Anesthesiology and Critical Care

[likeaboss]

I know we have a few guys in the anesthesiology forum who have done fellowships in CCM, i'm wondering how its affected the way you practice. Do you manage a unit? I'm currently rotating in the SICU and I think its really awesome. I'm with surgical CC guys, but I will be applying to anesthesia in a couple months with the hopes of doing part time anesthesiology and part time CCM. I like that there is a ton of thinking and medicine in the ICU and little social work (which what made me decide against IM).

What are the advantages of doing a CCM fellowship? Do you end up in more academic roles? how does it affect your lifestyle, hours, pay, job offer wise? is a fellowship necessary if you want to run an ICU? does it make you more valuable in private practice?

thanks everyone.

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[Idiopathic]

I know we have a few guys in the anesthesiology forum who have done fellowships in CCM, i'm wondering how its affected the way you practice. Do you manage a unit? I'm currently rotating in the SICU and I think its really awesome. I'm with surgical CC guys, but I will be applying to anesthesia in a couple months with the hopes of doing part time anesthesiology and part time CCM. I like that there is a ton of thinking and medicine in the ICU and little social work (which what made me decide against IM).

What are the advantages of doing a CCM fellowship? Do you end up in more academic roles? how does it affect your lifestyle, hours, pay, job offer wise? is a fellowship necessary if you want to run an ICU? does it make you more valuable in private practice?

thanks everyone.

i think anesthesia CCM is a great career, but dont get fooled into thinking you wont be a part-time social worker/counselor/psychologist/psychiatrist

 

[TrustMe]

I know we have a few guys in the anesthesiology forum who have done fellowships in CCM, i'm wondering how its affected the way you practice. Do you manage a unit? I'm currently rotating in the SICU and I think its really awesome. I'm with surgical CC guys, but I will be applying to anesthesia in a couple months with the hopes of doing part time anesthesiology and part time CCM. I like that there is a ton of thinking and medicine in the ICU and little social work (which what made me decide against IM).

What are the advantages of doing a CCM fellowship? Do you end up in more academic roles? how does it affect your lifestyle, hours, pay, job offer wise? is a fellowship necessary if you want to run an ICU? does it make you more valuable in private practice?

thanks everyone.

I will preface this by saying that I just finished a CCM fellowship so I may be a little biased.

I feel like the fellowship made me a better anesthesiologist even if I didn't practice CCM. I feel comfortable taking care of just about any patient in the OR (except the tiny kiddos). Can you be a great anesthesiologist without a fellowship, absolutely. Do you have to do a fellowship, no. You can't practice CCM, though, without completing a CCM fellowship. It is turf that will not be taken over by any mid-levels. For me it is a great change of pace from the regular OR routine.

In looking for jobs I felt like many of the anesthesia/CCM jobs were at academic places, but I feel like private practice gigs are becoming more frequent, you just have to look a little bit. Some of the private practice CCM guys on here would know more than me. I am joining an academic practice doing 50/50 anesthesia/CCM. Depending on the practice setting it can affect your lifestyle a little. You are probably more tied to your pager than many anesthesiologists but not like other specialties.

Idio is right, there is some aspect of social work/family counselor/etc. that is inherent to taking care of critically ill pt's, but it is nothing like general medicine. I feel like CCM is a great choice of you enjoy it. There will be more and more opportunities in the future.

 

[seinfeld]

i have posted frequently on this subject. what everyone has said thus far is true including the social work part. Its been a great career thus far in private practice.

 

[WholeLottaGame7]

I will preface this by saying that I just finished a CCM fellowship so I may be a little biased.

I feel like the fellowship made me a better anesthesiologist even if I didn't practice CCM. I feel comfortable taking care of just about any patient in the OR (except the tiny kiddos). Can you be a great anesthesiologist without a fellowship, absolutely. Do you have to do a fellowship, no. You can't practice CCM, though, without completing a CCM fellowship. It is turf that will not be taken over by any mid-levels. For me it is a great change of pace from the regular OR routine.

In looking for jobs I felt like many of the anesthesia/CCM jobs were at academic places, but I feel like private practice gigs are becoming more frequent, you just have to look a little bit. Some of the private practice CCM guys on here would know more than me. I am joining an academic practice doing 50/50 anesthesia/CCM. Depending on the practice setting it can affect your lifestyle a little. You are probably more tied to your pager than many anesthesiologists but not like other specialties.

Idio is right, there is some aspect of social work/family counselor/etc. that is inherent to taking care of critically ill pt's, but it is nothing like general medicine. I feel like CCM is a great choice of you enjoy it. There will be more and more opportunities in the future.

Unless you're at Vandy, per that forum thread...

I have mixed feelings on CCM. On the one hand, it adds variety, different problems than you encounter in the OR, a little bit more continuity, more job security, etc etc. But, as an intern/resident, it's a lot of scut/social work, so that aspect is hard to like. I suspect it is much more enjoyable as an attending, but you're kind of rolling the dice there.

 

[likeaboss]

when you work in the unit what are the hours like? seems like our attendings in the icu whether neuro or surgical alll work from 8am to like 10 pm depending on volume. is it one week on. one week off?

 

[XRanger]

I'm currently doing rotation in anesthesia icu and our attendings work from 730-3pm mon-fri and then they do 24 hr call sat-sun. They work 1 week in unit and 3 weeks in OR.

 

[cchoukal]

when you work in the unit what are the hours like? seems like our attendings in the icu whether neuro or surgical alll work from 8am to like 10 pm depending on volume. is it one week on. one week off?

It can vary heavily depending on your set-up. I do a week at a time, 12-14 weeks per year. When I'm on, I'm ON, so I can get called any time. I have residents and fellows to buffer much of that burden. In general, I work 7a-6p M-F, and 7a-3p on Sa and Su, but again, this varies. On average, I get called at home < once per night, and I can count on one hand the number of times I come in at night each year.

Some places have in-house hospitalists or nocturnal intensivists (or e-intensivists) holding the pager at night, and so when the intensivist is off, they're off, but there are lots of different arrangements.

 

[TheSweetness]

Can someone explain firsthand the Tele-ICU ? I've heard some good things about this but only second hand... Are there many anesthesia CCM physicians using this?

 

[1981]

Anesthesia and ICU practice complement each other.

 

[likeaboss]

I like the idea of 1 week of ICU and 3 weeks OR. But don't many full time ICU docs get 7 days on 7 days off type schedules? So wouldn't you be getting cheated out of like 26 weeks of vacation each year (maybe I'm over stating the case but you get the point)...

 

[TenderRender]

I don't know if anyone on here can comment on it, but if you want to do CCM, is there a big difference between getting certified through a fellowship after IM->Pulm vs through Anesthesiology? Is the only real difference that you'll either also have training in pulmonology vs anesthesiology, or are there more fundamental differences in how the two approach CCM?

 

[Spandex]

You can technically skip the pulm portion and do CCM only after an IM residency, although it seems most do the more traditional 3 years route.

There is absolutely a fundamental difference in the approach to patients one garners from an IM vs. anesthesia based fellowship. My most simplistic way to summarize this difference is anesthesiologists are "doers" and medicine guys are "thinkers." Not so say each doesn't do the other. However gas guys seem to fix the issue at hand then find out what was causing it, while med dudes round 3-4 times then decide if they can go to the bronch suite or not. Skills gained within your respective residency/fellowship also lend oneself to specific patient populations. Generally in the SICU I'm dealing with more acute situations rather than chronic disease.

Three of my trainers had previously completed IM residencies then converted to gas as they preferred this (anesthesia) approach to CCM. I have no reference of someone doing the opposite.

 

[yappy]

Spandex,

Thanks for providing information about the different approaches to care. How would you contrast the subsequent employment opportunities of taking the Anesthesia path vs the medicine path to ICU medicine? I have heard that the former tends to operate in academic medicine rather exclusively but that has always puzzled me.

Thank you.

 

[TheSweetness]

Here is a good link with the history of CCM and anesthesia

http://journals.lww.com/anesthesiol...ine_.34.aspx?WT.mc_id=EMxALLx20100222xxFRIEND

 

[Spandex]

My feeling is in the private sector it's (more) difficult to find an anesthesia group and/or hospital system willing to subsidize an anesthesiologist working in the ICU. The fact is, you're worth more ($$$ speaking) in the OR supervising four nurses. Whereas the pulm/ccm guys supplement their intake with diagnostic bronchoscopy, PFTs, and office visits while rounding in the ICU -- we do not. That said, PP groups with anesthesiologist/intensivists do exist, but everyone I trained with stayed in academics -- save one guy who isn't doing CCM post fellowship. Hope that helps.

 

[2win]

My feeling is in the private sector it's (more) difficult to find an anesthesia group and/or hospital system willing to subsidize an anesthesiologist working in the ICU. The fact is, you're worth more ($$$ speaking) in the OR supervising four nurses. Whereas the pulm/ccm guys supplement their intake with diagnostic bronchoscopy, PFTs, and office visits while rounding in the ICU -- we do not. That said, PP groups with anesthesiologist/intensivists do exist, but everyone I trained with stayed in academics -- save one guy who isn't doing CCM post fellowship. Hope that helps.

Overall I do bring more money for the hospital in the ccm than in anesthesia.
I do diagnostic and therapeutic bronchs, chest tubes , lines and all the rest ( except trachs) for anybody who cares to consult me. The service is really busy - average census 25 plus - sick patients. I am in academics - although I had offers from pp groups with better $$$. I enjoy what I do. I enjoy doing anesthesia 2 weeks, 1 week a month.
I am not at all worried about future. I know that I can make it also as an intesivist ( hospitalist sic) with 200k plus 2weeks on and 2 off. In the 2 off ( if I want..) - I can make some extra cash. Actually doubling my income.
I have less and less the desire to make extra money when I see that taxes...
So - I stay low and enjoy life.

 

[likeaboss]

So I'm doing a surgical ICU rotation which is run by this hospitals surgery department- attendings have done general surgery residencies and critical care and or trauma fellowships.

My question is this: how is this SICU different from an anesthesia SICU? I always thought SICU was run by anesthesia, is this incorrect? Do they have a more surgical approach to things in a surgeon run SICU?

Just a bit confused here...

Thank you everyone for the great discussion btw!

 

[PMPMD]

My feeling is in the private sector it's (more) difficult to find an anesthesia group and/or hospital system willing to subsidize an anesthesiologist working in the ICU. The fact is, you're worth more ($$$ speaking) in the OR supervising four nurses. Whereas the pulm/ccm guys supplement their intake with diagnostic bronchoscopy, PFTs, and office visits while rounding in the ICU -- we do not. That said, PP groups with anesthesiologist/intensivists do exist, but everyone I trained with stayed in academics -- save one guy who isn't doing CCM post fellowship. Hope that helps.

He sounds like a real weirdo.

Nice screen name (and apparel choice)

 

[PMPMD]

So I'm doing a surgical ICU rotation which is run by this hospitals surgery department- attendings have done general surgery residencies and critical care and or trauma fellowships.

My question is this: how is this SICU different from an anesthesia SICU? I always thought SICU was run by anesthesia, is this incorrect? Do they have a more surgical approach to things in a surgeon run SICU?

Just a bit confused here...

Thank you everyone for the great discussion btw!

SICU's can be staffed by anesthesiologists, surgeons or internists/pulmonologists. (Technically, OB/Gyn's can get CCM certification but this is uncommon.) I had the experience of having both anesthesiologists and surgeons as staff in residency and fellowship. Each brought a different perspective. As an anesthesiologist, I appreciated the insight that surgeons have taking care of surgical patients. Their knowledge of surgical technique and pathophysiology of abdominal problems was very useful. They also know the likely complications of various surgeries that can cause someone to end up in the SICU. I didn't find the surgeon-intensivists' approach to be strikingly different from that of the anesthesiologist-intensivists. Both groups are sadly under-represented in the pool of intensivists in this country (I believe each is less than 10% of the total.)

 

[madhi]

I am a practising anesthesiologist. Can anyone suggest any pulmonology programs which take anesthesiologist in their fellowships either here or in canada. your help will be highly appreciated.

 

[Happy doc05]

Hi all,

what are the differences between anaesthesiology and ICU?

Thanks.

 

[chocomorsel]

In the US, anesthesiologists work in the OR. If they want to work in the ICU that requires an extra year after residency and then one can work in the ICU as well.

For the rest of the world, training in ICU is included in residency and anesthesiologists run both the ICUs and ORs.

 

[dchz]

You can't practice CCM, though, without completing a CCM fellowship. It is turf that will not be taken over by any mid-levels. For me it is a great change of pace from the regular OR routine.

This is not true. Virtually all the ICUs in the hospital in my residency is runned by mid levels. In fact, the services with low ICU census often hire mid levels rather than ICU docs to cut cost. I had to drop off an intubated Mitral Valve balloon dilation to a NP with no experience extubating.... it wasn't good for the pt, but the service saves $200k per year on this...

If the ICU has a high census, the model is 1 ICU doc + 3 NPs. Doc runs the big decisions, NPs run the mundane stuff.

I do agree it's a different change of pace, while ICU is a step up in acuity for most specialties, it's a step down for anesthesiologists.

 

[Psai]

This is not true. Virtually all the ICUs in the hospital in my residency is runned by mid levels. In fact, the services with low ICU census often hire mid levels rather than ICU docs to cut cost. I had to drop off an intubated Mitral Valve balloon dilation to a NP with no experience extubating.... it wasn't good for the pt, but the service saves $200k per year on this...

If the ICU has a high census, the model is 1 ICU doc + 3 NPs. Doc runs the big decisions, NPs run the mundane stuff.

I do agree it's a different change of pace, while ICU is a step up in acuity for most specialties, it's a step down for anesthesiologists.

Thank god it is really hard to harm patients