It does require an ACGME accredited fellowship involving care of the cardiovascular patient. A cardiac surgery fellow could be eligible if the required numbers are obtained. So could a medical CCM fellow. So could an anesthesia CCM fellow. However, none of those people would be a cardiac anesthesiologist.

 

[imfrankie]

National Board of Echocardiography Perioperative Echo certification does not require a cardiac anesthesiology fellowship. It does require an ACGME accredited fellowship involving care of the cardiovascular patient. A cardiac surgery fellow could be eligible if the required numbers are obtained. So could a medical CCM fellow. So could an anesthesia CCM fellow. However, none of those people would be a cardiac anesthesiologist.

There was(is) some kind of practice pathway also, at least when I took the exam.

 

[Bertelman]

There was(is) some kind of practice pathway also, at least when I took the exam.

It no longer leads to Advanced PeriopTEE certification. That ended in 2009, I think.

 

[proman]

There was(is) some kind of practice pathway also, at least when I took the exam.

You can still challenge the test and get testamur status but not board certification. It'll be interesting to see how the renewals do now that there's an advanced test. I did get confirmation that the advanced test was made more challenging because of the introduction of the basic exam.

 

[nycitygas]

Anybody know how many spots Brigham has for CC a year?

 

[Doctor4Life1769]

Anybody know how many spots Brigham has for CC a year?

So, MGH is not > Brigham?

 

[nycitygas]

So, MGH is not > Brigham?

In terms of rep, I cant think MGH being < than anything.
Just trying to get a feel on how many spots each program has.
I thought I read once that only like 50-60 anesthesia res go into CCM a year
but all the top programs seem to have large classes (I guess filled with surgery/EM?).
Hopefully, less competition for me

 

[Doctor4Life1769]

In terms of rep, I cant think MGH being < than anything.
Just trying to get a feel on how many spots each program has.
I thought I read once that only like 50-60 anesthesia res go into CCM a year
but all the top programs seem to have large classes (I guess filled with surgery/EM?).
Hopefully, less competition for me

You'll be fine dude.

 

[dbth77]

So, MGH is not > Brigham?

Mgh>brigham for ccm, brigham>mgh for hearts

 

[lushmd]

Mgh>brigham for ccm, brigham>mgh for hearts

What are you basing this statement on?

 

[dbth77]

What are you basing this statement on?

near universal agreement between mgh and brigham residents

 

[Bertelman]

What are you basing this statement on?

Don't be so dense. Everyone knows there is a clear, objective ranking system for all residencies and all fellowships. It's indisputable.

Did you not get the recent ranks from US News & World Report? There was a sidebar discussing the particular merits of the three big Boston programs. Brigham was clearly better in hearts, MGH clearly better in CCM, and BID clearly better in ...wait let me look that one up.




...

Wait, none of this exists. No one REALLY knows anything. This stuff changes from year to year, yet we hang on to the advice of anonymous strangers like a lost ship in a fog-covered sea, looking for advice to pick the best possible audition rotation/residency/fellowship/malpractice insurance/handgun/tequila.

 

[nycitygas]

My interest in Brighams is that I know a previous graduate who had a very positive experience there. I find it unlikely that BID MGH or BW has any serious deficiencies in their programs.
Any residents chime in on how living in Boston as a resident? NYC has been great but having < zero savings while my friends in other cities are buying homes has grown tiresome hah.

 

[scotchnwater]

Are there combined CC/CT anesthesia fellowships out there? It seems like someone who did both fellowships would be prefect for CVTS-ICU's. You take care of them in the OR and then in the ICU once they're out of surgery.

Columbia was one of the first to offer this and still does. IMHO, it's one of the few places where CCM and Cardiac are both solid.

Anybody know how many spots Brigham has for CC a year?

I believe 6. This year they had space for 5, I think it was because someone was doing extra time on thoracic...

Mgh>brigham for ccm, brigham>mgh for hearts

That's what I've heard from multiple sources as well. Interviewed at BWH for hearts and was mighty impressed!

 

[PMPMD]

my program -- cleveland clinic -- has a guy doing a CC fellowship w TEE certification as part of it, (so some CT rotations so he gets his echo numbers and then some). i think it is going to be a 18 month fellowship. its a good idea i think and i think its going to work out great but he is the first. that said if you are looking for a 2012 gig we are full and then some. if you were thinking 2013 speak up soon because i think they are already working on those classes.... thats nothing official, just what i hear

I'm one of the CCF SICU fellows. You don't need 18 months to get TEE certified. Most of the fellows in my class are going for certification after our 12 month CCM fellowship. We have changed the rotations this year so we can get the required # of studies.

 

[nycitygas]

Anybody have any input on the John Hopkins CCM fellowship year?

 

[imfrankie]

I'm one of the CCF SICU fellows. You don't need 18 months to get TEE certified. Most of the fellows in my class are going for certification after our 12 month CCM fellowship. We have changed the rotations this year so we can get the required # of studies.

How you like the fellowship? Details if you've the time?

 

[lushmd]

Anybody have any input on the John Hopkins CCM fellowship year?

I'm sure that its an excellent training experience. One of my residency classmates is going there for CCM fellowship next year. IIRC, he indicated that the call schedule is rough (Q3 for nine months) but that he was most impressed by the program. Basically, he'll get killed for a year but come out a rock solid intensivist.

 

[nycitygas]

I'm sure that its an excellent training experience. One of my residency classmates is going there for CCM fellowship next year. IIRC, he indicated that the call schedule is rough (Q3 for nine months) but that he was most impressed by the program. Basically, he'll get killed for a year but come out a rock solid intensivist.

Thanks!

 

[MTGas2B]

Anybody have any input on the John Hopkins CCM fellowship year?

One of my staff in fellowship trained there after he had been on faculty at hopkins for a bit, then he stayed on for a while, until he came to my program. He loved, misses it, wishes he was back. He's a sharp dude too. Did say he worked his @$$ off though.

 

[amyl]

I'm one of the CCF SICU fellows. You don't need 18 months to get TEE certified. Most of the fellows in my class are going for certification after our 12 month CCM fellowship. We have changed the rotations this year so we can get the required # of studies.

Basic TEE or testamured?

 

[PMPMD]

Basic TEE or testamured?

Testamur means you passed the exam. Certified means you passed the exam and met other criteria (did the required # of studies).

http://www.echoboards.org/faq

 

[periopdoc]

Anybody have any input on the John Hopkins CCM fellowship year?

I talked with the anesthesia ICU folks (mostly anesthesia residents rotating through the ICU) when I was at Hopkins and was planning the switch to anesthesia.

The SICUs are run by anesthesia and you do work your a** off when on service. The attendings are very present, very fair, and work their a**es off too. The training is excellent and you will come out rock solid.

I can't speak to the fellows schedule etc.

Despite it being in Baltimore (the best thing about Baltimore is that it is only 45 min to DC), I count my year at Hopkins as one of the best in my training. There was great inter-specialty collegiality.

I bet you would love it.

- pod

 

[RussianJoo]

I talked with the anesthesia ICU folks (mostly anesthesia residents rotating through the ICU) when I was at Hopkins and was planning the switch to anesthesia.

The SICUs are run by anesthesia and you do work your a** off when on service. The attendings are very present, very fair, and work their a**es off too. The training is excellent and you will come out rock solid.

I can't speak to the fellows schedule etc.

Despite it being in Baltimore (the best thing about Baltimore is that it is only 45 min to DC), I count my year at Hopkins as one of the best in my training. There was great inter-specialty collegiality.

I bet you would love it.

- pod

I am truly sorry about the hijack, but What are your thoughts on their CT fellowship?

 

[nycitygas]

I talked with the anesthesia ICU folks (mostly anesthesia residents rotating through the ICU) when I was at Hopkins and was planning the switch to anesthesia.

The SICUs are run by anesthesia and you do work your a** off when on service. The attendings are very present, very fair, and work their a**es off too. The training is excellent and you will come out rock solid.

I can't speak to the fellows schedule etc.

Despite it being in Baltimore (the best thing about Baltimore is that it is only 45 min to DC), I count my year at Hopkins as one of the best in my training. There was great inter-specialty collegiality.

I bet you would love it.

- pod

Thanks Pod, I've heard nothing but good things about John Hopkins. The clinical training seems unparalleled and hell its only a year!