I'm not really sure. Both seem to get dumped on pretty hard.do you want to be an anesthesiologist or an internist?
No not really honestly.Do you like clinic?
I don't think I really would like it at all, but they say that you will go crazy being in the hospital and particularly the ICU all the time and need the outpatient pulmonology to keep your sanity.Would you want to have a pulm practice?
So would you say then that private practice/community jobs for anesthesia/ccm are hard to find?If you already know you ONLY want to do ICU than would probably go Anesth route since I feel Anesth residency is more critical training, more enjoyable if you like ICU stuff, better at procedures and airway mgmt
Imed/CCM: Better at medicine initially and managing MICU pts, play catchup with procedures and airway mgmt
Anesth/CCM: Better at Procedures/airway, hemodynamics intially and managing SICU pts, play catchup with medicine ie; ID
But either way in the end both routes will provide adequate training for any environment to practice, CCM is a multidisciplinary field
Or if u really enjoy IMed you dont have to do pulm can do just CCM fellowship which is 2yrs vs 3yrs so same total time IM/CCM (5yrs) as Anesth/CCM (5yrs) route
However that being said, the overwhelming majority of ICU jobs in private practice want Pulm since thats the setup with splitting time between ICU and covering Pulm. Anesth/CCM you will be mainly limited to Academia however there are jobs out there in Private Practice if your willing to move. I myself cover both MICU and SICU pts in private practice so its possible just harder to find
But in the end I think comes down to where would you rather be when not in the ICU --> OR or Clinic
Can always do 100% ICU but personally I think its good to change things up otherwise ICU burnout can happen pretty fast
yup i think so although may change in futureSo would you say then that private practice/community jobs for anesthesia/ccm are hard to find?
That actually sounds really flexible and appealing. Life is short.yup i think so although may change in future
one way to do it is what i am currently doing is find a gig that is 100% ICU 1week on/off model and then can do anesth per diem/locums during your off days or possibly vice versa
This is not accurate. (anymore)the ABIM changed their rules a couple of years ago where you must be an internist to train IM residents or something like that, so only the pulm/cc guys attend in the MICU in academic centers
A common scenario which keeps people from pursuing CCM. Complete accurate statement which needs to be addressed if Anesthesia wishes to produce more CCM docs.Residency in the ICU is NOT a great look into the practice of CCM, at least not where I trained. Scut work abounds, and unfortunately that will jade a resident's experience and desire to actually pursue Critical Care.
In general are anesthesiologists limited to SICU or CTICU? I know you are not, but in general, is it hard to find jobs at community/private hospitals covering both SICU/MICU or combined units?A common scenario which keeps people from pursuing CCM. Complete accurate statement which needs to be addressed if Anesthesia wishes to produce more CCM docs.
Honestly think Pulm is the worst way to get into CCM. They are internets and are taught to focus on the minutia of care, not the skills to resuscitate. Anesthesiologists are rare physician in that we are very accustomed to pushing our own meds, giving our own fluids/blood. We don't wait for IV therapy, we don't ask "anesthesia" for intubation, we don't get so focused on a patients hx (i.e. CHF) that we fail to make act. We are thinkers who act on our thoughts immediately not persevere while the patient succumbs.
And there's plenty that don't, so don't lump them all together.Last weekend I ran into a nephrologist whom I have worked with in the ICU for 6+ years. During our conversation he said " You are you an anesthesiologist? I guess I never knew that."
Yes we can work anywhere, anytime, and with great skill and expertise. It more about how bad do you want to be a well rounded physician in your medical knowledge base. I know surgeons and internal medicine trained CCM docs who are more quick to consult for the most minor of things. I usually only consult when i need something i can't do, i.e. dialysis, cardiac cath, VADs, figure out autoimmune diseases etc
There's actually not a whole lot that needs a consult in the ICU from an intensivist perspective. If you think the patient needs a knife but other than that . . . Not too much. Dialysis. But intensivists can run our own crrt so even then not until intermittent time.merely pointing out that everyone has a different level of comfort and consultations with specialists is a personal decision not one born out based upon your training background