Anesthesia/Critical Care Combined Residency Tracks

[Lurch]

Current 4th year med student and first-time poster here.
I am currently applying for Anesthesiology residencies with the hopes of applying for critical care fellowship after residency. I was wondering what the opinions were of residency programs (OHSU, UW, UCSF for instance) that offer combined Anesthesiology and Critical Care training lumped into a 5 year track.
These tracks enable a graduate to sit for both anesthesia and ccm boards upon completion of the program but it doesn't appear that they get you done with residency any sooner.
What do people think about these combined programs? Are there any advantages over simply completing a standard anesthesia residency and applying for CC fellowships as a CA2/3?
Thanks

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[bigdan]

I was in the same boat as you last year, and looking at some of the programs that you named. I'm sure a lot of this is stuff you've already thought of, but my impressions were:

Advantages:
- you don't have to apply for fellowships. Just do what they tell you, and skate on in.
- you know what you're getting into, in terms of faculty, nursing, equipment, etc
- you get plugged in early, so that you'll be sought after for research and mentoring, instead of you having to hunt it down.
- you get to do some anesthesia while you do your CCM in the last two years. This was the most attractive point to me; I'm worried that as a CA3 I might finally be comfortable with my skills in intraoperative anesthesiology, and then with a full CCM fellowship, I would spend the next 12 months out of the ORs.

Disadvantages:
- you learn one way to do things.
- your faculty/nursing/location/etc might suck, and you're locked into that
- there are some programs (Vanderbilt comes to mind) have very enticing programs that give you a fellowship after your 3 anesthesia years, with a plan to seduce you into becoming an academic. I don't remember all the numbers, but I think the Vandy thing gave you like an extra 15K per year during your CA years, then paid you half-attending salary during your fellowship year, then guaranteed you a attending spot at a higher salary for your first year out. Or something like that. Robbins Scholar, I think.
- You might change your mind. I wanna do CCM too, even after my first two months as a resident were in an ICU. But you might love hearts or peds or pain. Seems like you might likely be able to slip out of whatever agreement you have with your program if you're locked into a combinded anes-CCM, but why be "that guy"?

I ended up going for "normal" anesthesia residency, which I think is the better choice for me.

Good luck with the interviews! It was a lot of fun, and there are a ton of great programs.

dc

 

[cchoukal]

I think the biggest downside of the combined programs is that you'll be doing "fellowship" months in the ICU when you are still a "resident." As a critical care fellow, I can tell you that the roles are different and the whole point of being a fellow is different. You focus on different things and your goals and how you interact w/ others (your attgs, nurses, the rest of the hospital) is just different from that as a resident. I think it would be very hard to get the most out of the fellowship experience if you're doing it as a resident. I think it'd be really hard to flip roles every month, and I'd also be a little concerned about how the fellow role fits on somebody who might be technically junior to the people they're interacting with. It's not some dom/sub fantasy or anything, I just would worry about diluting the experience by not really "being" a fellow during your fellow months interspersed among your resident months.

Critical care fellowships are not nearly so competitive that you should worry about not getting a good one when the time comes.

I have a hard time seeing an advantage unless they offered more money. An anesthesia resident interested in critical care will get more mentoring than they can possibly use simply because so few people are into it and those faculty that are tend to lock onto interested juniors. This all assumes, of course, that you're a good applicant in the other normal ways and not some social misfit.

 

[Lurch]

Thank you both for your nice responses...I feel similarly at this point. I will probably still check them out if I am lucky enough to be granted an interview. The programs themselves may be able to pitch it from a different angle as well.
bigdan, glad to hear your first two months of residency haven't killed the notion of critical care...even as a med student, i've seen many people change their mind after their first icu months. best of luck

 

[bigdan]

Lurch -

DEFINITELY check them out if you can get interviews there - even if you go and choose the "regular" track, the places you listed will give you an excellent experience for anesthesiology. If you have the South anywhere on your radar, please add in Duke (don't know the name of their program) and Vanderbilt (Robbins Scholars) to your list of programs; they add in a little extra cheddar if you agree to stay on to do fellowship with them, and both were extraordinary programs in my opinion...ranked 'em #2 and #4, respectively.

Cchoukal's point is from a perspective that I don't yet have, but it is a very good point. The fellows in my ICU experience ranged from very good to extraordinary. And saying "...the fellow said so" was the end of any argument or discussion. They really were like attendings in many ways. The title of "fellow", at least at my place, carried a lot of weight, and the same simply couldn't be said for "resident". Again, I think that cchoukal's point is great, and should be considered.

dc