Critical Care

[Dryacku]

I know this issue has been addressed in the past, but just wanted some new thoughts esp from practicing docs or residents.

It scared the hell out of me when I went into my internship (at a private hosp with a private group of anesthesiologists) and saw CRNA's doing everything from blocks to cardiac cases... all the doc's did is supervise once in awhile. I had a difficult time understanding the value of being a "doctor"

I personally really enjoyed CC medicine and am debating whether or not to pursue a fellowship following my training for two reasons one to cover my butt and second to understand my value as a physician. But I hate the thought of doing the fellowship and then realizing there is no value as far as compensation and making more competitive in the job mkt?

I know this post may seem a bit tangential, but I think you get the point.

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[BOOP]

Dryacku: I know how you feel. While I am no expert, I have spent a considerable amount of time looking into this very subject. It amazes me that more of our colleagues don't find ICU fascinating. What it may lack in pay and cushy hours it easily makes up with sense of satisfaction, depth of complexity and level of interaction with patients and their family.
Not only is there a huge shortfall of critical care physicians now, numerous studies predicte this need to increase even more in the coming decades. Intrestingly, combio fellowships like pulmonology/critical care have become incredibly popular recently lately, in 2005/2006 - only 1-2% of total programs went unfilled. Sadly anesthesia critical care has failed to generate similar trends 2005/2006 and saw 48% of the positions went unfilled, at least this was down 4% from the previous year!

So to answer your questions consider the following:

1) The need for intensivists now and in the coming years is clear.
2) Given the number of unfilled fellowships, you have your choice!
3) While CRNAs may eventually win rights to practice independently in other areas like pain. You will never see a CRNA taking over an MD's role in the ICU, period.
4) Critical Care doc's are some of the most widely respected in the hospital. And in my experience make some of the best teachers
5) Perhaps the most important reason: If you love it go for it and don't worry about the rest.

Lets hope that this trend reverses in the coming years, and more people take interest. It certainly could help reverse the perception of our field.

Heres some links you should check out:

HRSA - Report to Congress on the Critical Care workforce
ftp://ftp.hrsa.gov/bhpr/nationalcenter/criticalcare.pdf

And a June 2006, report by the Society of Critical Care Medicine
http://www.sccm.org/SCCM/Publications/Critical+Connections/Archives/June+2006/workforce_June06.htm

- BOOP

 

[fakin' the funk]

Dryacku: I know how you feel. While I am no expert, I have spent a considerable amount of time looking into this very subject. It amazes me that more of our colleagues don't find ICU fascinating. What it may lack in pay and cushy hours it easily makes up with sense of satisfaction, depth of complexity and level of interaction with patients and their family.

Yeah, seriously, why would anyone want THAT crazy stuff?

Honestly though if you made ICU pay the same as OR anesthesia pay, those programs wouldn't be unfilled now would they?

 

[Glp1del]

No one can predict the future; however, the demand for critical care trained anesthesiologists is currently quite high. Just open any current issue of Anesthesia or Anesthesia and Analgesia and look at the job listings. In addition, the ASA leadership is strongly pushing for the role of anesthesia to that of a perioperative physician and in that vane have increased the ICU time during residency from 2 to 4 months. In my opinion, a career that encompasses both anesthesia and critical care is more likely to be accomplished in academics; however, I am sure that some positions exist in private practice.

In fact, the need for intensivists may actually increase in the near future. Medicare is pushing for legislation that would no longer make them responsible to pay for known complications following surgery. If this passes, private insurance agencies are not likely to be far behind. The Leapfrog study (2000) showed multiple studies that indicated that a dedicated intensivist decreased the number of complications. At some point, hospitals may find it more financially sound to hire intensivists then treat patients for complications that they are not being compensated for.

 

[coprolalia]

Critical Care trained anesthesiologists is a nice little secret right now. In the future, there will be more "virtual" units, where the intensivist (however trained) will sit and monitor multiple patients remotely. They will direct intervention based upon what they see on the monitors. To me, this may become a really sweet gig, especially if the current high-reimbursement environment for anesthesia dries up in the next decade or so. So, for anyone with an interest in being a "real" physician outside the OR, and who wants to hedge their bets against a changing practice environment, doing an extra year of training to be certifed in CC seems like a no-brainer.

-copro

 

[TIVA]

I think I've said this before but I'll say it again:

One extra year buys you a whole extra career.

Besides, you can always tell the difference between Anesthesia Attendings with and without critical care experience ... the ones with a fellowship under their belt tend to bring a certain extra something to the OR.

 

[jeesapeesa]

anybody double certified in cardiac anesthesia and critical care? i think wash u. has a program. if so, would this idea be favorable for private practice or is it just a waste of time?

 

[coprolalia]

anybody double certified in cardiac anesthesia and critical care? i think wash u. has a program. if so, would this idea be favorable for private practice or is it just a waste of time?

It really only helps if you get the TEE certification, otherwise it's a waste of time. Penn offers a similar 18-month "critical care" fellowship which also allows you to get experience managing patients in the surgical cardiac ICU. In addition to being able to sit for the CC boards, you also get your TEE cert. Remember (at least right now), anyone can do cardiac cases with the cardiac fellowship. What most places who are going to hire you want is your TEE ability.

-copro

 

[Dr Serenity]

My apologies if this question sounds dumb...

Only time will tell for me whether or not I'll be interested in pursuing a critical care fellowship when the time comes for me to apply for one. At this point in time (as a 4th year med student going into gas), I think that a CC fellowship is a definite possibility for me.

My question is this...do CC fellows often pursue OR anesthesia jobs after their fellowship training (knowing that the extra training makes them a better physician both in and out of the OR), or do they mainly take jobs as intensivists? Is it the "expectation" for anesthesia-CC trained fellows to take jobs as intensivists (even though I'm sure that there are at least some that do otherwise)?

Thanks for the input.