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deleted171991
Doesn't one function more like a resident there?
CCM Fellowship Dilemma
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I said that I did not interview UPMC, so I did not include them in the discussion. I had heard what FFP and Partydoc mentioned, so did not apply there.
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I had a discussion with one of the SICU fellows today who mentioned "I recommend a critical care fellowship for every anesthesiologist. It's only one year, and makes you a much better doctor." I can certainly see how the latter part of his statement is true, and take issue with the bit about "only one year", but I find myself wondering how much net benefit there is for a PP anesthesiologist who, say, did a cardiac fellowship. How much does managing sepsis and delerium and weaning vents make you a better anesthesiologist? I've used this extreme example before to illustrate this point: one can imagine the ultimate intra-op physician, double-boarded in surgery and anesthesia. When is enough enough?
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I interviewed there, they do work hard but it is only one year and they're well known in the CCM world with participating in a ton of publications. I think you have to prioritize what you want: where you want to live, what exposure you want and how much you're willing to work. To me doing one year of hard work where on some units they're understaffed is worth it if you're going to be a baller attending, I've worked with people who came out of cush programs and they're not the same. UPMC has the name, exposure even if it is a lot more work, in 10 years when you want to switch jobs or some place is looking for someone to be in a leadership position I think this would help. Consider all the top programs that are workhorses like Hopkins and Columbia, there fellows work hard but when they want a job they've the network and experience to back it up
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deleted171991
CCM is for people who love (acute care) internal medicine.
To answer your question, it's never enough. The more you know, the more you know what you don't know.
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There is an entire spectrum between cush programs, and those that exist to make fellows' lives miserable. You can get excellent training, with a good network without killing yourself in the process. As someone who finished residency already, there is something to be said about having the time to relax, reflect on what you did, and do some reading to dig deeper. If you're Q3 for the year, covering all of the units at night, you're not likely able to do that. I'm not advocating going to a program with no call, that is strictly 7-3, M-F.
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deleted171991
Probably not. It comes with a huge tuition.
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Did anyone else interview at UT Houston, bc I'm still having a love fest with the program, even after interviewing at the "big names" (CCF, UPMC, MGH, Emory, Duke) or am I crazy?
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Go with your gut. PD seemed like a really nice guy
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If you're still in love with a program, then rank it number 1. There's more to a program than the power of its name.
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deleted171991
I chose my program based on gut feeling. Best decision of my life.
The corollary is: if you don't like them at their best behavior on your interview day, you probably won't like them during your fellowship either.
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I'm a UT resident planning to do CCM. George Williams is our CCM PD, he's literally the most amazing guy of all time. Super smart, enthusiastic, loves to teach and really cares about his fellows. Also very involved politically and academically. Has been one of my mentors since before residency.
Definitely feel free to contact me if you have questions, but long story short I have very good things to say about Dr. Williams, Memorial Hermann Hospital trauma and neuro exposure (esp neurotrauma and stroke) and MD Anderson's case variety and brilliant intensivists (I've been thru each of these units as a resident). I have never rotated through the Memorial Hermann SW ICU though so can't say as much about it, seems like a lot more bread/butter medicine / gen surg type patients.
Definitely feel free to contact me if you have questions, but long story short I have very good things to say about Dr. Williams, Memorial Hermann Hospital trauma and neuro exposure (esp neurotrauma and stroke) and MD Anderson's case variety and brilliant intensivists (I've been thru each of these units as a resident). I have never rotated through the Memorial Hermann SW ICU though so can't say as much about it, seems like a lot more bread/butter medicine / gen surg type patients.
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deleted171991
Dude, forget neuro. You cannot certify and/or work as a neurointensivist without another fellowship. People should downright avoid the neuro-heavy CCM fellowships; they make nice money for the hospital, nothing more. And one already knows more than enough neuroCCM after an anesthesia residency.
Go for MICU- and cardiac-heavy fellowships. After caring for some of those patients, nothing will scare you. You want to care for extremely sick patients, not for vegetables, during your fellowship.
Go for MICU- and cardiac-heavy fellowships. After caring for some of those patients, nothing will scare you. You want to care for extremely sick patients, not for vegetables, during your fellowship.
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As a colleague across the street, I have to also attest to Dr. Williams' enthusiasm and genuine care for the well-being and education of his trainees. Best of luck, wickedskillz!
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I interviewed at UT Houston for a faculty position when I was in the job hunt. The gross compensation was ok, but the benefits and the time off after a week in the ICU was amazing. George Williams was an excellent host and is an amazing person. I did enjoy my time during that interview. Unfortunately, they decided they needed someone with more NeuroCCM training under their belt. I did the usual one month, but they wanted 2 months. It's a very Neuro-heavy CCM division, and they're just now reclaiming their positions in other ICU's. I do remember them mentioning tension with Pulm, who currently runs their CVICU. Take that for what it's worth.
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To conclude the thread: Matched at Stanford, top choice. Thanks for the advice, gang! Glad I didn't take the outside offer.
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deleted171991
That is fantastic. Congratulations to everybody.
I have a peeve though: many people make their choice make on brand or location, not on program quality. "I know it's not such a good program, but it will say ******* on my diploma." I too have done that mistake in the past, thank you.
You're giving up $200K not for the brand, but for the education. If it is too cushy, you're getting shortchanged on your education. Talk to the fellows; they should look rested, but enthusiastic about their education and opportunities. They should both supervise and do stuff, when needed. They should have meaningful electives. They should be able to go to conferences. They should have 4 weeks of vacation they don't want to use up completely. They should be true junior attendings, the kings of the ICU and viceroys of the hospital after hours. Most importantly, there should be locals among the candidates or (recent/incoming) fellows (the canary in the mine).
And don't be lazy to go shopping. All the travel costs are nothing in comparison to the income you lose during the fellowship year. The more places you see, the better your chances of finding the right program. I would say that the ideal number is between 5 and 10.
(Before I get more questions about my program: it has its own weaknesses, and I might have chosen a top one with what I know now, except that the people were fantastic to work with, and the entire year was a joy. And no, I can't tell you about it; you'll have to unearth this gem alone.)
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deleted171991
Now you know why so many ICU fellows have the middle initial V.
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Sorry to bump an older thread, but I felt the need to share. Only two weeks into ccm fellowship and I'm already feeling like the fk'ing viceroy. SICU attending was running late today and tells me on the phone to just get started with rounds without him (have not rounded without an attending present yet). It was a breath of fresh air to be leading the team, making global decisions, talking with families about the prognosis and the plan, and reassuring the nurses that this newbie might actually know what he's talking about. Been studying for boards mostly, but I've also been having a ball reading Marik, Parrillo, and Marino and refreshing myself on shock, sepsis, microbiology, electrolytes, arrhythmias, fluid management that goes beyond bolusing a couple liters and starting a neo drip, ventilator weaning, and a whole host of surgical and medical topics which I had forgotten about long ago. Also had a badass lecture today by a CT/CCM attending that was supposed to be on swans, which evolved into a 1.5hr tour-de-force review of applied cardiac physiology as it pertains to sick post-cardiac surgical patients.
Long story short, ccm fellowship is rockin' so far.
Long story short, ccm fellowship is rockin' so far.
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Any thoughts on applying to some of the combined Anesthesia-CCM programs (like U of Washington)? So you commit to 5 years from the beginning, but your fellow year is split between PGY4 and PGY5. (I like this because you don't end up spending an entire year outside the OR for fellowship)
I am applying anesthesia this fall. Seriously thinking CCM fellowship at this point, though I admit my ICU exposure is limited. I really enjoy reading and learning about critical care (especially resuscitation) as well as taking care of really sick patients.
I see this as being nice in that you don't have to do the whole application, interview, match, move process again. But it's also obviously a risk to commit to a CCM program so early.
Just looking for some insight. Any thoughts? What would you do?
I am applying anesthesia this fall. Seriously thinking CCM fellowship at this point, though I admit my ICU exposure is limited. I really enjoy reading and learning about critical care (especially resuscitation) as well as taking care of really sick patients.
I see this as being nice in that you don't have to do the whole application, interview, match, move process again. But it's also obviously a risk to commit to a CCM program so early.
Just looking for some insight. Any thoughts? What would you do?
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deleted171991
My advice is to not commit to a combined program. There is very little to gain and a lot to lose.
First, you're giving up the chances of getting into both the best anesthesia program and the best fellowship program you can. Usually they are not the same.
Second, you have no idea where the field (and you) will be in 4-5 years. You might fall in love with something completely different, such as pain. Or your spouse might.
Third, what kind of fellow will you be, in your last 1-2 years? Fellow in the ICU, resident in the OR? Seriously? A fellow should be a junior attending, and that's why it's best to do one's fellowship away from the residency program, so that one is not looked at as a PGY-5 resident. (And that's also the reason people should not take a job at their previous residency program.)
Fourth, a good CCM fellowship is enjoyable. You might miss the OR, but not as much as you'd think. And good skills come back fast. Plus nobody stops you from moonlighting at a different institution.
First, you're giving up the chances of getting into both the best anesthesia program and the best fellowship program you can. Usually they are not the same.
Second, you have no idea where the field (and you) will be in 4-5 years. You might fall in love with something completely different, such as pain. Or your spouse might.
Third, what kind of fellow will you be, in your last 1-2 years? Fellow in the ICU, resident in the OR? Seriously? A fellow should be a junior attending, and that's why it's best to do one's fellowship away from the residency program, so that one is not looked at as a PGY-5 resident. (And that's also the reason people should not take a job at their previous residency program.)
Fourth, a good CCM fellowship is enjoyable. You might miss the OR, but not as much as you'd think. And good skills come back fast. Plus nobody stops you from moonlighting at a different institution.
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Thank you FFP. Some of those I definitely didn't think of. I have spent countless hours pouring over the many threads on here and I value the great information and opinions shared by you and the many others who contribute here.My advice is to not commit to a combined program. There is very little to gain and a lot to lose.
First, you're giving up the chances of getting into both the best anesthesia program and the best fellowship program you can. Usually they are not the same.
Second, you have no idea where the field (and you) will be in 4-5 years. You might fall in love with something completely different, such as pain. Or your spouse might.
Third, what kind of fellow will you be, in your last 1-2 years? Fellow in the ICU, resident in the OR? Seriously? A fellow should be a junior attending, and that's why it's best to do one's fellowship away from the residency program, so that one is not looked at as a PGY-5 resident. (And that's also the reason people should not take a job at their previous residency program.)
Fourth, a good CCM fellowship is enjoyable. You might miss the OR, but not as much as you'd think. And good skills come back fast. Plus nobody stops you from moonlighting at a different institution.
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deleted171991
Let me put it this way: why is nobody selling combined anesthesia residency-cardiothoracic fellowship programs, just anesthesia-CCM? Because they can't get enough suckers for their CCM fellowship (which should speak volumes), but more than enough for the CT one. CCM is a buyer's market; don't give up your advantage.
