Anesthesia/Critical Care Med

[OldManDave]

Anyone besides me planning to do a CCM fellowship after completion of an anesthesiology residency? I have a guranteed slot at Dartmouth - already signed the letter - for 2007~2008.

Love to hear from ya!

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[DropkickMurphy]

I've considered it.....although my preference is strongly towards EM, but I feel that my background would put at a distinct advantage in a CCM setting.

 

[psychbender]

I'm very much considering it. However, being that I'm still an MS1, it'll be a long time before anything is certain.

 

[Sugar72]

Anyone besides me planning to do a CCM fellowship after completion of an anesthesiology residency? I have a guranteed slot at Dartmouth - already signed the letter - for 2007~2008.

Love to hear from ya!

Aren't you getting an MPH or something too - you are dangerously overeducated! I still have a couple more years before I commit! Would love to hear if anyone else is taking your route too.
Do you plan on staying in academic medicine (anesthesiology trained intensivists?) after you finish your fellowship? Working in a private intensivists practice, or working in the OR? Just playing in by ear?

 

[OldManDave]

Aren't you getting an MPH or something too - you are dangerously overeducated! I still have a couple more years before I commit! Would love to hear if anyone else is taking your route too.
Do you plan on staying in academic medicine (anesthesiology trained intensivists?) after you finish your fellowship? Working in a private intensivists practice, or working in the OR? Just playing in by ear?

I WAS working on my MPH - elected to withdraw from that program. It simply was not meeting my individual needs & was a waste of my energy. However, from square one, I have been intent upon the anesth/CCM route. I had already secured my CCM slot prior to even applying to the MPH program.

No regrets in changing my course!

Regarding my post-training plans - private practice for 5~10 years & the return to academia. I love to work with students & residents. In private practice, I hope to be able to split time b/t ICU & OR - but OR will be my preference overall...and I am not interested in taking any cut in pay for my ICU time. So, it is entirely possible that I will not actually work in an ICU until I return to academic medicine where I can split my time w/o financial punishment.

 

[SexPanther]

I'm a soon to be 4th year with an interest in either Anesthesiology/CCM or EM. Dave, how prepared do you feel you are for the CCM fellowship? Does anyone find it interesting that in Europe, Anesthesiologists make up the majority of intensivists and are considered super docs, but here IM accounts for the majority of intensivists?

Any other advice for a confused MSIV trying to make a huge decision is appreciated.

 

[ecCA1]

"I hope to be able to split time b/t ICU & OR - but OR will be my preference overall...and I am not interested in taking any cut in pay for my ICU time. So, it is entirely possible that I will not actually work in an ICU until I return to academic medicine"

I respect your willingness to pursue a fellowship that you may very well be unable to justify having achieved, considering you're already older than most residents. Most people wouldn't go for it, kudos to you for your decision. Hopefully unit work will be plausible during private practice, otherwise you'll be working in the unit very briefly indeed.

 

[proman]

I am, assuming I don't change my mind in 2010. My ideal job would be a private practice OR and academic ICU combo.

 

[FlacoFlo]

I am, assuming I don't change my mind in 2010. My ideal job would be a private practice OR and academic ICU combo.

Is this possible??? Has anyone ever heard of it??? Because I second that idea! If possible, that would sound like a great job! Anyone out there know of this scenario??

 

[nimbus]

The only people who I have witnessed successfully incorporating OR work with ICU work in private practice are the pediatric anesthesiologist/intensivists at our local children's hospital. They spend a week or two in one of the ICUs every month. The balance of their time is OR anesthesia. The institution is quasi-academic in that residents from the university hospital rotate there, but the physicians are members of our local single-specialty private practice anesthesia group. Most of them are peds+anesthesia+PICU or NICU trained. This is a pretty well established pathway if you are truly interested in combining anesthesia with ICU work.

 

[SleepIsGood]

...

Regarding my post-training plans - private practice for 5~10 years & the return to academia. I love to work with students & residents. In private practice, I hope to be able to split time b/t ICU & OR - but OR will be my preference overall...and I am not interested in taking any cut in pay for my ICU time. So, it is entirely possible that I will not actually work in an ICU until I return to academic medicine where I can split my time w/o financial punishment.

Dave-

Out of curiosity. When I was interviewing for residency spots at academic institution X, the PD there said that Anesthesiology CCM fellowships would be financially rewarding. He made it sound like it would be the next "Pain Medicine". His justification for this was the great need for them given the lack of intensivists trained in CCM currently. Is he right?

He is probably the only person that I've talked to that stated that CCM would actually be financially rewarding. What do the folks you interact with over in the East Coast have to say?

 

[nimbus]

Dave-

Out of curiosity. When I was interviewing for residency spots at academic institution X, the PD there said that Anesthesiology CCM fellowships would be financially rewarding. He made it sound like it would be the next "Pain Medicine". His justification for this was the great need for them given the lack of intensivists trained in CCM currently. Is he right?

He is probably the only person that I've talked to that stated that CCM would actually be financially rewarding. What do the folks you interact with over in the East Coast have to say?

This is an interesting analogy. Just as pain can be financially very rewarding if you become a pump/stim/needle jockey, CCM could pay $$$ if you try to steer your practice toward bronchs/echos/lines. This could be politically tumultuous. If you want to practice comprehensive diagnosis/therapy/ and followup, I doubt CCM could be more rewarding than OR work. It does not pay to round for hours with house staff every day.

 

[militarymd]

It will depend on how successful the Leapfrog initiative is, and how well the payors will pay.

There are a few groups along the east coast...I know of one in Massachusetts and one in one of the Carolinas and one in Ohio where the anesthesia department provides full time ICU coverage for the hospitals....medical and surgical.

You can bill the insurance companies and Medicare for your services, but in general, an anesthesiologist will generate more revenue in the OR, unless you are VERY efficient with your ICU rounds.

I remember G. Maccioli (spelling) telling me about his ICU....I can't remember the exact number of patients he sees a day, but I was impressed, and remember thinking that I could never see that many in a day....without MUCH more experience.

The other way of generating more revenue is if the hospital buys into the idea of having full time CCM coverage...and they are willing to subsidize you....meaning, they take on the onus of billing for your services, and actually pay you more than what they bill, knowing that your presence is saving them money in the long run (less tests, less vent days, less complications, etc.)

 

[gutonc]

I'm a soon to be 4th year with an interest in either Anesthesiology/CCM or EM. Dave, how prepared do you feel you are for the CCM fellowship? Does anyone find it interesting that in Europe, Anesthesiologists make up the majority of intensivists and are considered super docs, but here IM accounts for the majority of intensivists?

Any other advice for a confused MSIV trying to make a huge decision is appreciated.

"It's all about the Hamilton's baby."

Gas in the OR pays a boatload. Gas in the unit pays Jack with a Squat bonus if you're lucky.

A friend of mine who is primarily an Anes/CC attending at a top northern Midwestern private university program makes ~ 70% of what a residency classmate of his who is strictly Anes/OR makes and the straight OR/Gas guy didn't do a fellowship. The differential is likely to be greater in a private setting since most of the OR folks will be private practice contracted to the hospital while the CC ones will be hospital employed. At least, that's what I've heard from anesthesiologists at 3 different private hospitals in 3 cities on both coasts.

BE (now PE)
YMMV of course.

 

[MedWiz]

Does anyone find it interesting that in Europe, Anesthesiologists make up the majority of intensivists and are considered super docs, but here IM accounts for the majority of intensivists?

In Europe, Anesthesiologists sort of ARE "super docs", simply because they have to be as EM isn't yet a specialty in its own: whenever there is any sort of "critical" patient in general, Anesthesiologists will usually see them first (regardless of whether the patient is already in the ED or still "in the field") and ensure that the patient is stabilized before referring them to a corresponding specialist, the logics behind this is, that stabilization of all sorts of extremely critical patients is exactly what Anesthesiologists usually do in the OR, too.

Since emergency medicine isn't even yet a separate specialty in many places in Europe, you will see the majority of EMS vehicles (i.e. ambulance & helicopters, medevac planes) being staffed with highly experienced anesthesiology-intensivsts (unlike the US system, you'll see emergency physicians being directly dispatched to an accident scene, rather than paramedics only: Anglo-American vs. Franco-German EMS) who underwent special training (at least 6-12 months) during residency to cater for emergent situations that Anesthesiologists aren't necessarily that familiar with (i.e. OB/GYN). Likewise, it's often Anesthesiologists who are trauma team leaders (of course including surgeons) until the patient is stable.
In fact, as Anesthesiologists usually also staff emergency departments, they are often even trained to do minor (outpatient) surgeries (i.e. mole/toenail removal etc.) as well as special surgical procedures that may be required at an accident scene (i.e. tracheotomies).
While Anesthesiologists aren't the only specialists who can qualify as emergency physicians, they are widely acknowledged as being the "first choice" for the majority of cases (the 2nd choice being traumatologists ("emergency/accident surgery" is a separate surgical specialty in many places in Europe), nevertheless doctors from other specialties can also be dispatched if the nature of the emergency is known and if it directly requires a certain specialist (i.e. again OB/GYN).