Wow, there's a lot of doom and gloom and negativity here, but honestly that isn't surprising. I agree, burnout is a problem, and being part of a "service" specialty is definitely a contributor to that problem. I see it all the time: when in the OR, fighting with the idiocy of certain surgeons (usually the specialists like neurosurgeons and neurointerventionalists) can get trying. Those days, I'm crying for my week in the ICU to come sooner. Then I face a different surgical idiocy: a cardiac surgeon who thinks he understands hemodynamics and proceeds to volume overload his POD 7 thoracoabdominal repair for "sepsis" to the point of heart failure: the problems of an "open" ICU. However all is NOT doom and gloom. In the ICU I have my share of "closed ICU" patients: medical and ECMO patients in whom I still feel I make a difference. No one touches those patients other than my service, and it is very gratifying to get the young mother of 3 in severe ARDS from H1N1, doomed to die elsewhere, but who makes it through an ecmo run at our place to walk out of the hospital back to her toddlers.
Still, the combo job can be VERY trying, and the death and dying in the ICU can get to you. You need to make sure your entire job isn't only the clinical aspects. In academic practice I've started to focus on resident education in the ICUs and to try and change our residents' perspective of CCM from one of service only to one where I can show them we actually make a difference. In addition, for an academic practice I get a good amount of time off to recover from clinical duty (especially ICU) duty.
RE: closed ICUs. We manage, through teleICU, some community ICUs. It's given me some insight: many community ICUs are managed by hospital medicine with an occasional consult to a pulmonary "Intensivist" who barely does anything for that patient. So not even community ICUs are closed at all times. A surgical patient gets admitted and then the surgeon still interferes because the medicine guys want nothing to do with surgical patients.
What I'm saying is that if Anesthesiology becomes a problem, critical care in the community is still a possibility, at least for me. You don't need to be ABIM boarded if there are no medical residents. Actually, one of our Anesthesia / CCM docs will assume control of that ICU and begin a real CCM service.
Back to my academic practice, salary is good, despite it being W-2. I don't take OR call, and I only pick up extra telemedicine ICU shifts that I think will be less busy, for the extra cash, and less likely to contribute to burnout. Plus, I SAVE and INVEST (in low-cost index funds) a lot of my salary because the ultimate focus down the road is to work because I want to, not because I have to.
Focus on the doom and gloom and I think you'll only accelerate the burnout process. Find a way to focus on some other endeavors to help keep you sane.
Sent from my iPhone using
SDN mobile
