Why CCM?

[Build]

If you care to share, I'd love to hear reasons why people decided to go into CCM.

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[souljah1]

Caveat: I'll be a Pulmonary/CC fellow and my comments will reflect why I went into critical care in medicine.

Clinical:
1. I found the ICU to be THE PLACE where the most interesting cases land, i.e. fulminant failure from Budd Chiari, disseminated zoster c/b encephalitis, H1N1 ARDS, toxic ODs, septic shock, thyrotoxic periodic paralysis, fanconi's syndrome, TTP, severe electrolyte abnormalities, etc.
2. Because all of medicine's most sick come to the ICU, an intensivist needs to maintain a strong understanding of general medicine.
3. I enjoy discussing goals of care, "end of life", etc with both patients and their families. Too many subspecialist flog patients b/c they are fixated on their organ or disease - I think the ICU is a place where you are forced to look at the forest.
4. I really enjoy a multi-disciplinary team. The MICU where I trained had great nursing, clinical pharmacists, respiratory therapists, physical therapists, nutritionists, fellows, residents, students, etc - all join rounds led by an intensivist.
5. While I really enjoy doing procedures and being in the thick of things, I am much more interested in working as an intensivist in an academic setting where my work day includes leading rounds, family meetings, bronching those who need them, etc - rather than putting in admission orders, placing lines, etc.
6. It's a great place to teach!
7. There aren't any fakers receiving care in the ICU. I can't stand the ED for this reason - so many of the patients in the ED demand the most amount of your time when they have the least concerning problems. Then, half of them get admitted because they mention the words "chest" or "leg swollen" or "i passed out" and then medicine winds up managing faker pants on the wards. These patients don't get transferred to the unit. Don't get me wrong, somatization is a real problem - but is better served in the clinic.

Academic Interests:
1. While my clinical interests are what drew me to critical care, my interest in health services research will likely keep me there.
2. Baby boomers, a finite number of resources, the new and growing population of the chronic critically ill, etc - all pose significant challenges and I think that academic intensivists skilled in health services/health policy research can help lead the way to implement evidence-based policies, i.e. regionalization, tele-medicine, early institution of palliative care, etc. There are some amazing people studying critical care organization and delivery, bioethics and rationing, etc - hugely relevant and important. Evidence-based medicine is useless if we don't have evidence-based policy.


Plan B:
1. It's nice to know that if I aggressively go after an academic career in critical care and it doesn't work out - that I can work as an intensivist in a community/private setting and do shift work. The pay for that is not too shabby.

 

[The right Path]

Caveat: I'll be a Pulmonary/CC fellow and my comments will reflect why I went into critical care in medicine.

Clinical:
1. I found the ICU to be THE PLACE where the most interesting cases land, i.e. fulminant failure from Budd Chiari, disseminated zoster c/b encephalitis, H1N1 ARDS, toxic ODs, septic shock, thyrotoxic periodic paralysis, fanconi's syndrome, TTP, severe electrolyte abnormalities, etc.
2. Because all of medicine's most sick come to the ICU, an intensivist needs to maintain a strong understanding of general medicine.
3. I enjoy discussing goals of care, "end of life", etc with both patients and their families. Too many subspecialist flog patients b/c they are fixated on their organ or disease - I think the ICU is a place where you are forced to look at the forest.
4. I really enjoy a multi-disciplinary team. The MICU where I trained had great nursing, clinical pharmacists, respiratory therapists, physical therapists, nutritionists, fellows, residents, students, etc - all join rounds led by an intensivist.
5. While I really enjoy doing procedures and being in the thick of things, I am much more interested in working as an intensivist in an academic setting where my work day includes leading rounds, family meetings, bronching those who need them, etc - rather than putting in admission orders, placing lines, etc.
6. It's a great place to teach!
7. There aren't any fakers receiving care in the ICU. I can't stand the ED for this reason - so many of the patients in the ED demand the most amount of your time when they have the least concerning problems. Then, half of them get admitted because they mention the words "chest" or "leg swollen" or "i passed out" and then medicine winds up managing faker pants on the wards. These patients don't get transferred to the unit. Don't get me wrong, somatization is a real problem - but is better served in the clinic.

Academic Interests:
1. While my clinical interests are what drew me to critical care, my interest in health services research will likely keep me there.
2. Baby boomers, a finite number of resources, the new and growing population of the chronic critically ill, etc - all pose significant challenges and I think that academic intensivists skilled in health services/health policy research can help lead the way to implement evidence-based policies, i.e. regionalization, tele-medicine, early institution of palliative care, etc. There are some amazing people studying critical care organization and delivery, bioethics and rationing, etc - hugely relevant and important. Evidence-based medicine is useless if we don't have evidence-based policy.


Plan B:
1. It's nice to know that if I aggressively go after an academic career in critical care and it doesn't work out - that I can work as an intensivist in a community/private setting and do shift work. The pay for that is not too shabby.

 

[Build]

Thanks for the input! It's an area of medicine I'm taking a closer look at, and it's useful to hear some different perspectives on deciding to enter the field.

 

[drdev]

Hi Guys, I am new to this forum. I am currently working as a Hospitalist for almost 2 years now. Now planning to go to either Primary care- traditional versus Pulmonary and Critical Care. I am really confused between the two. Hospitalist is great but there is no room for growth after a point. Can someone help me decide between Primary care and PCCM. I know specialist codes have been gone but I believe that if I DONT do it now I will never bbe able to do it. I would appreciate any input from any attendings, fellows or Pulmonologits. Thank you.

Dev

 

[Build]

Dr. Dev,

Welcome to SDN. I recommend re-posting this question in a new thread with a better descriptive title to attract the input you're looking for.

Best of luck,
Build

 

[drdev]

Dr. Dev,

Welcome to SDN. I recommend re-posting this question in a new thread with a better descriptive title to attract the input you're looking for.

Best of luck,
Build

Thanks, will do.

Dev

 

[ResidentMD]

Caveat: I'll be a Pulmonary/CC fellow and my comments will reflect why I went into critical care in medicine.

Clinical:
1. I found the ICU to be THE PLACE where the most interesting cases land, i.e. fulminant failure from Budd Chiari, disseminated zoster c/b encephalitis, H1N1 ARDS, toxic ODs, septic shock, thyrotoxic periodic paralysis, fanconi's syndrome, TTP, severe electrolyte abnormalities, etc.
2. Because all of medicine's most sick come to the ICU, an intensivist needs to maintain a strong understanding of general medicine.
3. I enjoy discussing goals of care, "end of life", etc with both patients and their families. Too many subspecialist flog patients b/c they are fixated on their organ or disease - I think the ICU is a place where you are forced to look at the forest.
4. I really enjoy a multi-disciplinary team. The MICU where I trained had great nursing, clinical pharmacists, respiratory therapists, physical therapists, nutritionists, fellows, residents, students, etc - all join rounds led by an intensivist.
5. While I really enjoy doing procedures and being in the thick of things, I am much more interested in working as an intensivist in an academic setting where my work day includes leading rounds, family meetings, bronching those who need them, etc - rather than putting in admission orders, placing lines, etc.
6. It's a great place to teach!
7. There aren't any fakers receiving care in the ICU. I can't stand the ED for this reason - so many of the patients in the ED demand the most amount of your time when they have the least concerning problems. Then, half of them get admitted because they mention the words "chest" or "leg swollen" or "i passed out" and then medicine winds up managing faker pants on the wards. These patients don't get transferred to the unit. Don't get me wrong, somatization is a real problem - but is better served in the clinic.

Academic Interests:
1. While my clinical interests are what drew me to critical care, my interest in health services research will likely keep me there.
2. Baby boomers, a finite number of resources, the new and growing population of the chronic critically ill, etc - all pose significant challenges and I think that academic intensivists skilled in health services/health policy research can help lead the way to implement evidence-based policies, i.e. regionalization, tele-medicine, early institution of palliative care, etc. There are some amazing people studying critical care organization and delivery, bioethics and rationing, etc - hugely relevant and important. Evidence-based medicine is useless if we don't have evidence-based policy.


Plan B:
1. It's nice to know that if I aggressively go after an academic career in critical care and it doesn't work out - that I can work as an intensivist in a community/private setting and do shift work. The pay for that is not too shabby.