Critical care...medicine vs anesthesia

[ButImLETired]

Hey guys,

so I'm just a first year, but my school is all about "exploring specialties early" so I've been doing a lot of that. I currently find that I really like critical care. I was wondering if anyone knew what the differences are between anesthesia critical care and the pulmonology/IM critical care. How are the jobs different (besides working in a SICU instead of a MICU). How are the cases different? Lifestyle? Training? Pay?

Thanks!

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[thesauce]

Hey guys,

so I'm just a first year, but my school is all about "exploring specialties early" so I've been doing a lot of that. I currently find that I really like critical care. I was wondering if anyone knew what the differences are between anesthesia critical care and the pulmonology/IM critical care. How are the jobs different (besides working in a SICU instead of a MICU). How are the cases different? Lifestyle? Training? Pay?

Thanks!

It's great that you're getting started early in thinking about this. I don't know much about this, but I had a good friend who had this decision to make and chose anesthesia. Lifestyle is similar between the two. Training is a little longer with anesthesia, but easier and the pay is substantially more (1.5x). I wish I could provide more specifics but I never had a rotation in either myself.

 

[obiwan]

While I can't really mention much about anesthesia critical care, I recently just got off my MICU month and I really enjoyed the rotation.... it is definitely a different sort of mindset compared to general medicine floor i thought because while you are working up these disease processes, MICU docs have to stabilize patients because they are really sick .... critical care gives you just enough flavor for procedures if you also fancy that sort of stuff

 

[sunset823]

Hey LET,
I'm a fellow first year, and am also extremely interested in critical care. (I shadowed in the ICU this year, with an IM --> CC physician, and absolutely loved it). I decided to take matters of figuring out the difference between the anesthesia and IM routes into my own hands and will be doing an anesthesia research fellowship this summer (at Vandy, actually, I believe that's where you're at school? I remember you were a frequent poster in our pre-med days, haha). We have 15% shadowing time in the OR/ICU over the summer, so I'll get to find out more about how anesthesia CCM works and then make a decision about which route to take.

I have heard that CCM pays less than general anesthesia, so it is not a very popular fellowship from the anesthesia route, but that doesn't dissuade me at all. Maybe you could explore a similar option, at Vandy or elsewhere? If you will be in Nashville for the summer, PM me, it would be great to work together

 

[MossPoh]

http://forums.studentdoctor.net/showthread.php?t=714254

There are other discussions about it in the critical care medicine forum as well I bet. There shouldn't be any significant income differences. If there is, it may be more of a difference in locale and practice type than anything else. There are tons of ways into CCM besides the traditional meds/gas route though. You can actually go into neuro intensive care and EM can do it now as well.

 

[ACSurgeon]

Hey guys,

so I'm just a first year, but my school is all about "exploring specialties early" so I've been doing a lot of that. I currently find that I really like critical care. I was wondering if anyone knew what the differences are between anesthesia critical care and the pulmonology/IM critical care. How are the jobs different (besides working in a SICU instead of a MICU). How are the cases different? Lifestyle? Training? Pay?

Thanks!

To answer your questions first...

How are the cases different? I don't think they have to be different. Some hospitals have one ICU for surgical and non-surgical patients. Thus, theoretically, you can manage the same types of critical patients. The big difference is with the anesthesia route, you can do general anesthesia as part of your practice (3 months out of the year, for example), and that would obviously be a different type of practice than what an internist could do.

Lifestyle? Unfortunately, the answer you'll get is that you can make of it what you want. Again, if you do the anesthesia route, you can set it up such that you do X months of critical care and X months of anesthesia. The anesthesia months should be low stress and fairly good hours. With that said, general internal medicine has the potential for good hours too (the residents do alot of the work, unless you're a hospitalist w/o residents).

Training? anesthesia: 4 years. Medicine 3 years. Anesthesia is overall more competitive to get into, but not terrible. Not sure about the anesthesia CC fellowships, but I know for medicine you can do a 2 or 3 year fellowship (pure CC vs. pulmonary and CC).

Pay? I think the difference in pay will depend on how much general anesthesia vs. general medicine you include in your practice. I would imagine the actual critical care pay would be similar (although I have no evidence).

If you noticed, I almost make the assumption that CC docs always do some other "general" work in their practice. This is based on what ONE 3rd year medicine resident told me. He happened to be interested in CC, but he chose to do an anesthesia residence (after completing his medicine residency) and then do a CC fellowship. His reasoning was that you burn out too quickly if you do 12 months of straight up CC, and he preferred doing general anesthesia in his "alternate" time as opposed to general medicine.

I hope this helps

 

[ACSurgeon]

http://forums.studentdoctor.net/showthread.php?t=714254

There are other discussions about it in the critical care medicine forum as well I bet. There shouldn't be any significant income differences. If there is, it may be more of a difference in locale and practice type than anything else. There are tons of ways into CCM besides the traditional meds/gas route though. You can actually go into neuro intensive care and EM can do it now as well.

General surgery too

 

[thesauce]

http://forums.studentdoctor.net/showthread.php?t=714254

There are other discussions about it in the critical care medicine forum as well I bet. There shouldn't be any significant income differences. If there is, it may be more of a difference in locale and practice type than anything else. There are tons of ways into CCM besides the traditional meds/gas route though. You can actually go into neuro intensive care and EM can do it now as well.

There is a difference in salary. It might boil down to being able to provide coverage for general anesthesia as well...I'm not sure.

Although it doesn't seem fair, there are other examples of 2 docs doing the exact same job getting paid different amounts depending on their training. For instance, a peds ER doc will make more if he did an EM residency and then a fellowship in peds EM as opposed to a peds residency/EM fellowship. This holds true even if they don't cover for the adult ER at all.

 

[RxnMan]

Hey guys,

so I'm just a first year, but my school is all about "exploring specialties early" so I've been doing a lot of that. I currently find that I really like critical care. I was wondering if anyone knew what the differences are between anesthesia critical care and the pulmonology/IM critical care. How are the jobs different (besides working in a SICU instead of a MICU). How are the cases different? Lifestyle? Training? Pay?

Thanks!

There are quite a few paths to CC.

IM + CC = 3+ 3 = 5 years, 6 if added with pulm.
Anes + CC = 4 + 1 = 5 years
EM + CC = 3/4 + 2 = 5-6 years
G Surg + CC = 3-5 + 1-2 = 4-7 years
There's a neuro CC training path, but I don't know much about it.

To my understanding, the type of cases that are admitted to the unit drive the lifestyle. Trauma/CC surgeons often have the worst schedule; other training paths often have a shift schedule in the ICUs. Similarly, IM/CC generally work in MICUs, Neuro in NICUs, EM and Anes in combined/MICUs, surgery in SICUs. There are differences in open vs closed ICUs, as well as group or combined programs (places like Pitt have all fellows from all residencies train in the same combined program). Major differences in training paths will even out over fellowship. Each path has strengths, but none come to fellowship knowing everything.

 

[RxnMan]

...Training is a little longer with anesthesia, but easier and the pay is substantially more (1.5x). I wish I could provide more specifics but I never had a rotation in either myself.

Not so. See my previous post. IM/CC/Pulm is a little longer than Anes/CC.

There is a difference in salary. It might boil down to being able to provide coverage for general anesthesia as well...I'm not sure...For instance, a peds ER doc will make more if he did an EM residency and then a fellowship in peds EM as opposed to a peds residency/EM fellowship...

I'd expect any CC doc would get the same pay as another, assuming the same practice area and barring some bonus for experience.

Peds ER doesn't generally get more $$$ than adult EM, despite doing more training. Peds -> Peds EM is usually an increase in pay however. Generally, fellowships in EM do not lead to a greater salary.

 

[thesauce]

Not so. See my previous post. IM/CC/Pulm is a little longer than Anes/CC.

I stand corrected. 3yrs?...damn.

I'd expect any CC doc would get the same pay as another, assuming the same practice area and barring some bonus for experience.

Peds ER doesn't generally get more $$$ than adult EM, despite doing more training. Peds -> Peds EM is usually an increase in pay however. Generally, fellowships in EM do not lead to a greater salary.

I think you misunderstood my post. I wasn't comparing their salaries before and after fellowships.

Take 2 doctors that are working in a peds ER:
Doctor 1: Did a residency in EM and a fellowship in peds EM
Doctor 2: Did a residency in peds and a fellowship in peds EM

Doctor 1 will make more money 99% of the time. That's just the way it is. I've had 2 peds ER rotations and this has come up on both from disgruntled docs that took the latter path.

 

[RxnMan]

Take 2 doctors that are working in a peds ER:
Doctor 1: Did a residency in EM and a fellowship in peds EM
Doctor 2: Did a residency in peds and a fellowship in peds EM

Doctor 1 will make more money 99% of the time. That's just the way it is. I've had 2 peds ER rotations and this has come up on both from disgruntled docs that took the latter path.

I guess if doc 1 does shifts in the adult section in addition to peds shifts, sure. But my understanding was that they'd get paid the same, but for #1, it's a slight pay drop from general EM, for #2 it's a good increase from Peds.

My understanding comes from the posts in the EM forum, so that may be open all kinds of biases.

 

[thesauce]

I guess if doc 1 does shifts in the adult section in addition to peds shifts, sure. But my understanding was that they'd get paid the same, but for #1, it's a slight pay drop from general EM, for #2 it's a good increase from Peds.

Yep, that's true.

My understanding comes from the posts in the EM forum, so that may be open all kinds of biases.

They may be right. All my info comes from disgruntled attendings which is definitely open to bias.

 

[Smurfette]

Keep in mind that gen surg with critical care fellowship can be a better lifestyle from a surgical standpoint with some increased reimbursement of inpatient care (i.e. can be billed separately as compared to a typical post op patient where it's one lump-sum for their care)...you do not need to do trauma with it. Often the surgeons will have light schedules while on ICU, and may have complete weeks off, depending how they plan their operative/clinic schedules and size of the hospital they are working at.

 

[RxnMan]

Keep in mind that gen surg with critical care fellowship can be a better lifestyle from a surgical standpoint with some increased reimbursement of inpatient care (i.e. can be billed separately as compared to a typical post op patient where it's one lump-sum for their care)...you do not need to do trauma with it. Often the surgeons will have light schedules while on ICU, and may have complete weeks off, depending how they plan their operative/clinic schedules and size of the hospital they are working at.

Yes, from what I've been told, surgeons in CC run the gamut from CC (SICU) only with shift schedules, to combined operative experience and CC time. The latter is more common overall, while the former is more commonly done by those doing 3 years of general surgery -> CC fellowship.

 

[MossPoh]

There is a difference in salary. It might boil down to being able to provide coverage for general anesthesia as well...I'm not sure.

Although it doesn't seem fair, there are other examples of 2 docs doing the exact same job getting paid different amounts depending on their training. For instance, a peds ER doc will make more if he did an EM residency and then a fellowship in peds EM as opposed to a peds residency/EM fellowship. This holds true even if they don't cover for the adult ER at all.

We are talking strictly operating as a CCM doc though. As one improves and focuses in one area, their skills tend to atrophy in the other. Just as an anesthesia person could technically flip around. A person going the internal medicine route could also do pulm work or whatever else, a general surgeon could do surgery and so on. But if you are doing that, then your cash flow is no longer considered just critical care. It is considered critical care + whatever you are doing.

Such a situation is dependent on things such as the practice you choose to join. Many groups may not WANT you to take call if you are strictly their CCM doc. Just as if you did a fellowship in pain, your OR skills may (and most likely will) get weaker. Some groups may want you to mix it up. If you are talking strictly CCM with no other money pathways, then there shouldn't be any difference in income. I think it is kind of a moot point since you should just go with what interests you more, but oh well.