2021 CCM fellowship application

[Menaisnassuos]

Hi everyone,
I’m a CA2 that is applying soon to anesthesia critical care fellowship.
It seems there aren’t much information about the programs online. I tried to reach out to several programs and they all paint a very good picture about schedule and experience which might not be totally true.
I’m wondering if there is anyone that interviewed or matched in CCM that can help me and the other applicants with some information.

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[Dam272]

Any regional preference?

 

[Menaisnassuos]

Any regional preference?

No. I’m open to going anywhere where I can get good training.

 

[psychbender]

There are threads regarding anesthesia-CCM on this form that address some of this. Do you have questions about specific programs? Are you looking for more MICU, SICU, CVICU, or broad/multidisciplinary training? Trying for ECMO exposure, echo training, or time back in the OR on top of critical care training? Do you want to be like a super resident, seeing pts individually and writing notes, or solely sit back and manage the team of residents and mid-levels? What about working nights and weekends?

 

[Menaisnassuos]

There are threads regarding anesthesia-CCM on this form that address some of this. Do you have questions about specific programs? Are you looking for more MICU, SICU, CVICU, or broad/multidisciplinary training? Trying for ECMO exposure, echo training, or time back in the OR on top of critical care training? Do you want to be like a super resident, seeing pts individually and writing notes, or solely sit back and manage the team of residents and mid-levels? What about working nights and weekends?

I have read the threads from previous years about the same topic but I feel my situation is unique as an IMG who would like to get this fellowship at a recognized name because I’m hoping to stay in academics and doing a masters in education currently. I don’t have any problem with working nights or weekends since it’s just a one year fellowship. I don’t have expectations that it will be a 40 hour a week or anything like that. I appreciate any feedback.

 

[deleted171991]

I have read the threads from previous years about the same topic but I feel my situation is unique as an IMG who would like to get this fellowship at a recognized name because I’m hoping to stay in academics and doing a masters in education currently. I don’t have any problem with working nights or weekends since it’s just a one year fellowship. I don’t have expectations that it will be a 40 hour a week or anything like that. I appreciate any feedback.

Anesthesiologist with master in education (especially one during anesthesiology residency) and CCM fellowship? You bet you'll stay in academia, as in you'll smell like clinically weak to most PP groups. Heck, I would think twice even to hire you for academia. You sound like "those who can't do, teach" (which is exactly the kind of person who shouldn't be in academia).

Get the best brand CCM fellowship you can. I have a feeling you'll need it. Are you truly passionate about CCM, or is the fellowship just to extend a visa?

 

[psychbender]

I have read the threads from previous years about the same topic but I feel my situation is unique as an IMG who would like to get this fellowship at a recognized name because I’m hoping to stay in academics and doing a masters in education currently. I don’t have any problem with working nights or weekends since it’s just a one year fellowship. I don’t have expectations that it will be a 40 hour a week or anything like that. I appreciate any feedback.

My info is rather out of date, but look into Michigan, Wash-U, and Vanderbilt. They're workhorse programs with broad exposure, good reputations, and large alumni networks. There are several grads from those programs on this forum that can give actual first-hand information.

 

[bigdan]

Michigan ACCM was easily the best year of my anesthesiology training (including residency, CCM and ACTA).

In retrospect, the breadth of exposure to patients with grave critical illnesses (which every place has) AND the allowed autonomy (which few places allow) made for an outstanding experience.

No matter where you go, I strongly encourage you to seek a place that will give you some degree of autonomy, allow you to read and digest the foundations of critical care, and constant exposure to both TTE and TEE.

Good luck. Despite all naysayers, doing critical care from the anesthesia pathway is the best career-related choice I’ve made in my life. I hope you enjoy it as well!

 

[hununuh]

Anesthesiologist with master in education (especially one during anesthesiology residency) and CCM fellowship? You bet you'll stay in academia, as in you'll smell like clinically weak to most PP groups. Heck, I would think twice even to hire you for academia. You sound like "those who can't do, teach" (which is exactly the kind of person who shouldn't be in academia).

Get the best brand CCM fellowship you can. I have a feeling you'll need it. Are you truly passionate about CCM, or is the fellowship just to extend a visa?

What if the OP is strong clinically, but also has passion for education? I think it's an unfair assumption that people who are interested in teaching are weak clinically. If the OP had amazing letter of recommendations from the chair and PD that specifically comment on strong clinical skills, would that change your perception of the OP, at least on paper?

 

[deleted171991]

What if the OP is strong clinically, but also has passion for education? I think it's an unfair assumption that people who are interested in teaching are weak clinically. If the OP had amazing letter of recommendations from the chair and PD that specifically comment on strong clinical skills, would that change your perception of the OP, at least on paper?

No.

Doctors who are interested in teaching and strong clinically don't feel the need to do a master in education, because everything else will speak in their favor. Usually, they also don't feel the need for a critical care fellowship, unless they are PASSIONATE about it (e.g. they just can't help not doing one, as much as they are aware of the fellowship's shortcomings).

Come to me with a critical care fellowship and, if I can't feel the passion when you open your mouth, I'll be VERY curious why you did it.

Don't guide yourself by my opinions. I am not involved in hiring many people. I am also the kind of guy who believes in the academic Napoleon syndrome: the more incompetent the person the more one will be obsessed with padding one's resume (I like to keep mine thin and pertinent to my job). So how would one differentiate the true researchers/educators from the resume padders? Again, passion.

I have a friend who could make double his salary in PP (he's clinically very competent). I always pull his leg about that, but the truth is that he's simply passionate about educating the younger generations. He gives tens of poorly paid presentations a year, beyond the daily academic clinical work. Not unexpectedly, he's also very good at it, with multiple teaching awards from his residents and fellows (not "master in education").

 

[Silo004]

Good luck. Despite all naysayers, doing critical care from the anesthesia pathway is the best career-related choice I’ve made in my life. I hope you enjoy it as well!

How has it affected your career so far? What opportunities have you had with CC that you wouldn't have had otherwise?

 

[Menaisnassuos]

Michigan ACCM was easily the best year of my anesthesiology training (including residency, CCM and ACTA).

In retrospect, the breadth of exposure to patients with grave critical illnesses (which every place has) AND the allowed autonomy (which few places allow) made for an outstanding experience.

No matter where you go, I strongly encourage you to seek a place that will give you some degree of autonomy, allow you to read and digest the foundations of critical care, and constant exposure to both TTE and TEE.

Good luck. Despite all naysayers, doing critical care from the anesthesia pathway is the best career-related choice I’ve made in my life. I hope you enjoy it as well!

I appreciate your feedback. I checked the program at UofM and it seems like a well balanced program and they deal with a good mix of cardiac/trauma and surgical. They also have one week /month where I can do resident teaching /research which is great.

 

[bigdan]

How has it affected your career so far? What opportunities have you had with CC that you wouldn't have had otherwise?

Aww, man (or woman), I could talk your ear off about this topic.

Most simply, it was the right fit for me. I left a prior career in healthcare to become a physician to take care of sick patients, and found anesthesiology and critical care (and cardiac anesthesia) gave me the best balance and training to meet that goal. For me, personally, ICU fellowship made me a better physician overall, and it allows me a bit more extension of care than OR anesthesia does.

The most obvious opportunity I get with the fellowship is that I get to round in the ICUs; for full disclosure, I am an "ICU believer" - so I am in the group of people that believe that robust, thoughtful ICU care makes a difference in patient outcomes. If you are not in that group, then the fellowship and the "benefit" of rounding in the ICU will seem more like a ruse or a curse.

In direct correlation with that ICU experience, I feel like a have a great rapport with the surgeons, I preferentially get posted to OR cases that are a little sicker, and - of less intellectual or altruistic value - I have periodic opportunities to supplement my income with additional shifts. While I don't expect to stop working on the anesthesia side of things, CCM certification provides me an independent ABMS-recognized board certification that would allow me to scratch my clinical itch without ever setting foot in an OR again.

 

[bigdan]

I appreciate your feedback. I checked the program at UofM and it seems like a well balanced program and they deal with a good mix of cardiac/trauma and surgical. They also have one week /month where I can do resident teaching /research which is great.

Do yourself a favor and go interview there if you would ever consider living there.

I'm pretty sure I did a long post somewhere once about the schedule and environment in the fellowship - feel free to search on that, understanding that things might have changed. To speak to your comments vis a vis my experience:

1. In your core ICU months (4 mo CTICU & 4 mo SICU), you do 2 weeks "on-service" - you round, supervise, teach, hold the ECMO phone, and are first call for all crises; one week "back-up service - come in at rounding time, do lines, handle consults, cover codes/airways/etc while the rounding team is rounding, then you can bounce, and one week "administration" - you are not required to be in house except for a lecture that you give the residents at some point during that week. Work hard/play hard(ish). It was perfect for me. Now, my first week of fellowship I was in CTICU on service, which is 24/7 cover. I spent 120+ hrs in the hospital that week. But each month, there's a light in the tunnel, and you do have time to teach or do research as you see fit.
2. Ann Arbor is a safe and benign college town. Maybe things have changed, but I did NOT see a "good mix of ... trauma" when I was there. It's a level 1 trauma center, but I'd point you to Detroit or Cleveland (or Baltimore, Miami, or LA) if you want to see a good mix of trauma. You will see billions of VADs (I think they were north of 200 last year), heart and lung transplants, ECMO (you can do ride-alongs to go out an cannulate and retrieve if so inclined), surgical mishaps, etc. But it's not gonna be confused with Ryder or Shock anytime soon.

 

[psychbender]

To clear one thing up from BigDan, CCF does not really get much trauma exposure, either. I remember when interviewing there that they said they don't deal with that at home, but it was an optional (though encouraged) part of the community ICU rotations.

For those thinking of doing the fellowship, apply broadly, and interview where you can. You may be surprised by some of the programs. One program to which I applied, knowing really nothing about, impressed me enough that I ranked it number 1, much to the surprise of a couple of PDs at bigger-named programs who felt I was for sure ranking them number 1.

 

[Dam272]

Aww, man (or woman), I could talk your ear off about this topic.

Most simply, it was the right fit for me. I left a prior career in healthcare to become a physician to take care of sick patients, and found anesthesiology and critical care (and cardiac anesthesia) gave me the best balance and training to meet that goal. For me, personally, ICU fellowship made me a better physician overall, and it allows me a bit more extension of care than OR anesthesia does.

The most obvious opportunity I get with the fellowship is that I get to round in the ICUs; for full disclosure, I am an "ICU believer" - so I am in the group of people that believe that robust, thoughtful ICU care makes a difference in patient outcomes. If you are not in that group, then the fellowship and the "benefit" of rounding in the ICU will seem more like a ruse or a curse.

In direct correlation with that ICU experience, I feel like a have a great rapport with the surgeons, I preferentially get posted to OR cases that are a little sicker, and - of less intellectual or altruistic value - I have periodic opportunities to supplement my income with additional shifts. While I don't expect to stop working on the anesthesia side of things, CCM certification provides me an independent ABMS-recognized board certification that would allow me to scratch my clinical itch without ever setting foot in an OR again.

Could you kindly elaborate on the utility of Cardiac fellowship along with the CCM year? esp for someone like me who LOVES CCM, LIKES Cardiac (ORs), but would INTEND doing everything anesthesia, blocks, OB, healthy peds, some neuro, etc when in the ORs, and not ONLY Cardiac

 

[partydoc]

Could you kindly elaborate on the utility of Cardiac fellowship along with the CCM year? esp for someone like me who LOVES CCM, LIKES Cardiac (ORs), but would INTEND doing everything anesthesia, blocks, OB, healthy peds, some neuro, etc when in the ORs, and not ONLY Cardiac

if you wanna do all that stuff you're best off in pp, dont do either fellowship

 

[psychbender]

Could you kindly elaborate on the utility of Cardiac fellowship along with the CCM year? esp for someone like me who LOVES CCM, LIKES Cardiac (ORs), but would INTEND doing everything anesthesia, blocks, OB, healthy peds, some neuro, etc when in the ORs, and not ONLY Cardiac

That's kind of what my new job is like. I'm just CCM fellowship trained, and do everything my PP group does, plus ICU. I totally lucked into this, though, and what I have is not a common opportunity (prototype case that developed from a set of needs between both the hospital and the group that I could fill). My first job after fellowship assured it could give me what I have now, but couldn't live up to it's promises and imploded in a terrible fashion.

 

[deleted171991]

if you wanna do all that stuff you're best off in pp, dont do either fellowship

He should do cardiac, but not CCM.

 

[deleted171991]

My first job after fellowship assured it could give me what I have now, but couldn't live up to it's promises and imploded in a terrible fashion.

The expression for that is "deja vu".

Don't believe most of the BS an employer tells you about how they will make special arrangements in the ICU for you. If the group is not already covering the ICU, you're wasting your time.

 

[hununuh]

He should do cardiac, but not CCM.

But can you do icu without ccm fellowship?

 

[psychbender]

The expression for that is "deja vu".

Don't believe most of the BS an employer tells you about how they will make special arrangements in the ICU for you. If the group is not already covering the ICU, you're wasting your time.

They actually were already covering the unit. Almost half the anesthesiologists were CC trained. However, the new management of the hospital ran the whole operation into the ground, resulting in a lot of people losing their jobs, and ultimately the closure of the hospital. By the time I got there, the referral volume had dropped to such a degree that we were unable to bill enough to meet our salaries in either the unit or the OR.

 

[deleted171991]

But can you do icu without ccm fellowship?

In some places they let you do cardiac surgical ICU with just cardiac anesthesia. The real question is "SHOULD you...?". And the answer to that is an emphatic no.

 

[AdmiralChz]

In some places they let you do cardiac surgical ICU with just cardiac anesthesia. The real question is "SHOULD you...?". And the answer to that is an emphatic no.

I didn't used to agree when I was in training as we had some of those faculty that went that route. Then I did a fellowship and rotated more in the CVICU - this is a sick and complicated patient population that is high risk of having a lot happen preoperatively. Plus many institutions merge their acute coronary patients (STEMI, ROSC with cooling protocol, acute Baloon pump/Impella/ECMO) with the CVICU adding another layer of patients the typical (cardiac) anesthesiologist doesn't have a lot of experience with. Us new grads are excellent at the first 24-to even-72 hours of perioperative care as it is largely resuscitation, titrating vasoactive meds and ventilatory support changes - but get outside of those first 3 days, that's where the care starts to really change and be different from our daily routine. Back in the day even 10 years ago there was more flexibility in training so those interested could load up their 3rd year schedule with CCM and cardiac. Those days are largely gone (more RRC requirements like so many months of chronic and acute pain, neuroanesthesia, pediatrics, etc) which has contributed to the rise of fellowships since folks aren't getting as much continuous subspecialty exposure in residency. To be fair, these requirements create a much more well-rounded anesthesiologist.

I have now changed my tune. If you want to cover a critical care unit, you need to do a fellowship. I guess maybe there are some desperate institutions out there that might hire you without one, but more likely they would just hire a (cheaper) IM-CCM person to do it.

The best CCM fellowships allow autonomy (but without being a super-resident b*tch ideally churning out 15+ notes a day) and extensive exposure to MICU and CVICU where general grads typically get the least exposure. Anes CCM at most places will cover SICU and CVICU so it's important to be most comfortable there, but the variety of MICU isn't to be discounted and a very different population from our typical wheelhouse. With the rise of neurocritical care subspecialty particularly from Neurology, there will be a decline in anes CCM coverage there (since now it will take 2 years for certification, right?)

 

[deleted171991]

I'll post my usual spiel about the fellowship, although I am not sure that OP is interested. I am not so sure about his priorities. Here it goes.

Some food for thought...

IMO, any CCM fellowship where you're not on call in-house, covering 30-40+ patients with residents, doing consults and admitting, all alone, without any attending to babysit you after business hours, at least for 400-500 hours worth of call, is probably weak sauce, regardless what big name it's attached to. Any fellowship where you can't get fellow-level MICU exposure (with call), at least as a couple of months of electives - same. Any fellowship without heart/lung US exposure - same. Cardiac surgical ICU is a must nowadays. Fellowship slanted towards one or two subspecialties (as in tons of Cardiac or Neuro) - bad (especially the latter). No time/energy left for reading (you should read 10+ hours/week) - bad. No big alumni network - bad. No big names among the anesthesia residencies fellows come from - usually hints to something.

I should have started by talking about PASSION. Any anesthesiologist who chooses to do a CCM fellowship should feel incomplete before it. One should feel like CCM is what s/he was made for. One should ENJOY reading CCM literature, even the "boring" kind. One should just naturally gravitate towards critical care-related things, unconsciously, like choosing the TV channel with the favorite sports team. And one should like helping AWAKE people, chatting with them, even "babying" them. One shouldn't have done the anesthesiology residency because one hated medicine. Candidate, know thyself! Otherwise it's just a waste of money and time.

 

[deleted171991]

I didn't used to agree when I was in training as we had some of those faculty that went that route. Then I did a fellowship and rotated more in the CVICU - this is a sick and complicated patient population that is high risk of having a lot happen preoperatively. Plus many institutions merge their acute coronary patients (STEMI, ROSC with cooling protocol, acute Baloon pump/Impella/ECMO) with the CVICU adding another layer of patients the typical (cardiac) anesthesiologist doesn't have a lot of experience with. Us new grads are excellent at the first 24-to even-72 hours of perioperative care as it is largely resuscitation, titrating vasoactive meds and ventilatory support changes - but get outside of those first 3 days, that's where the care starts to really change and be different from our daily routine. Back in the day even 10 years ago there was more flexibility in training so those interested could load up their 3rd year schedule with CCM and cardiac. Those days are largely gone (more RRC requirements like so many months of chronic and acute pain, neuroanesthesia, pediatrics, etc) which has contributed to the rise of fellowships since folks aren't getting as much continuous subspecialty exposure in residency. To be fair, these requirements create a much more well-rounded anesthesiologist.

I have now changed my tune. If you want to cover a critical care unit, you need to do a fellowship. I guess maybe there are some desperate institutions out there that might hire you without one, but more likely they would just hire a (cheaper) IM-CCM person to do it.

The best CCM fellowships allow autonomy (but without being a super-resident b*tch ideally churning out 15+ notes a day) and extensive exposure to MICU and CVICU where general grads typically get the least exposure. Anes CCM at most places will cover SICU and CVICU so it's important to be most comfortable there, but the variety of MICU isn't to be discounted and a very different population from our typical wheelhouse. With the rise of neurocritical care subspecialty particularly from Neurology, there will be a decline in anes CCM coverage there (since now it will take 2 years for certification, right?)

It's not only the devices. Most of the time, those will just work, and one doesn't need an ICU fellowship to learn to troubleshoot them.

It's also the proper care. I am not an expert in cardiac surgical patients, but the typical OR approach may decrease survival in the ICU. What's good for short-term number-padding doesn't necessarily translate into increased survival. An MI is not a CABG. An acute heart failure with pulmonary edema is not a CABG, even in a postop patient. Left in the hands of cardiac surgeons in the ICU, those patients may not do well, mostly because the physicians have no idea of modern ICU literature, and lack perspective. Heck, even some cardiologists (and generally any knee-jerk mediocrity who doesn't know how to properly personalize care) can mess them up royally.

There is a reason why the CCM fellowship is a year or two (and still feels like not enough). I personally believe that (cardiac) surgeons should have almost zero prescribing privileges in the ICU, and cardiac anesthesiologists are not far behind. This ain't our grandfathers' critical care.

 

[MoMoGesiologist]

I'll post my usual spiel about the fellowship, although I am not sure that OP is interested. I am not so sure about his priorities. Here it goes.

Some food for thought...

IMO, any CCM fellowship where you're not on call in-house, covering 30-40+ patients with residents, doing consults and admitting, all alone, without any attending to babysit you after business hours, at least for 400-500 hours worth of call, is probably weak sauce, regardless what big name it's attached to. Any fellowship where you can't get fellow-level MICU exposure (with call), at least as a couple of months of electives - same. Any fellowship without heart/lung US exposure - same. Cardiac surgical ICU is a must nowadays. Fellowship slanted towards one or two subspecialties (as in tons of Cardiac or Neuro) - bad (especially the latter). No time/energy left for reading (you should read 10+ hours/week) - bad. No big alumni network - bad. No big names among the anesthesia residencies fellows come from - usually hints to something.

I should have started by talking about PASSION. Any anesthesiologist who chooses to do a CCM fellowship should feel incomplete before it. One should feel like CCM is what s/he was made for. One should ENJOY reading CCM literature, even the "boring" kind. One should just naturally gravitate towards critical care-related things, unconsciously, like choosing the TV channel with the favorite sports team. And one should like helping AWAKE people, chatting with them, even "babying" them. One shouldn't have done the anesthesiology residency because one hated medicine. Candidate, know thyself! Otherwise it's just a waste of money and time.

Liked this post but not sure about covering 30-40 pts. You cannot take as good of care of 30-40 critically ill pts as 10-20; you just can’t know their history, numbers, labs to make good, nuanced decisions in half the time. If you’re covering that many patients, then I’m assuming you are making knee jerk reactions: hypotension? Keep giving fluids. Tachy? Give IV beta blocker. Good crit care requires time and thought. Anyone can keep a pt alive til the end of their shift, doesn’t make it good care.

 

[CUBR]

No. I’m open to going anywhere where I can get good training.

Good training is very personal and subjective. What type of patient population/ ICU do you think you're most interested in?
I can say too Michigan CCM was a phenomenal year, but it was very cardiac and surgical ICU heavy. There is really no trauma to speak of in Ann Arbor, and we don't have responsibilities in the MICU. So, if you're looking to staff a mixed unit in the future with a lot of MICU patients...maybe you should look at a program more like Washington with a lot of MICU time. If you want to exclusively do cardiac, then look at places like Michigan, Vandy, Emory...

If you're interested in doing education research with your master's degree, there are definitely couple people at Michigan doing that. However, it would be hard to do anything of substance within a one-year fellowship. There were two surgical crit care fellowships who stayed on another year to do more research, so you can always do that.

 

[deleted171991]

Liked this post but not sure about covering 30-40 pts. You cannot take as good of care of 30-40 critically ill pts as 10-20; you just can’t know their history, numbers, labs to make good, nuanced decisions in half the time. If you’re covering that many patients, then I’m assuming you are making knee jerk reactions: hypotension? Keep giving fluids. Tachy? Give IV beta blocker. Good crit care requires time and thought. Anyone can keep a pt alive til the end of their shift, doesn’t make it good care.

Not solo, but with PGY-2 or midlevel teams. Of course, in some places, 10 patients can be the equivalent of 40 in others. Also, if you're covering interns, that's playing resident, and that's not what I am advocating for.

 

[Dam272]

Anybody here with info on the Stanford ccm program?

 

[deleted697535]

I'm trying to gather my thoughts into where my feelings lie re anesthesia ccm fellowship.i dont know anything about where is good for training in the us I'm only commenting on the utility of doing icu as a fellowship at all.

1 to do ccm even cvicu you have to have at least a 1 year fellowship in a mixed icu setting of some degree. A pure anaesthetist in there is going to lose people. It's a bad idea

2 most of the world outside north America has a high percentage of anesthesia in their icus and it seems to work both pay wise and quality wise

3 things are becoming specialized with neuro icus and burn icus etc but the general jist is the same. Once you get your 'final' job you will settle in after a few call shifts and get good at what your icu does best. No where can or will ever be a tertiary heart lung medical neuro icu all in one. It's just not possible for 1 physician to be super all all those so have some solace in the fact that you may not know everything but neither does the guy on tomorrow night.

4 having an ICU year ccm wont delay your retirement by much not will it financially make you or break you

5 having a year icu fellowship wont make you a worse anaesthetist. I believe it will likely make you better. In most countries it would definitely make you more employable.

6 when the nurses squeeze you us out even more you might be delighted you have future proofed your career!