Hospitalist-->Critical Care Medicine pathway

[DoctorDr]

With the huge lack of CCM/intensivist taking care of critical ill patients one possible solution is the creation of the pathway for hospitalists who are currently managing ICUs and for those who plan to do hospitalist medicine first..One year of Critical Care Medicine fellowship after 3 years of Hospitalist Medicine. I guess this is one solution that would provide solution to ongoing deficit in intensivist manpower.

What about you? do you think this is good or bad?

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[deuist]

Here is the article from the Societies of Hospital Medicine and Critical Care Medicine that support this pathway: http://onlinelibrary.wiley.com/doi/10.1002/jhm.1942/full

 

[Hernandez]

If they're medicine graduates from the medicine program where I'm at, you'd have to make that a 3 year CC program......

 

[europeman]

Why? Why not fast track them for a 12 month fellowship? Surgeons and anesthesiologists only do 12 months for critical care.

 

[Hernandez]

Why? Why not fast track them for a 12 month fellowship? Surgeons and anesthesiologists only do 12 months for critical care.

Surgeons and anesthesiologist also have longer training. I was post call and having dealt with lazy sr IM residents who has no buisness graduating much less having the option of doing CC in one year.

Sadly I'm in the camp that believes that IM traing should be increased to 4 years given new work hour restrictions.

But I do know there are some IM programs that produce IM docs who could this tract.

This first posting I had seen about this had suggested mandating a few years of real world work before allowing them to be eligible. But without a doubt, we need more CC docs.

 

[JacobSilge]

If they're medicine graduates from the medicine program where I'm at, you'd have to make that a 3 year CC program......

If that 3 year Pulm/CC program includes a year of research and a year of pulm, isolating out just 12 months of clinical ICU may work out to a comparable number of months of managing critically ill patients. Just don't expect to have the same level of knowledge regarding the primary pulmonary processes.

 

[Hernandez]

If that 3 year Pulm/CC program includes a year of research and a year of pulm, isolating out just 12 months of clinical ICU may work out to a comparable number of months of managing critically ill patients. Just don't expect to have the same level of knowledge regarding the primary pulmonary processes.

Except for call. In 2 years, I've done 8 months CC, and 4 months of call. I have 2 more months of call and 3 more CC months.

Yes some programs are research oriented, but many of those people who go there end up on academic tracts where they only do part time clinical work.

That post was post-call cranky being stuck with lazy incompetent senior residents who I would not give the option of 1 year CC to them. examples were being called to see a pt with a Chem CO2 of 18 for micu eval without residents looking at pt, mismanaging a type 1 dm pt who also had a NSTEMI who's now going into Dka due to their gross mismanagement of insulin, eval of a CAP with PSI score class 2 for micu eval (again without them ever seeing pt) among other gems like that.

And personally, the thought of a full year of CC makes me tired just thinking about it. I do roughly half my year in CC and that's enough, cramming all the necessary CC in a year would be rough. Especially if you have a family.

I'm not opposed to it on paper.....just think the enrollment should be....stringent

 

[deleted19731]

So if this does happen will it be available to fm trained physicians who've already completed SHM hospitalist fellowships?

I mean it seems like it should since SHM supports fm being hospitalists...

 

[Hernandez]

ACCP does not support this proposal. http://journal.publications.chestnet.org/article.aspx?articleid=1206594

 

[deuist]

So if this does happen will it be available to fm trained physicians who've already completed SHM hospitalist fellowships?

I mean it seems like it should since SHM supports fm being hospitalists...

Why in the world would a family physician want to be an intensivist?

 

[europeman]

I think it's great when other non traditional fields do critical care! The more diversity to our field, the better educated our fellows and we become!

ER or ob/gyn critical care practicing docs are great.

That said, a family medicine trained physician just graduated from the Sicu fellowship at Maryland Shock Trauma.

She recognized the lack of post trauma patient primary care and thought her training would give her unique insight into that niche. It's fantastic.

First month or two she had a lot to learn not knowing how to intubated, bronch, do a chest tube, etc..... But those skills aren't that hard and by the time she graduated she was one bad arse intensivist!

 

[inspirationmd]

I think it's great when other non traditional fields do critical care! The more diversity to our field, the better educated our fellows and we become!

ER or ob/gyn critical care practicing docs are great.

That said, a family medicine trained physician just graduated from the Sicu fellowship at Maryland Shock Trauma.

She recognized the lack of post trauma patient primary care and thought her training would give her unique insight into that niche. It's fantastic.

First month or two she had a lot to learn not knowing how to intubated, bronch, do a chest tube, etc..... But those skills aren't that hard and by the time she graduated she was one bad arse intensivist!

Very Interesting. Did she end up taking an academic or private practice job? I assume she is primarily an intensivist but does she do any primary care or just use the FM training as a means to anticipate post ICU departure needs?

 

[deleted547631]

Sadly I'm in the camp that believes that IM traing should be increased to 4 years given new work hour restrictions.

But I do know there are some IM programs that produce IM docs who could this tract.

This first posting I had seen about this had suggested mandating a few years of real world work before allowing them to be eligible. But without a doubt, we need more CC docs.

Dude, no!

 

[Modanq]

Well NPs and PAs are practicing ICU care now. Its a free for all.

 

[chocomorsel]

With the huge lack of CCM/intensivist taking care of critical ill patients one possible solution is the creation of the pathway for hospitalists who are currently managing ICUs and for those who plan to do hospitalist medicine first..One year of Critical Care Medicine fellowship after 3 years of Hospitalist Medicine. I guess this is one solution that would provide solution to ongoing deficit in intensivist manpower.

What about you? do you think this is good or bad?

How much ICU do medicine residents do?

 

[chocomorsel]

Surgeons and anesthesiologist also have longer training. I was post call and having dealt with lazy sr IM residents who has no buisness graduating much less having the option of doing CC in one year.

Sadly I'm in the camp that believes that IM traing should be increased to 4 years given new work hour restrictions.

But I do know there are some IM programs that produce IM docs who could this tract.

This first posting I had seen about this had suggested mandating a few years of real world work before allowing them to be eligible. But without a doubt, we need more CC docs.

S hit if nurses can switch fields without retraining, this pathway should be very reasonable.

 

[CCM-MD]

This whole hospitalist to intensivist in 1 year thing has died. And NPs/PAs in the ICU doesn't change anything. I love mine, they function as interns and my life would be pretty miserable without them. NPs do my cardiology, GI, ortho etc. consults all the time. Maybe we need a 1 year cardiology fellowship for hospitalists to become "cardiology hospitalists".

Thumbs up to whoever decided to necrobump this thread.

 

[Hernandez]

S hit if nurses can switch fields without retraining, this pathway should be very reasonable.

You say that as if I think most aprns provide anything resembling actual care. Stopping to a nurses level of training is unbecoming of the medical profession

 

[jdh71]

How much ICU do medicine residents do?

Varies. Most will end up doing at least two months. Those who want time in the unit can easily get it because many are happy to trade away the months. The way training is set up you may also do a lot of additional "ICU" while doing cardiology or pulmonary.

 

[chocomorsel]

Varies. Most will end up doing at least two months. Those who want time in the unit can easily get it because many are happy to trade away the months. The way training is set up you may also do a lot of additional "ICU" while doing cardiology or pulmonary.

Guess what I meant was, what were the minimum requirements?

 

[chocomorsel]

You say that as if I think most aprns provide anything resembling actual care. Stopping to a nurses level of training is unbecoming of the medical profession

It was part sarcasm part real. Sometimes I feel like if we can't beat them, join them.
Why is it I am seeing so many jobs advertising for APRN coverage at night? I mean do the patients get less sick at night? Are there less emergencies?

 

[deleted171991]

It was part sarcasm part real. Sometimes I feel like if we can't beat them, join them.
Why is it I am seeing so many jobs advertising for APRN coverage at night? I mean do the patients get less sick at night? Are there less emergencies?

Nope, just fewer hospitals willing to pay a night-differential for a true intensivist.

 

[jdh71]

Guess what I meant was, what were the minimum requirements?

You made me go look it up. You need three months of critical care (and no more than six). This can be defined . . . creatively . . . but for most it will mean at least two months, usually one second year and one third of residency in what we usually think of as an ICU. Interns are +/- involved this days from what I've seen, mostly due to work hour concerns it seems.

 

[CCM-MD]

It was part sarcasm part real. Sometimes I feel like if we can't beat them, join them.
Why is it I am seeing so many jobs advertising for APRN coverage at night? I mean do the patients get less sick at night? Are there less emergencies?

What FFP said. In addition, there are lots of night positions advertised because APRNs don't want to work nights either.

 

[Hernandez]

It was part sarcasm part real. Sometimes I feel like if we can't beat them, join them.
Why is it I am seeing so many jobs advertising for APRN coverage at night? I mean do the patients get less sick at night? Are there less emergencies?

Because there is such a shortage that few places can obtain the number of docs to cover 24/7 coverage, and wanna bet those night APRNs have home back up docs. My place does until we get enough docs to cover the nights.

 

[chocomorsel]

Because there is such a shortage that few places can obtain the number of docs to cover 24/7 coverage, and wanna bet those night APRNs have home back up docs. My place does until we get enough docs to cover the nights.[/QUOTE
Again, that was meant to be more sarcasm from my end. I was just wondering though is doctors where OK with this because they get to sleep at home in they comfy beds.

 

[chocomorsel]

What FFP said. In addition, there are lots of night positions advertised because APRNs don't want to work nights either.

I want to be a night doc. I hear they make tons of money. And I like nights.

 

[Robert1979]

Well, I did 6 months MICU and traded most of my coverage shifts to be in the ICU and took a number of ICU patients during two of my cardiology months... so i think the one year option should be an option for hospitalists when it’s one year for cardio and nephro and id

a lot of those guys are great, but there are a number of them who have less unit time than i do

i’m a nocturnist and i regularly cover the icu and do their admissions, yes i tube and place central & arterial lines

i’d like to be board certified, 2 years is sorta long though

 

[chocomorsel]

Well to be real though ( I was being sarcastic with the NP) ****, we all need to do the same **** across the board. As in keep the minimum standards the same. Everyone who wants CCM board eligibility does a minimum of five years.

Some of the community ICUs are run very questionably. Just because one can be a hospitalist in a community hospital and take care of ICU patients does not mean that the caliber of care of that hospital or hospitalist is the same as the one down the street.

So we need to keep a minimum standard and stick to it so that the training people receive is held to a certain standard.

However, for the ones who want to do it, without the 2 year fellowship, you can still find some hospital that will let you do it. Just like some hospitals let FP and IM run their ERs. That option is still around.