Anesthesia CC

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ctsicu

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Anyone know what the job market is like for anesthesia cc? I feel like pulm-cc are pretty restrictive about letting non-IM trained people in. Which is crazy considering that in the rest of the world it is mostly anesthesia who run the ICUs.

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Current Anes CC fellow, job hunting, lots of straight intensivists jobs open (depending on where you want to live) with the medicine model of money and time off, very few mixed Anes/cc PP jobs some but rare, most ICUs want intensivist so background not as important but be prepared to hear the lower income more hours story compared to PP anesthesia.
 
seems like all the DO CCM fellowships are from IM. is there no pathway on the osteo side to do CCM from anesthesia?
 
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Anesthesia is NOT the same in the US as in the rest of the world. Different model.

I have been wondering about this. Our Pulm professor is a European trained anesthesiologist who practices here in the MICU as a Pulm/CC doctor. He is absolutely brilliant. I've been dying to ask him about his training but he is, shall we say, unapproachable.
 
Surgical ICUs in general prefer anesthesia or surgery or even ER trained Intensivists to medicine.
 
Surgical ICUs in general prefer anesthesia or surgery or even ER trained Intensivists to medicine.

So what? I thought sicu's preferred surgeons. I sure as hell wouldnt want to run a closed sicu. Even if, by some tragic twist of fate, I was offered to I wouldnt do anything other than pulm for academic SICUs. I dont prefer surgeons to run a MICU, but I'll consult the crap outta em when needed.

From what ive seen in PP the surgeon consults the "intensivist" who is most often a pulm/cc dude. He could be anesthesia or ER or maybe just a plain old "doctor." But guess what? They dont give a rats ass what they trained in. They put the consult in and get back to work.
 
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Vent you seem like a typical medicine dickhead who thinks extremely highly of himself.
Let me fill you in on a few things: there is NO ONE who seems to be less well managed than MICU patients in every IVY LEAGUE institution I've ever been at. Big fat patients on pressors going through a 22 g IV In the thumb and no art line, other patients on vent for 45 days with no trach, let's not even get into the ridiculousness of the intubation fiascos that occur. You're going to fall on your face with your arrogance and it won't be pretty.
P.S. the rest of the world can't be wrong, and we do more acute critical care in the OR than most MICU docs whose units are filled with gomers.
 
Vent you seem like a typical medicine dickhead who thinks extremely highly of himself.
Let me fill you in on a few things: there is NO ONE who seems to be less well managed than MICU patients in every IVY LEAGUE institution I've ever been at. Big fat patients on pressors going through a 22 g IV In the thumb and no art line, other patients on vent for 45 days with no trach, let's not even get into the ridiculousness of the intubation fiascos that occur. You're going to fall on your face with your arrogance and it won't be pretty.
P.S. the rest of the world can't be wrong, and we do more acute critical care in the OR than most MICU docs whose units are filled with gomers.

Damn bro, that's harsh! Venty is good guy. And for the record he did anesthesia before he did medicine so I'm sure he's well aware of what goes on in the OR.
 
Well attitudes like this are putting us further and further behind. Seems to me to disregard his anesthesia training entirely.
 
Well attitudes like this are putting us further and further behind. Seems to me to disregard his anesthesia training entirely.

How so? I just posted recently how my anesthesia training helps me be a better intensivist. No question about it. You sound like an academician with a chip/boulder on his/her shoulder. Its all good in the hood.

You are not in "the rest of the world" you in the US of f'n A. How many months of ICU do anesthesia grads have to do now? For me it was 3 back in 2008.
 
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I've never been entirely clear why it mattered how things were done in Europe with regards to critical care. How is it relevant.

IM has been admitting and managing patients in ICUs for as long as the specialty and ICUs have been around. It's only been the last few decades that general IM has started to leave the critical care to the critical care trained guys and usually the Pulm/crit guys. So it's not like IM wasn't already handling critical illness and has been forever. It's not like Pulm came along and stole the unit from anesthesia. Lolwut??

And gas has no one bit themselves to blame from the loss of ICU practice outside of the big academic centers. Most of those guys wanted to make the big buck knocking out home runs in same day surgery centers and low acuity cases in private hospitals. That doesn't bug me any. I've got no problem with anesthesia critical care. But to get upset at the current practice in this county seems kind of stupid. It is what it is. I don't get mad because the sky is blue and neither should anyone else.
 
At the end of the day, you can say specialty x does all this or that, screw the speciality. It's about which physician can actually nut-up and those that need to shut up. There are ER guys who aren't CC trained who are great, many just suck, there are gas guys who are better at medicine than they're IM conterparts, there are those (like at my shop) tell the CRNAs that they're better at airway management than themselves, and surgeons......well surgeons are surgeons. And I had co-fellows I would let manage my wife's cat if they were my only option, and I've had pulm-CC docs I thought suffered from anencephaly.........
 
If you are planning to live on East Coast, then there are lots of CCA (Crit Care Anesthesiology) jobs out there, probably more in academia than PP.
If you are planning a life in academics, then a career in CCA is viable--just don't be too upset when you never do your own cases in the OR since there are usually residents and CRNAs/SRNAs for that.

On the west coast, academics has always been where CCAs feel they have to be.

However, the options for PP anesthesia combined with crit care are about to get broader, especially with mature anesthesia groups starting to understand the value of providing services and leadership outside the OR (and I don't mean giving anesthesia for an MRI that a patient doesn't friggin need :)

...for the resident thinking this, a few things to check off:

-make sure you are one of the strongest residents in your program--the group(s) offering PP CCA are choosy and you need to be very good; in PP you will be expected to do OB, and be very good at regional blocks and catheters
-get really good at ultrasound (TTE, TEE, lung, nerve blocks, etc.)
-fellowship name doesn't mean as much--I went to a "no name" place simply because I got to have a lot more say in what I wanted to learn--time to do advanced TEE, tracheostomy (perc), some neuro, etc.--what matters is the skills level and maturity you display when you step into private practice. worked with some people from certain "big name" progams and found them to be mired down in dogma based on what they were told the "right way" was at their institution. They were also not very self-sufficient--can't handle situations at night and god...terrible, terrible hands and procedural skills! Make sure your co-fellows are there because they were cream of crop and had their choice and chose CC because they love it..not because they are too slow to function in a fast-paced OR.

I did medicine, then surgery, then anesthesia, then CC and neuro-CC. I agree that micu type patients can often seem more complex, but as often as not, I think the intensivist's job is to simplify management since patients have gone down one of a few paths by the time they get to the unit--with similar management strategies...
-ALI
-shock of some kind
-AKI
-shock liver
-hypoperfused splanchnic organs
-delirium
-anemia
-muscular weakness


No offense to those who are actually smart--but all the therapies with really really good efficacy are "low-lying" fruit (aggressive attempts at extubation, PT/OT, bedside cares, GI/DVT prophylaxis, early goals of therapy talks with families, aggressive efforts to reverse shock and frequent reassessments of organ perfusion, excellent communication)
A mentor once told me that most of what he does is:
1. Weigh risk vs. benefit
2. Manage expectations
keep your eyes open--pulm/cc doesn't have a monopoly on the business anymore
 
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In short, I did a anesthesiology CC fellowship after residency. I wanted to end up in a very specific location after fellowship which most would consider BFE. I first approached the anesthesia PP group and stated I was interested in practicing both anesthesia and CC. Initially the group was hesitant but after my initial interview the current head of the PP anesthesiology group contact the PP CC group who happen to be 100% pulm. I had three interviews with their group and in the end they were interested in working out a deal in which I could do 1 week CC and 3 weeks OR or 2 weeks CC and 2 weeks OR. They seem like a great group and were more than welcoming even with a different background….did not really seem to be an issue. Naturally they had a lot of questions regarding my skill set and training background which is not an issue. I ended up signing a contract with an great anesthesia group to start out 100% OR secondary to initial anesthesia needs in the OR for the initial part of the year but both groups are staying in contact and hopefully will be able to work out a partnership in which the relationship is beneficial for everyone involved. All I had to do is reach out to the PP plum group and they seemed more than happy to entertain the option.
 
4 are required of all anesthesia residents now. Typically it ends up being 2 as pgy1 (since you are allowed to count up to 2 months from pgy1) and then 2 in the CA years.
 
4 are required of all anesthesia residents now. Typically it ends up being 2 as pgy1 (since you are allowed to count up to 2 months from pgy1) and then 2 in the CA years.

That's not what I expected for a residency that allows a one year fellowship in CC for boarding. I did 9 months of MICU on my three years of IM, and most of my co residents did 5 or 6. I would have thought gas would be 10+ total ICU months.
 
Obviously you can choose to do more as electives. How many ICU months are required for internal medicine? Some would argue that much of an anesthesiology resident's time is spent doing hands on critical care, almost every day. Certainly we do far more procedures than the average IM resident, and I would also chance that the (average) pgy2 in anesthesiology knows more pulmonary/cardiac/ventilator physiology than the (average) graduating IM resident. Of course anesthesiology learns far less endocrine, GI, etc....
 
No disagreement there, my CC totals are way above norm. My point wasn't to compare the two, I was just surprised gas doesn't have more CC months that's all. And I think avg for I'm is 5 months
 
Vent,

Little delayed response to your post sorry.

Private practice surgery is obviously very different. It's all about maximizing billing and utilizing your time.

I have a buddy who is Icu trained; when he is on surgery he is like Any other surgeon consulting Icu. He could give a half second thought about the patients Icu day to day management.

But on his Icu week when he's not operating.... You would think he's a god damn ultra medicine nerd. Micro-managing sometimes to the point where it's funny! Double checking dietician calculations etc!


Point is..... It's all about compartmentalism and efficiency
 
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