Anesthesiology Critical Care Fellowship 2019-2020

SloeDOwn

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Hey all, as the SICU fellowship application opens it would be useful to have current and past fellows comment on the rigor and schedule of their prospective program. Also, I would be interested in prospective job offers or current jobs, like benefits, compensation, etc. Did you get a job during residency or fellowship??

I'm especially interested in UPenn, Vandy, Duke, Michigan, but would like to hear about everyone's experience. Thanks guys.
 

bigdan

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I'm a Michigan ACCM alum...that critical care year was the single best year of education in my life.

I know folks that trained at each of the institutions that you named - you'll get great training at any of those. But I LOVED me some Michigan ICU.

Good luck!
 
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MoMD

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I'm a Michigan ACCM alum...that critical care year was the single best year of education in my life.

I know folks that trained at each of the institutions that you named - you'll get great training at any of those. But I LOVED me some Michigan ICU.

Good luck!
you r welcome....
 
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SloeDOwn

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I'm a Michigan ACCM alum...that critical care year was the single best year of education in my life.

I know folks that trained at each of the institutions that you named - you'll get great training at any of those. But I LOVED me some Michigan ICU.

Good luck!
Can you comment on the schedule bigdan? For instance Call was q??? Did you actually take call. I know the fellows at CCF don't take 24hour call period. Secondly did you work 1 week of nights then off a few days? HOw many different ICUs? Any TEE experience? Did you see tons of ECMO or device patients?

Are you presently working academic or private? 100% ICU?

Thank you in advance.
 

SevoLution

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Current Anesthesiology CCM fellow at UC San Diego

Schedule is pretty brutal half the month (CTICU DAYS, CTICU NIGHTS each for 6 consecutive days)

That is followed by a week at the VA and a week of elective which includes your choice of any other ICU experience or dedicated Echo training, research etc. The elective week is pretty chill and allows for enjoyment of the beautiful city of San Diego. You're also welcome in the OR for TEE experience and I've found that surgeons appreciate when you take a vested interest in their patients before they reach the ICU as well.

I'd say clinically the experience here is excellent. We do any transplant you can think of and we do a LOT of them. VADs, ECMO out the wazoo. Fellows have dibs on airways, lines, chest tubes, echo, bronch you name it. It's also cool if you just want to help residents refine their skills. Staff at UCSD (Anesthesiology CCM docs and Surgeons) are really reasonable to work with and provide a fair amount of autonomy ... especially at night.

I'm sure there are tons of fellowships that offer a similar experience. There are probably MANY that are less rigorous and perhaps a few that are more demanding. In exactly a year, the rubber meets the road so get everything out of it that you can. I wanted to be able to run a major CTICU when I finished so I chose a cardiac heavy program. There's something out there for everyone.
 
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SloeDOwn

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Current Anesthesiology CCM fellow at UC San Diego

Schedule is pretty brutal half the month (CTICU DAYS, CTICU NIGHTS each for 6 consecutive days)

That is followed by a week at the VA and a week of elective which includes your choice of any other ICU experience or dedicated Echo training, research etc. The elective week is pretty chill and allows for enjoyment of the beautiful city of San Diego. You're also welcome in the OR for TEE experience and I've found that surgeons appreciate when you take a vested interest in their patients before they reach the ICU as well.

I'd say clinically the experience here is excellent. We do any transplant you can think of and we do a LOT of them. VADs, ECMO out the wazoo. Fellows have dibs on airways, lines, chest tubes, echo, bronch you name it. It's also cool if you just want to help residents refine their skills. Staff at UCSD (Anesthesiology CCM docs and Surgeons) are really reasonable to work with and provide a fair amount of autonomy ... especially at night.

I'm sure there are tons of fellowships that offer a similar experience. There are probably MANY that are less rigorous and perhaps a few that are more demanding. In exactly a year, the rubber meets the road so get everything out of it that you can. I wanted to be able to run a major CTICU when I finished so I chose a cardiac heavy program. There's something out there for everyone.

Did you or anyone else get advanced TEE certification??
 
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deleted171991

Did you or anyone else get advanced TEE certification??
Shouldn't matter. Really. If you want to practice cardiac anesthesia in a serious place, do a CT fellowship; TEE is just one facet of a great cardiac anesthesiologist. If you want to know TEE for community cardiac, just do as much cardiac as possible during your residency and get 50 pre+post-bypass OR TEEs done and read personally during your ICU fellowship (plus read and watch a lot of online echos/courses/books).

I would never choose an ICU program based on TEE certification. Even if you want to become the best cardiac intensivist, TEE is just one facet and you will learn more than enough in any good cardiac ICU program. Plus, for a cardiac intensivist, TTE skills are maybe even more important than TEE.
 
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AdmiralChz

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Shouldn't matter. Really. If you want to do cardiac anesthesia in a serious place, do a CT fellowship; TEE is just one facet of a great cardiac anesthesiologist. If you want to know TEE for community cardiac, just do as much cardiac as possible during your residency and get 50 pre+post-bypass OR TEEs done and read personally during your ICU fellowship (plus read and watch a lot of online echos/courses/books).

I would never choose an ICU program based on TEE certification. Even if you want to become the best cardiac intensivist, TEE is just one facet and you will learn more than enough in any good cardiac ICU program. Plus, for a cardiac intensivist, TTE skills are maybe even more important than TEE.

So much truth here. There are enough combined programs that will give you what people are desiring - cardiac intensivist with adult cardiac OR. You want that advanced certification to mean something, than do yourself a favor and just do the CT fellowship.

Can anyone speak to CCM fellowship at Texas Heart Institute/Baylor? Maybe looking to do combined CT/ICU at THI in the future. Thanks!

In general, if you want to do a combined program make it count and be sure that you are getting enough CTICU experience in fellowship. THI would almost certainly get you there since there are so many medical and surgical cardiac ICUs. Where I did residency only two months were spend in the cardiac ICU over a two year combined fellowship and I’m not sure this is enough exposure (By contrast, there was 6 months of SICU/Trauma ICU and 2-3 of Neuro). You also want exposure to transplants (both heart and lung) as well as devices if you are interested in cardiac - as is the case for CT fellowships, not all programs do these with ample frequency.
 
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SloeDOwn

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Anybody get interviews other than Vandy yet? Are there any programs that are just as well rounded??
 
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psychbender

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Anybody get interviews other than Vandy yet? Are there any programs that are just as well rounded??
We've already started interviewing some candidates here, so I assume other programs are starting to send out invites, as well. Don't be concerned, though. I didn't start getting invites until after Christmas, and had a slew of interviews set up for January through March.

Yes, there are plenty of well-rounded programs out there (as in, rotate as primary or sole fellow through all adult ICUs). At several of them, you also don't have to run yourself ragged for a year. Do yourself a favor and read program websites, apply broadly, and see what programs have to offer. You'll be surprised.

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vector2

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actually I wouldn't. I know people who got advanced cert. w/o ever performing a single exam. Just saying what the new "rules" supposedly are.

One of my CCM cofellows spoke with the NBE directly this past year to confirm if we were eligible for advanced certification, and they confirmed we were assuming exam numbers were sufficient, a substantial amount of time was spent on intraoperative echo electives and CTICU, and our prog director (who is dual CCM/CT) signed off on everything.
 
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Katheudontas parateroumen

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One of my CCM cofellows spoke with the NBE directly this past year to confirm if we were eligible for advanced certification, and they confirmed we were assuming exam numbers were sufficient, a substantial amount of time was spent on intraoperative echo electives and CTICU, and our prog director (who is dual CCM/CT) signed off on everything.

That's really interesting. Would you mind saying where this is?
 

psychbender

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One of my CCM cofellows spoke with the NBE directly this past year to confirm if we were eligible for advanced certification, and they confirmed we were assuming exam numbers were sufficient, a substantial amount of time was spent on intraoperative echo electives and CTICU, and our prog director (who is dual CCM/CT) signed off on everything.
Hmm, I may need to confirm this and speak to my PD. If true, that'd be a nice little bonus.

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I am certified by the NBE for Advanced PTE. It took me ALL year as a ACTA fellow to get the required TEE numbers. How can a CCM fellow do the same and still be in the ICU? Note: anyone can take the exam and pass and get 'testamur' status but that is NOT the same as board certification.
 
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psychbender

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I am certified by the NBE for Advanced PTE. It took me ALL year as a ACTA fellow to get the required TEE numbers. How can a CCM fellow do the same and still be in the ICU? Note: anyone can take the exam and pass and get 'testamur' status but that is NOT the same as board certification.
How few hearts are you doing that it took you a full year to get over 150 personally performed exams? Even just doing one a day, you should have had your numbers a few months prior to graduation.

I have heard of CCM fellowships that allow a lot of elective time, that some fellows spend in the CT ORs (one poster on here said he has three months of CT during fellowship). Others regularly drop probes in the unit, rather than do bedside TTE exams. I had my exams before fellowship, as I was an attending for several years, but finished residency after 2009, so the practice pathway is closed. I and my future employer are fine with me being just an Advanced testamur, but it'd be nice to have the certification if I just have to talk my PD into attesting my competence to the NBE.

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My opinion is that anyone who does the required number of perioperative TEE exams and passes the advanced written test should be eligible for certification. However, that's not what NBE's handbook says.

https://echoboards.org/docs/AAdvPTE_Cert_App-2017.pdf

page 4 said:
Applicants who finished their core residency training after June 30, 2009, can ONLY qualify for certification by completing fellowship training at an institution with an ACGME accredited fellowship program.

page 4 said:
Perioperative TEE is defined as a TEE performed 1) intraoperative, 2) post operative during the same hospitalization as surgery, or 3) preoperative in patients having surgery during the same hospitalization. Note that diagnostic TEEs performed on patients not having a surgical operation, e.g., to rule out thrombus before a cardioversion or ablation or to rule out a cardiac source of embolus, are not considered to be perioperative and cannot be used for certification.

page 5 said:
One of the following:
• A copy of a certificate of successful completion of fellowship training dedicated to the perioperative care of surgical patients with cardiovascular disease.
• A notarized letter typed on appropriate letterhead from the hospital or appropriate departmental Training Director, e.g., Residency Program Director; the Fellowship Training Director; Director of Cardiothoracic Anesthesiology; Cardiothoracic Surgery, or Cardiology; Chairs of Anesthesiology, Medicine, or Surgery; or the Medical Director of Echocardiography Laboratory, stating the applicant has completed a full 12 months of clinical training dedicated specifically to the perioperative care of surgical patients with cardiovascular disease. This letter must document the inclusive dates of the training, as well as the ACGME program number. A summary of the training program activities is recommended (see Letters Documenting Training and/or Level of Service: page 4 and Sample Letter: page 8)

Emphasis mine - I don't see how a CCM fellowship that includes even a single month in the MICU would meet this requirement.

Moreover, the 300 TEE exams performed (level 1) and read/reviewed under supervision (level 2) in a non-perioperative setting don't count.

And their sample letter from the program includes the phrasing
page 8 said:
To Whom It May Concern:

REQUIREMENT 4
This letter confirms that Dr. ____________________ successfully completed a minimum of 12 months of clinical fellowship training dedicated to the perioperative care of surgical patients with cardiovascular disease at our institution


All that said, several of the CCM fellows at my fellowship institution did the exams, passed the test, and (presumably) will be fully certified, whenever NBE gets around to processing the applications. (It's been 5 months since the exam and all of us are still listed as Testamurs, with certification "awaiting approval", the lazy bums.)

Bottom line, NBE has rules prohibiting CCM fellows from obtaining periop TEE certification, but they aren't enforcing them. I'm fine with that, don't mean to suggest otherwise. But, I list all the above, just so that CCM'ers going into fellowship are aware that NBE could quit allowing it at any moment. That's not a reason to not do the exams and not take the test, just ... caveat emptor.
 

Katheudontas parateroumen

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My opinion is that anyone who does the required number of perioperative TEE exams and passes the advanced written test should be eligible for certification. However, that's not what NBE's handbook says.

https://echoboards.org/docs/AAdvPTE_Cert_App-2017.pdf







Emphasis mine - I don't see how a CCM fellowship that includes even a single month in the MICU would meet this requirement.

Moreover, the 300 TEE exams performed (level 1) and read/reviewed under supervision (level 2) in a non-perioperative setting don't count.

And their sample letter from the program includes the phrasing



All that said, several of the CCM fellows at my fellowship institution did the exams, passed the test, and (presumably) will be fully certified, whenever NBE gets around to processing the applications. (It's been 5 months since the exam and all of us are still listed as Testamurs, with certification "awaiting approval", the lazy bums.)

Bottom line, NBE has rules prohibiting CCM fellows from obtaining periop TEE certification, but they aren't enforcing them. I'm fine with that, don't mean to suggest otherwise. But, I list all the above, just so that CCM'ers going into fellowship are aware that NBE could quit allowing it at any moment. That's not a reason to not do the exams and not take the test, just ... caveat emptor.

Hey thanks for the info! Where are you doing fellowship? Also, let's say NBE never certerifies you and you remain as advanced testamur with (assuming) basic certification. How would that change your practice? Still do hearts? Thanks
 

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I got a handful of interviews before Christmas, but haven’t heard from the majority of programs yet. I’m assuming the bigger programs wait until January to send out invites. Anybody else in this boat?
 

psychbender

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When I went through the process, most programs started sending invites in January and February. At my program, we've only interviewed a few candidates for this cycle, and have a few more lined up later this month. You'll probably start hearing back from others in the next two to four weeks.
 
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SloeDOwn

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I got a handful of interviews before Christmas, but haven’t heard from the majority of programs yet. I’m assuming the bigger programs wait until January to send out invites. Anybody else in this boat?

Yep. Heard from Hopkins, Vandy, and UPMC. Hoping to hear by most in the next month so i can allot my vacation.
 
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Niceguy2020

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How is the fellowship training at Johns Hopkins vs Upenn vs Penn State . Need inputs guys. Thank you
 

Niceguy2020

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Any one applied for dual critical care and cardiac fellowship . Are they worth to do? How competitive are they?
 

partydoc

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Any one applied for dual critical care and cardiac fellowship . Are they worth to do? How competitive are they?
I applied indepently to each, ccm during my ca2 year, and cardiac during my ca3 year. From what I understand combined spots are pretty competitive, but my n=2 both got offered spots.

It's worth it if you want to practice both when you're done
 

AdmiralChz

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Any one applied for dual critical care and cardiac fellowship . Are they worth to do? How competitive are they?

Compared to cardiac alone, not very competitive. Remember CCM has numerous open spots a year even at solid reputable programs, so many programs are practically begging their cardiac fellows to consider CCM as well.

As to whether it’s “worth it to do” only you can answer that question. It’s another year of fellowship and lost wages. You’ll be highly trained, but you’ll probably have to work in academics (or at least a big tertiary academic center) to utilize the extent of that training out in practice.
 
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SloeDOwn

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Any one applied for dual critical care and cardiac fellowship . Are they worth to do? How competitive are they?
Agree dual is less competitive. My peer is getting emailed if he is still interested in both because he checked that box..
 

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I agree that dual is not as competitive as cardiac solo; however, on the other hand you can view it as much more in "demand" if you are interested in staying in academics. Most academic programs are looking for combined folks to transition from fellowship into junior attending positions. For those more senior on this board please correct me if I am wrong...
 
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Niceguy2020

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I agree that dual is not as competitive as cardiac solo; however, on the other hand you can view it as much more in "demand" if you are interested in staying in academics. Most academic programs are looking for combined folks to transition from fellowship into junior attending positions. For those more senior on this board please correct me if I am wrong...
 
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Niceguy2020

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How is the interview at programs. Is it a casual talk or intense . Can u guys share your experience at Hopkins. Thank u.
 

Niceguy2020

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Compared to cardiac alone, not very competitive. Remember CCM has numerous open spots a year even at solid reputable programs, so many programs are practically begging their cardiac fellows to consider CCM as well.

As to whether it’s “worth it to do” only you can answer that question. It’s another year of fellowship and lost wages. You’ll be highly trained, but you’ll probably have to work in academics (or at least a big tertiary academic center) to utilize the extent of that training out in practice.
Thank u for great reply
 

Situasian

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How is the interview at programs. Is it a casual talk or intense . Can u guys share your experience at Hopkins. Thank u.
Mostly selling the program. The only real questions I got were why do you want to come here. I got pimped a random question, but it was more medicine based and not anesthesia.
 

Niceguy2020

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Mostly selling the program. The only real questions I got were why do you want to come here. I got pimped a random question, but it was more medicine based and not anesthesia.
What was the medicine based question??
 

Niceguy2020

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Hershey Penn state critical care fellowship ? How strong is the program. The hospital and city look beautiful thou?
 

vector2

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My opinion is that anyone who does the required number of perioperative TEE exams and passes the advanced written test should be eligible for certification. However, that's not what NBE's handbook says.

https://echoboards.org/docs/AAdvPTE_Cert_App-2017.pdf


Emphasis mine - I don't see how a CCM fellowship that includes even a single month in the MICU would meet this requirement.

Moreover, the 300 TEE exams performed (level 1) and read/reviewed under supervision (level 2) in a non-perioperative setting don't count.

And their sample letter from the program includes the phrasing

All that said, several of the CCM fellows at my fellowship institution did the exams, passed the test, and (presumably) will be fully certified, whenever NBE gets around to processing the applications. (It's been 5 months since the exam and all of us are still listed as Testamurs, with certification "awaiting approval", the lazy bums.)

Bottom line, NBE has rules prohibiting CCM fellows from obtaining periop TEE certification, but they aren't enforcing them. I'm fine with that, don't mean to suggest otherwise. But, I list all the above, just so that CCM'ers going into fellowship are aware that NBE could quit allowing it at any moment. That's not a reason to not do the exams and not take the test, just ... caveat emptor.

There's a lot in this post, but instead of going point by point I'll show you a snapshot of the questionnaire (pg 10) from the paper advanced PTE handbook/application located here: http://echoboards.org/docs/AdvPTE Cert App.pdf

I believe they did away with the questionnaire when they went to the pure online application, so the 2017 handbook here doesn't seem as ccm friendly http://echoboards.org/docs/AAdvPTE_Cert_App-2017.pdf

4EXVKSu.png
 
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Niceguy2020

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ITE round the corner in Feb. Hope it is less tougher than ABA basic
 
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deleted697535

am i readin this right? Do you have the basic echo exam prior to fellowship?
 
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deleted171991

A couple of years after my fellowship, despite easy (but too rare) ICU weeks, my advice is still the same: don't waste your time on a critical care fellowship unless you really need it to become a good anesthesiologist (and you won't practice CCM), or you want to practice it 100% (and give up anesthesia, like many pain docs), or you are doing a year of cardiac, too. There are too few mixed jobs for anesthesiologists, and many of them (will) involve cardiac surgery, either in the OR or the ICU, because that's a big moneymaker for the hospitals.

And don't waste your money on the Basic PTE exam (it's too easy, hence worthless for anything except ICU TEE privileges). Or your time to get the numbers for advanced TEE certification during your CCM fellowship. If you want to do hearts, just do a cardiac fellowship with excellent echo training.
 
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Katheudontas parateroumen

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A couple of years after my fellowship, despite easy (but too rare) ICU weeks, my advice is still the same: don't waste your time on a critical care fellowship unless you really need it to become a good anesthesiologist (and you won't practice CCM), or you want to practice it 100% (and give up anesthesia, like many pain docs), or you are doing a year of cardiac, too. There are too few mixed jobs for anesthesiologists, and many of them (will) involve cardiac surgery, either in the OR or the ICU, because that's a big moneymaker for the hospitals.

And don't waste your money on the Basic PTE exam (it's too easy, hence worthless for anything except ICU TEE privileges). Or your time to get the numbers for advanced TEE certification during your CCM fellowship. If you want to do hearts, just do a cardiac fellowship with excellent echo training.

In my intern year right now in IM and ICU has clearly been the most enjoyable part of intern year although I am ready to move on for sure from medicine. I fully plan on doing academics. Do you feel that way about ICU fellowship for someone wanting to do academics where there is a mix? What are your thoughts on academic anesthesia jobs? I'm also considering cardiac or combined ICU/cardiac too but the extra year is something to consider a lot. But no exposure to it yet until next year. I can't stand clinic/pain. I like the idea of being able to become a whole different physician in the ICU.
 
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deleted171991

Find out what the department chairs are looking for, for the academic ICU jobs in your area of interest, and get into a regional program that provides good training in those specific areas (cardiac, neuro etc.), or do an extra year of cardiac. I myself couldn't work in two places I was interested in just because I was not cardiac-trained, nor had extensive CVICU experience (despite having advanced TEE and decent TTE knowledge).

There are few good combined anesthesiology-SICU jobs, even in academia, simply because there are too many intensivists. A lot of IMGs go for the low-hanging fruit of a CCM fellowship to extend their visas, hence CCM fellowships are not appreciated at their real professional value.
 
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deleted697535

A couple of years after my fellowship, despite easy (but too rare) ICU weeks, my advice is still the same: don't waste your time on a critical care fellowship unless you really need it to become a good anesthesiologist (and you won't practice CCM), or you want to practice it 100% (and give up anesthesia, like many pain docs), or you are doing a year of cardiac, too. There are too few mixed jobs for anesthesiologists, and many of them (will) involve cardiac surgery, either in the OR or the ICU, because that's a big moneymaker for the hospitals.

And don't waste your money on the Basic PTE exam (it's too easy, hence worthless for anything except ICU TEE privileges). Or your time to get the numbers for advanced TEE certification during your CCM fellowship. If you want to do hearts, just do a cardiac fellowship with excellent echo training.
How to decide whether to do a cardiac fellowship or a pain fellowship??
 

Nivens

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How to decide whether to do a cardiac fellowship or a pain fellowship??

There isn’t an easy answer to this question, and I struggled with it for 18 months. Ultimately, I applied for Cardiac/ICU. I really tried to make pain fit me better, but in the end it just didn’t- the deciding factors were very specific to me. Having gone through this I’m not sure any amount of advice is going to make it easier- you just gotta educate yourself and do some soul searching.

That being said, I do find it interesting how many of the people I talk to that are going into pain haven’t seemed to have thought it through. “I want to own my own practice, be independent.” I hear that a lot. But when I scratch the surface, and ask what they think about some of the significant barriers to doing that (say, building a referral base in an intervention-only, non-opioid provate practice, in areas filled with money-hungry crooks), the just stare blankly at me.

Point is not don’t do pain- cardiac and icu have their issues too. Just educate yourself so you can make a decision based on reality.

Good luck.
 
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deleted171991

How to decide whether to do a cardiac fellowship or a pain fellowship??
Get informed and do the one you like (or none at all). Otherwise you'll end up boxed into a subspecialty you won't enjoy, for life. That's even worse than being a generalist.
 
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