AMA: Graduating CT/ICU fellow

[Nivens]

Good morning all,

Last night, after six years, I walked out of the hospital as a trainee for the last time. I joined this board as a junior medical student, and learned so much about medicine, anesthesiology and it’s subspecialties, and professional/financial life from it’s members. In a sense, I even got my first job because of this board.

I’m going to be laid up for a few days, so I figure I might be able to give back with a little AMA. I’m happy to answer any questions about anesthesia residency, CT/ICU fellowship, and my job search. I did all my training at a single major academic center in the northeast, and took an academic job doing both anesthesia and ICU in the southeast.

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[IMGASMD]

Congrats!

 

[GassYous]

Yeah I got a question. Why weren't you done on June 30th?

Also I hope you're not working at vandy.

 

[NicMouse64]

Good morning all,

Last night, after six years, I walked out of the hospital as a trainee for the last time. I joined this board as a junior medical student, and learned so much about medicine, anesthesiology and it’s subspecialties, and professional/financial life from it’s members. In a sense, I even got my first job because of this board.

I’m going to be laid up for a few days, so I figure I might be able to give back with a little AMA. I’m happy to answer any questions about anesthesia residency, CT/ICU fellowship, and my job search. I did all my training at a single major academic center in the northeast, and took an academic job doing both anesthesia and ICU in the southeast.

Did you know beforehand you wanted to do both CT/ICU and do "combined" training or did you apply to one before the other? What type of ICU do you plan on working in mostly? CVICU, MICU, or SICU? I've heard the CVICU you are often beholden to the whims of the CT surgeon.

 

[abolt18]

Good morning all,

Last night, after six years, I walked out of the hospital as a trainee for the last time. I joined this board as a junior medical student, and learned so much about medicine, anesthesiology and it’s subspecialties, and professional/financial life from it’s members. In a sense, I even got my first job because of this board.

I’m going to be laid up for a few days, so I figure I might be able to give back with a little AMA. I’m happy to answer any questions about anesthesia residency, CT/ICU fellowship, and my job search. I did all my training at a single major academic center in the northeast, and took an academic job doing both anesthesia and ICU in the southeast.

Any ragrets?

 

[Nivens]

Yeah I got a question. Why weren't you done on June 30th?

Also I hope you're not working at vandy.

I had a kid as a CA-3, before the ABA changed the rules about paying back parental leave. I used terminal leave to get paid for a month between residency and fellowship while my wife went back to work, so I had to pay that back.

And nope, not vandy. Though I have a good friend that's there and he seems pretty happy (albiet not CT/ICU).

 

[Nivens]

Any ragrets?

Not yet! Look, the crit care year was the absolute hardest year of my training. I did it after cardiac, but was pulled from cardiac in the second half of the fellowship to staff the ICU during the first surge. So I was a fellow in the ICU for the entirety of the dog days of covid. My wife is also a doc, we have two kids, and we are far from family. It was really tough. BUT, the critical care year was up and away the most valuable of my training. I learned and grew so much. Would do it again in a heartbeat.

 

[Nivens]

Congrats!

Thanks so much!

 

[Nivens]

Did you know beforehand you wanted to do both CT/ICU and do "combined" training or did you apply to one before the other? What type of ICU do you plan on working in mostly? CVICU, MICU, or SICU? I've heard the CVICU you are often beholden to the whims of the CT surgeon.

My plan when I applied to anesthesia was to do CT/ICU- I really looked up to a combined guy as a medical student which sort of set me down that path. I wavered a little while I was a resident (flirted with pain in a misguided search for "independence"), but I'm a cardiopulmonary guy all the way. I really need the stakes to put my feet on the floor every morning, and I get what I need from this combo.

I will work primarily in a cardiothoracic/transplant ICU. MCS, ECMO, and transplant are definitely areas of interest/budding expertise of mine.

Regarding being "at the whim of the surgeon": because I work with the surgeons both in the OR and ICU, there is an enhanced relationship and level of trust. Outliers exist, but this isn't the 1980s- medicine is a a team sport, and that's only going to become more true in the future. A lot of it comes down to how you carry yourself too- I take a lot of pride in my work and try to practice good "physicianship": I know my patients well, develop relationships with their families, come early and stay late when the situation calls for it, and try and bring value to the team. The surgeons see I'm invested (I know because they've told me so), and treat me as an equal, even if we don't always agree. In those cases that we don't agree, we work to come to some sort of compromise- ultimately we are both working for the same goal.

To get to the heart of your question: no one steamrolls me, because I don't let them. But that comes at a cost: often earlier mornings, stressful days, and late nights. I worry a subset of people applying to anesthesia are looking to have their cake and eat it too: work like nurses but be paid/treated like doctors. It's hard to have both.

 

[sevoflurane]

My plan when I applied to anesthesia was to do CT/ICU- I really looked up to a combined guy as a medical student which sort of set me down that path. I wavered a little while I was a resident (flirted with pain in a misguided search for "independence"), but I'm a cardiopulmonary guy all the way. I really need the stakes to put my feet on the floor every morning, and I get what I need from this combo.

I will work primarily in a cardiothoracic/transplant ICU. MCS, ECMO, and transplant are definitely areas of interest/budding expertise of mine.

Regarding being "at the whim of the surgeon": because I work with the surgeons both in the OR and ICU, there is an enhanced relationship and level of trust. Outliers exist, but this isn't the 1980s- medicine is a a team sport, and that's only going to become more true in the future. A lot of it comes down to how you carry yourself too- I take a lot of pride in my work and try to practice good "physicianship": I know my patients well, develop relationships with their families, come early and stay late when the situation calls for it, and try and bring value to the team. The surgeons see I'm invested (I know because they've told me so), and treat me as an equal, even if we don't always agree. In those cases that we don't agree, we work to come to some sort of compromise- ultimately we are both working for the same goal.

To get to the heart of your question: no one steamrolls me, because I don't let them. But that comes at a cost: often earlier mornings, stressful days, and late nights. I worry a subset of people applying to anesthesia are looking to have their cake and eat it too: work like nurses but be paid/treated like doctors. It's hard to have both.

Sounds like advent health Orlando. Busy heart place 4 sure. May be busiest in Florida.

 

[Zekchar]

What is your W2 starting salary?

 

[sevoflurane]

I think i would have liked a place like that after training. 4 CT/ICU floors and high complexity of cases. Good booster to anything that will follow. Congrats. 🤙🏽

 

[NicMouse64]

My plan when I applied to anesthesia was to do CT/ICU- I really looked up to a combined guy as a medical student which sort of set me down that path. I wavered a little while I was a resident (flirted with pain in a misguided search for "independence"), but I'm a cardiopulmonary guy all the way. I really need the stakes to put my feet on the floor every morning, and I get what I need from this combo.

I will work primarily in a cardiothoracic/transplant ICU. MCS, ECMO, and transplant are definitely areas of interest/budding expertise of mine.

Regarding being "at the whim of the surgeon": because I work with the surgeons both in the OR and ICU, there is an enhanced relationship and level of trust. Outliers exist, but this isn't the 1980s- medicine is a a team sport, and that's only going to become more true in the future. A lot of it comes down to how you carry yourself too- I take a lot of pride in my work and try to practice good "physicianship": I know my patients well, develop relationships with their families, come early and stay late when the situation calls for it, and try and bring value to the team. The surgeons see I'm invested (I know because they've told me so), and treat me as an equal, even if we don't always agree. In those cases that we don't agree, we work to come to some sort of compromise- ultimately we are both working for the same goal.

To get to the heart of your question: no one steamrolls me, because I don't let them. But that comes at a cost: often earlier mornings, stressful days, and late nights. I worry a subset of people applying to anesthesia are looking to have their cake and eat it too: work like nurses but be paid/treated like doctors. It's hard to have both.

I'm definitely considering your path as I do like the ICU and OR, but will find some clarity with rotations in the future. Thanks for answering my question, I guess I've just heard surgeons can be fairly disrespectful in the CVICU.

 

[jthedestroyr]

I'm definitely considering your path as I do like the ICU and OR, but will find some clarity with rotations in the future. Thanks for answering my question, I guess I've just heard surgeons can be fairly disrespectful in the CVICU.

Not all of us do CVICU/SICU only, @chocomorsel and I are purely MICU @psychbender is Split 50-50, but also MICU.

 

[dchz]

Why did you waste a year doing ICU?

Seriously question though: do you feel like the ICU fellowship really added to your appeal as a job prospect or was it just the timing?

 

[POW16]

What metro area is this ?

 

[Lidolover]

Good morning all,

Last night, after six years, I walked out of the hospital as a trainee for the last time. I joined this board as a junior medical student, and learned so much about medicine, anesthesiology and it’s subspecialties, and professional/financial life from it’s members. In a sense, I even got my first job because of this board.

I’m going to be laid up for a few days, so I figure I might be able to give back with a little AMA. I’m happy to answer any questions about anesthesia residency, CT/ICU fellowship, and my job search. I did all my training at a single major academic center in the northeast, and took an academic job doing both anesthesia and ICU in the southeast.

Congratulations! I hope and wish your career from now on meets your expectations and aspirations you had starting dual fellowship.

 

[Nivens]

Why did you waste a year doing ICU?

Seriously question though: do you feel like the ICU fellowship really added to your appeal as a job prospect or was it just the timing?

Hard for me to say- I think with any job it depends on the groups specific needs. This particular practice must have seen some value in my combined training, but in terms of whether or not it was *the* factor that elevated me above the other candidates, I'm not sure.

 

[Katheudontas parateroumen]

Good morning all,

Last night, after six years, I walked out of the hospital as a trainee for the last time. I joined this board as a junior medical student, and learned so much about medicine, anesthesiology and it’s subspecialties, and professional/financial life from it’s members. In a sense, I even got my first job because of this board.

I’m going to be laid up for a few days, so I figure I might be able to give back with a little AMA. I’m happy to answer any questions about anesthesia residency, CT/ICU fellowship, and my job search. I did all my training at a single major academic center in the northeast, and took an academic job doing both anesthesia and ICU in the southeast.

Thanks for doing this!
Did you have any issues finding a combined job? I wonder if doing combined makes it easier to get a combined job however I always see combined folks in the CVICU whether that’s just selection bias of course.
In terms of resources for ICU, what do you think are the must haves/reads?

 

[Nivens]

Thanks for doing this!
Did you have any issues finding a combined job? I wonder if doing combined makes it easier to get a combined job however I always see combined folks in the CVICU whether that’s just selection bias of course.
In terms of resources for ICU, what do you think are the must haves/reads?

I personally didn’t have any issues, but I was targeting academic/semi-academic/very large private groups that did MCS/transplant. Most (though not all) of the groups I spoke with either already had a presence in the ICU or were looking to grow one.

As for CVICU- it’s true that in my limited experience most (if not all) of the combined folks I know spend most of their time in the CVICU. I think this is natural- if you do both you hopefully find CT surgery patients interesting. Also, you learn a lot about CT surgery as a cardiac fellow, and the more you know about the surgeries themselves, the better intensivist you are. Lastly, like I mentioned above, the relationships you form in the OR can smooth out a lot of the rumored interpersonal unpleasantness of the unit.

With regards to reading, check out Paul Marik’s Evidence-Based Critical Care, and the website derangedphysiology.com

 

[vector2]

Good morning all,

Last night, after six years, I walked out of the hospital as a trainee for the last time. I joined this board as a junior medical student, and learned so much about medicine, anesthesiology and it’s subspecialties, and professional/financial life from it’s members. In a sense, I even got my first job because of this board.

I’m going to be laid up for a few days, so I figure I might be able to give back with a little AMA. I’m happy to answer any questions about anesthesia residency, CT/ICU fellowship, and my job search. I did all my training at a single major academic center in the northeast, and took an academic job doing both anesthesia and ICU in the southeast.

What is your schedule for taking oral boards, osce, CCM exam, and aPTE?

 

[Nivens]

What is your schedule for taking oral boards, osce, CCM exam, and aPTE?

I was lucky and got my orals/OSCE in the first week before Covid shut everything down. PTE is done, so now it’s just CCM this fall and this cardiac exam whenever it materializes. I elected not to take critical care ultrasound boards.

There is no denying it’s a stupid number of tests.

 

[Aheadbyacentury]

Do you think the Cardiaac ABA exam will impact future Cardiac anesthesia applicants? Will fewer people be willing to jump those hoops

 

[Nivens]

Do you think the Cardiaac ABA exam will impact future Cardiac anesthesia applicants? Will fewer people be willing to jump those hoops

If the exam is enough to dissuade someone from doing cardiac, this probably isn't the field for them, though it does beg the question how they got this far...

 

[Aheadbyacentury]

If the exam is enough to dissuade someone from doing cardiac, this probably isn't the field for them, though it does beg the question how they got this far...

Spoken like a true academic LOL. kinda figured you did 3 fellowships.

 

[Nivens]

Spoken like a true academic LOL. kinda figured you did 3 fellowships.

Two fellowships, but your point stands.

I guess I mean you really shouldn’t do a fellowship in something you aren’t interested in; at the end of the day we are talking about becoming a true expert in a subject. And how interested are you in it really if a test is enough to convince you not to do it?

We are tested a truly ridiculous amount- it’s all a money-making scheme- but I’d want to be a CT anesthesiologist even if it meant three more tests.

 

[Zekchar]

Two fellowships, but your point stands.

I guess I mean you really shouldn’t do a fellowship in something you aren’t interested in; at the end of the day we are talking about becoming a true expert in a subject. And how interested are you in it really if a test is enough to convince you not to do it?

We are tested a truly ridiculous amount- it’s all a money-making scheme- but I’d want to be a CT anesthesiologist even if it meant three more tests.

Answer the only real worthwhile question on this whole thread. Who does an AMA then bypasses the one uncomfortable question beyond the regular platitudes

What is your W2 starting salary?

 

[Nivens]

Answer the only real worthwhile question on this whole thread. Who does an AMA then bypasses the one uncomfortable question beyond the regular platitudes

I’ll pass friend.

 

[POW16]

I guess it's an AMA not an I'll Answer Anything.

 

[Nivens]

I guess it's an AMA not an I'll Answer Anything.

Haha I suppose you’re right.

 

[vector2]

Haha I suppose you’re right.

Answer the only real worthwhile question on this whole thread. Who does an AMA then bypasses the one uncomfortable question beyond the regular platitudes

The guy took an academic job in the southeast. Odds are he's making whatever their standard clinical assistant prof salary is plus whatever call stipend (or extra PTO) they get for cardiac, icu, and/or general call.

I highly doubt the figure is at the extremes of 95% MGMA or 10% MGMA. What I do know is that the best case scenario for dual trained folks is they find a PP where they can make as much as the cardiac partners, and worst case scenario is they get an academic/AMC/hospital employed job where they're about on par with every other fellowship trained/call taking staff. Additionally, dual trained almost always incurs opportunity cost where 1 yr of attending salary is lost because virtually no job will have you making more than you would've having only been CT trained

 

[Lidolover]

How is the market looking these days for dual trained?

 

[BLADEMDA]

The OP will be earning 80th percentile MGMA after 3 years. He landed a very good job

 

[JoelJoel84]

The OP will be earning 80th percentile MGMA after 3 years. He landed a very good job

Add in those 2 extra years of training, and that’s a nearly $2 million opportunity cost to work in academia, 70ish hours a week if you count call, department meetings, etc, with a very limited upside to income long term.

Sounds like the OP is happy with the trade off, but the younger residents need to really think about what they’d be willing to sacrifice for that career. And you can easily find >70th% MGMA jobs as a generalist right out of residency in some pretty desirable areas.

 

[Nivens]

Add in those 2 extra years of training, and that’s a nearly $2 million opportunity cost to work in academia, 70ish hours a week if you count call, department meetings, etc, with a very limited upside to income long term.

Sounds like the OP is happy with the trade off, but the younger residents need to really think about what they’d be willing to sacrifice for that career. And you can easily find >70th% MGMA jobs as a generalist right out of residency in some pretty desirable areas.

Yes, the opportunity cost was very high, and while I am happy with how things turned out now, right out of training, who knows how I’ll feel in 5-, 10-, 15-years?

The problem I have with these sort of analysis, however, is they make choosing a specialty/subspecialty seem like a simple math problem: find the spot on the curve where your income is highest for the lowest effort/hours worked. But we all know career satisfaction- and life in general- is so much more complicated than that.

I interviewed at one practice where >95% MGMA was attainable in a couple of years. Could have joined up right after CT fellowship. But no one is going to pay you that kind of money to sit on your @$$- they worked like dogs, providing the bare minimum supervision to stay out of trouble. Not how I personally want to practice.

I’m not disagreeing with you. Is there a more efficient path to $X00,000/yr than what I chose? Absolutely. But this is such a nuanced discussion it’s hard to do it justice in this forum.

 

[Justice4all]

He seems happy at his decision. I also did 2 years of fellowship and do not regret it. Was I expecting to earn more? No
If it comes time just the dinero, get a job as a generalist and you will be rewarded handsomely.

 

[Nivens]

Via PM:

"How is the dual market? Could you be any more specific as far as what you will be making? What % ICU vs OR will you be doing? Exclusive cardiac OR? Supervision vs sitting own cases?

Any major tips when I start looking for jobs this fall?"

---

The "dual market" is (appropriately) actually two different markets. In practices where the anesthesiology department/group is responsible for covering both the OR and ICU, dual-trained folks are super desirable, and the market is wide open. Many of these groups/departments have put the word out that they are only interested in speaking to people with both fellowships.

In situations where there ICU is covered by a different entity (usually a pulmonary or surgical division), the anesthesia group would be forced to share you/"lease" your services to the other group. Depending on their situation, this may not be a big deal, but in the few instances I came across this the anesthesia group wasn't thrilled about losing 1/3 FTE of call.

I'm roughly 1/3 ICU, 2/3 OR, covering a mix of cardiac/thoracic with some general and taking only CT call. It's primarily supervision.

When you start looking around, really leverage the various networks available to you. Just like liquor stores, the good stuff is always in the back. Use alumni networks to gain interviews at groups that aren't advertising- you'll be amazed how much flexibility there is to bring someone with solid recommendations in, even if the group doesn't have an immediate need.

Once you have the interview, try and get a sense for the relationships between the surgeons and intensivists. How do they communicate? Closed or open unit? Are there joint high-risk conferences and M&Ms? This sort of stuff will give you a clue to the sort of team you'll be joining. To me this is a big determinate of job satisfaction.





As an aside- getting a bunch of PMs about my salary/specific location of practice. I am sorry if this is perceived negatively, but I am going to keep these details to myself. I don't blame anyone for being curious, but I still feel entitled to some degree of privacy, even in the setting of an AMA.

 

[deleted697535]

What is mgma?

 

[Aheadbyacentury]

I guess it's an AMA not an I'll Answer Anything.

I'll answer. Its probably median, if that.

 

[Nivens]

because virtually no job will have you making more than you would've having only been CT trained

Keep in mind there are ways to be paid other than salary. If you can make as much as the cardiac partners per year, but get an extra week off for every week you do in the ICU, I'd say you've come out ahead big time. Just a theoretical example. This is what I mean when I say things are not as simple as "what % MGMA are you bruh?".

 

[Aheadbyacentury]

As an aside- getting a bunch of PMs about my salary/specific location of practice. I am sorry if this is perceived negatively, but I am going to keep these details to myself. I don't blame anyone for being curious, but I still feel entitled to some degree of privacy, even in the setting of an AMA.

It is LOw!

 

[Nivens]

It is LOw!

You got me.

I'm volunteering.

 

[Hork Bajir]

No need to harp on compensation endlessly- we can all agree it is important, but not the end-all-be-all of a career in medicine. @Nivens has said he doesn’t want to discuss his salary so we should let him be- he’s trying to do a nice thing for the forum here

 

[vector2]

Keep in mind there are ways to be paid other than salary. If you can make as much as the cardiac partners per year, but get an extra week off for every week you do in the ICU, I'd say you've come out ahead big time. Just a theoretical example. This is what I mean when I say things are not as simple as "what % MGMA are you bruh?".

Yep, that's the nice part of ICU depending on the group you join. Why I said "plus whatever call stipend (or extra PTO) they get for cardiac, icu, and/or general call."

 

[Nivens]

Yep, that's the nice part of ICU depending on the group you join. Why I said "plus whatever call stipend (or extra PTO) they get for cardiac, icu, and/or general call."

Sorry- missed the bolded part. I'm still relatively early post-op. Anesthesia is no joke ;P

Maybe it's the part of me that's spent the last 18 months locked in an ICU, but those extra weeks off are looking extra sweet right now...

 

[chocomorsel]

I'll answer. Its probably median, if that.

We got us a new cynic lately. Welcome @FFP junior. Try and contribute some clinical stuff as well please. Not just doom and gloom alone. We love a well rounded cynic here.

 

[Aheadbyacentury]

We got us a new cynic lately. Welcome @FFP junior. Try and contribute some clinical stuff as well please. Not just doom and gloom alone. We love a well rounded cynic here.

Go Home!

 

[Arch Guillotti]

Go Home!

Lighten up Frances. She has a point

 

[sethco]

And you can easily find >70th% MGMA jobs as a generalist right out of residency in some pretty desirable areas.

Where? Feel free to be as specific as possible

 

[deleted697127]

Keep in mind there are ways to be paid other than salary. If you can make as much as the cardiac partners per year, but get an extra week off for every week you do in the ICU, I'd say you've come out ahead big time. Just a theoretical example. This is what I mean when I say things are not as simple as "what % MGMA are you bruh?".

I’m 2 years out of residency. Maybe straight salary positions without incentives or perks where you know exactly what you’ll make exist, which I doubt, but it seems like an immature oversimplification to talk about your earning potential by just a number. My best guess towards the end of last year wasn’t even remotely in the ballpark of the final numbers on my tax return.

My point is that residents asking a new attending about their salary before they start a job is the blind leading the blind. I would bet there is a tendency to low ball estimates overall as it’s better to under promise and over deliver but residents asking questions about your salary is aggressive and dubious at best.