anesthesiology and critical care

[Jtherang]

I am a fourth year considering the field of anesthesia, but am mainly interested in critical care. For anesthesiologists who do the critical care fellowship, how much ICU management do they actually get to do? Are they limited only to the SICU? How available are these fellowships? Thanks for any advice.

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[CambieMD]

Hi,

@ VCU the surgicaL ICUs are staffed by a mixture of Int. med and anesthesia trained critical care staff. The int. med folk did critical care fellowships following int. med recidencies. Anesthesiologists played a much more prominent role in the managing of icu patients in the past. This has fallen off over the years for a number of reasons. The anesthesia faculty members who are critical care trained split their time between the OR and ICU. If you like being in the OR and also working in the ICU, gas would be a good fit for you. The medical ICUs @ VCU are staffed by pulmonologists. A pulmonary fellowship is three years.

CambieMD

 

[Jeff05]

you can work as much or as little as you want in the ICU. you may work in the SICU or the CT(cardiothoracic) ICU. at my institution attendings round in ICU one week per month.

 

[UMMS FMD]

If you're interested in critical care/anesthesiology OHSU (Oregon Health & Science University) has one of (if not the ONLY) combined anesthesiology residency/critical care fellowship programs in the US. Definitely check it out if you're serious about critical care!

 

[Pilot Doc]

If you're interested in critical care/anesthesiology OHSU (Oregon Health & Science University) has one of (if not the ONLY) combined anesthesiology residency/critical care fellowship programs in the US. Definitely check it out if you're serious about critical care!

While that sounds appealing ... and I'm sure it's a fine program, I wouldn't put too much stock into it. Any good anes program will give you a robust critical care experience, and you can spend 6 months of your CA3 year in the unit if you wish. You'll then have the option of staying at your home program for fellowship or going to see/learn somewhere else.

As for paths to critical care and job options thereafter, I think anes is the best way.

Your options are
GS (5 yrs) + CCM (1 yr)
Anes (4 yrs) + CCM (1 yr)
IM (3 yrs) + Pulm/CCM (2-3 yrs)

Anes is the quickest. Along with surgery it also gives you essentially two entirely separate careers. Arguable, the anes OR skillset will be more useful in the unit than the GS or IM skillset as well.

Who staffs what ICU is highly variable by institution. My impression is that in most places, Anes CCM guys run units that have at least some surgical flavor to them - SICU, CTICU, Neuro ICU, etc. You're probably not well trained for academic MICU patients (HIV, oddball ID,etc.)

As for a community ICU - you can get a job anywhere doing anything coming out of Anes CCM.

 

[radslooking]

While that sounds appealing ... and I'm sure it's a fine program, I wouldn't put too much stock into it. Any good anes program will give you a robust critical care experience, and you can spend 6 months of your CA3 year in the unit if you wish. You'll then have the option of staying at your home program for fellowship or going to see/learn somewhere else.

As for paths to critical care and job options thereafter, I think anes is the best way.

Your options are
GS (5 yrs) + CCM (1 yr)
Anes (4 yrs) + CCM (1 yr)
IM (3 yrs) + Pulm/CCM (2-3 yrs)

Anes is the quickest. Along with surgery it also gives you essentially two entirely separate careers. Arguable, the anes OR skillset will be more useful in the unit than the GS or IM skillset as well.

Who staffs what ICU is highly variable by institution. My impression is that in most places, Anes CCM guys run units that have at least some surgical flavor to them - SICU, CTICU, Neuro ICU, etc. You're probably not well trained for academic MICU patients (HIV, oddball ID,etc.)

As for a community ICU - you can get a job anywhere doing anything coming out of Anes CCM.

i think that's a pretty good post. academic medical icu's run some of the longest differentials in medicine...along with infectious disease. im sure anyone smart enough to get into anesthesia could make the switch, but it would take a little practice.

 

[lord_jeebus]

If you're interested in critical care/anesthesiology OHSU (Oregon Health & Science University) has one of (if not the ONLY) combined anesthesiology residency/critical care fellowship programs in the US. Definitely check it out if you're serious about critical care!

I thought one attractive feature of this program was that you can spread out the whole fellowship's worth of unit months over the 4 years of the program.

Also, the OHSU tram.

 

[Pilot Doc]

I thought one attractive feature of this program was that you can spread out the whole fellowship's worth of unit months over the 4 years of the program.

Are you saying that you come out CCM board eligible after your PGY4 year?

 

[UMMS FMD]

Are you saying that you come out CCM board eligible after your PGY4 year?

No, you come out CCM board eligible after your PGY-5 year. They spread out the ICU months over the latter two years of your residency and make it so you never have >8 weeks in the unit at a time. It's nice because you get to bounce between the OR and the unit and hone your skills in both.

 

[cchoukal]

I thought one attractive feature of this program was that you can spread out the whole fellowship's worth of unit months over the 4 years of the program.

Also, the OHSU tram.

My opinion is that being a fellow is very different from being a resident, in terms of responsibilities, knowledge base, expectations, and how people perceive you. I think to mix fellow months with resident months would really dilute the experience.

 

[cchoukal]

And in any case, CC fellowships out of anesthesiology are wide open, so it's not like doing the combined program has any safety aspect to it. If you want to do CC from anesthesiology, the opportunities for fellowship are easily obtainable.

 

[Pilot Doc]

I think to mix fellow months with resident months would really dilute the experience.

Agree, strongly, with both posts above.

 

[scotchnwater]

GS (5 yrs) + CCM (1 yr)
Anes (4 yrs) + CCM (1 yr)
IM (3 yrs) + Pulm/CCM (2-3 yrs)

Not trying to split hairs here at all...but I heard that now most GS programs are SIX TO SEVEN YEARS (they now have mandatory research).

Can you friggin' believe that??? I would poke my eye out with a stick somewhere around year 1.5 .

 

[cchoukal]

Not trying to split hairs here at all...but I heard that now most GS programs are SIX TO SEVEN YEARS (they now have mandatory research).

Can you friggin' believe that??? I would poke my eye out with a stick somewhere around year 1.5 .

I don't know how mandatory the research years are, but many people DO do extra years in GS. I can say with certainty that it is possible to graduate from a GS residency without taking lab time, even from an academic, university-based program.

As an aside, many IM-Pulm-CC fellowships have gone to 4 years to accomodate an extra year of research and, in fact, many premier anesthesiology-CC fellowships offer a 2nd year of primarily research training.

 

[Pilot Doc]

Not trying to split hairs here at all...but I heard that now most GS programs are SIX TO SEVEN YEARS (they now have mandatory research).

Not true. Only about 1/3 of gs residents spend time in the lab. About half of those are 1 year guys, half two. The programs that require every resident to go into the lab are quite rare.

 

[scotchnwater]

Not true. Only about 1/3 of gs residents spend time in the lab. About half of those are 1 year guys, half two. The programs that require every resident to go into the lab are quite rare.

It sounds like your info is better than mine. Talking to the new surgery residents at my institution (which is generally a 7 year GS program) they conveyed that finding the 5 year program was becoming more the exception than the rule unless you were trying to train at a community program.

My only point was to say how utterly miserable 7 years of residency for GS sounds.

 

[bigdan]

My opinion is that being a fellow is very different from being a resident, in terms of responsibilities, knowledge base, expectations, and how people perceive you. I think to mix fellow months with resident months would really dilute the experience.

My worry about CC fellowship immediately after residency is that you've just spent 3 years learning (mainly) OR management, and then you spend 12 months doing something outside of the ORs. While I imagine some OR skills are well imprinted, is there some degree of skill loss after doing a non-OR based fellowship?

Doing your OR and ICU training concurrently sounds reasonable in my (entirely naive) opinion.

dc

 

[militarymd]

My worry about CC fellowship immediately after residency is that you've just spent 3 years learning (mainly) OR management, and then you spend 12 months doing something outside of the ORs. While I imagine some OR skills are well imprinted, is there some degree of skill loss after doing a non-OR based fellowship?

Doing your OR and ICU training concurrently sounds reasonable in my (entirely naive) opinion.

dc

It's not as bad as you might think.

 

[cchoukal]

I would add, too, at least at my institution, the CC attendings generally get a different subset of patients when they are assigned to the OR. They aren't in the ambulatory setting doing blocks or spinals. Instead, they're usually doing big cases on sick people, which is a lot like what they did in the unit during their fellowship, so I think a lot of the skillset is transferrable.

 

[Hockeyguy]

Mil I know you are CC fellowship trained. Do you ever formally "attend" in the unit where you work or are you exclusively in the ORs.

 

[militarymd]

Mil I know you are CC fellowship trained. Do you ever formally "attend" in the unit where you work or are you exclusively in the ORs.

OR only.

 

[Pilot Doc]

OR only.

How would you assess the value of a CCM fellowship to a resident who is looking for a job like yours?

 

[militarymd]

How would you assess the value of a CCM fellowship to a resident who is looking for a job like yours?

scale from 1 to 10


11

 

[Pilot Doc]

11

Can you explain?

 

[toughlife]

scale from 1 to 10


11

 

[bubalus]

The anesthesia CCM fellows at Wash U rotate through all the units--neuro/neurosurg, MICU, CCU, CT, SICU, etc.

The fellowships and job market are wide open. It wouldn't be difficult to find a place to "sponsor" you as a fellow and give you a significant bonus in return for agreeing to work for them for a certain period of time.

I'd suggest you think about how you want to spend your time when you're done as well as how you want to spend your time while in training. Does 3 years of floor medicine and clinic and then a 3+ year fellowship sound fun to you? How about 5-7 years of gen surg plus a 1 year fellowship? A transitional year, 3 of anesthesia, and one of CCM? It's pretty easy to see where I come down on this issue.

 

[militarymd]

Can you explain?

All other things being equal....who would you hire?

some schmo who just finished training....

or some schmo who got another year of training in being a physician outside of the OR and is already board certified?


Now if you fail your Orals during your fellowship ......I don't know how to rate that.

 

[fakin' the funk]

All other things being equal....who would you hire?

some schmo who just finished training....

or some schmo who got another year of training in being a physician outside of the OR and is already board certified?

In your experience, in PP, what does the CCM fellowship translate into? More $$$ for the same job? Does it help you get more desirable jobs (location/hours/call/partner) that you wouldn't otherwise get? Does it bump you up in your group's hierarchy?

The reason I ask is because, if the CCM fellowship is so great, why are they mostly unfilled? You always paint it as the hidden secret in anesthesia.

 

[militarymd]

In your experience, in PP, what does the CCM fellowship translate into? More $$$ for the same job? Does it help you get more desirable jobs (location/hours/call/partner) that you wouldn't otherwise get? Does it bump you up in your group's hierarchy?

The reason I ask is because, if the CCM fellowship is so great, why are they mostly unfilled? You always paint it as the hidden secret in anesthesia.

I don't know...and I don't know...

I'm offering only my personal opinion...and that is EVERYONE should have additional training on care of patients outside of the OR...

The way I see things in this day and age of lifestyle and money, etc. etc.......why bother with additional training when you can step right into LIFESTYLE and MONEY without any more hassle.