Anesthesiology Critical Care Fellowship 2019-2020

[Laryngophed]

A resident classmate of mine interviewed there for Cardiac/CC. I believe it was a combined program, so maybe that's how they get out of ACGME requirements. They only have funding for 3 out of 4 spots. So in order to have that last spot,the 4th fellow sticks around as an attending (without full attending pay) in order to pay off the training they had.

I have heard a very similar story. I know a few people who are close to that program and it has been said that when the offer for the combined CCM/CT spot is made, it is conditional upon an agreement to work for six months s/p graduation from both as an attending but not at an attending rate.

---

Members don't see this ad.

 

[AdmiralChz]

I have heard a very similar story. I know a few people who are close to that program and it has been said that when the offer for the combined CCM/CT spot is made, it is conditional upon an agreement to work for six months s/p graduation from both as an attending but not at an attending rate.

I didn’t really want to be scopes or rumor debunker but ok...

Unless it changed in the past year it’s 3 months. You get junior attending pay and can take call for extra $$$, CV fellows make north of $120K which goes pretty far in Gainesville plus no state taxes. You can also take weekend call shifts as staff during fellowship for $$$.

If you are CCM-only you can’t do any of it and make typical fellow salary...

Acute Pain has almost the same deal except every 4th week or so they work as staff and do no fellowship duties. Many programs operate their acute pain fellowship like this which artific

 

[Psai]

I have heard a very similar story. I know a few people who are close to that program and it has been said that when the offer for the combined CCM/CT spot is made, it is conditional upon an agreement to work for six months s/p graduation from both as an attending but not at an attending rate.

When it comes to screwing anesthesiologists, no one comes close to other anesthesiologists.

 

[chocomorsel]

I didn’t really want to be scopes or rumor debunker but ok...

Unless it changed in the past year it’s 3 months. You get junior attending pay and can take call for extra $$$, CV fellows make north of $120K which goes pretty far in Gainesville plus no state taxes. You can also take weekend call shifts as staff during fellowship for $$$.

If you are CCM-only you can’t do any of it and make typical fellow salary...

Acute Pain has almost the same deal except every 4th week or so they work as staff and do no fellowship duties. Many programs operate their acute pain fellowship like this which artific

Are you getting 120k each year you are there as a fellow? Without extra call? And then you tack on three months at the end for regular attending pay?

 

[AdmiralChz]

Are you getting 120k each year you are there as a fellow? Without extra call? And then you tack on three months at the end for regular attending pay?

That’s with some extra call, but I don’t know specifics. It’s a supervisory CV fellowship so you have plenty of time.

 

[Ronin786]

I didn’t really want to be scopes or rumor debunker but ok...

Unless it changed in the past year it’s 3 months. You get junior attending pay and can take call for extra $$$, CV fellows make north of $120K which goes pretty far in Gainesville plus no state taxes. You can also take weekend call shifts as staff during fellowship for $$$.

If you are CCM-only you can’t do any of it and make typical fellow salary...

Acute Pain has almost the same deal except every 4th week or so they work as staff and do no fellowship duties. Many programs operate their acute pain fellowship like this which artific

Call it what you want, but you're forced into sticking around after your fellowship to pay off your time there. Regardless of what you make or how much moonlighting is available. Your time as a FULL-TIME anesthesiologist with 2 fellowships is worth more than whatever they're giving you in those three months, and you don't have to moonlight either.

 

[pgg]

It’s a supervisory CV fellowship so you have plenty of time.

Ah, an "echo fellowship" ...

 

[deleted171991]

Ah, an "echo fellowship" ...

A gentleman's fellowship.

 

[deleted547339]

In that context, "it" referred to my owner mindset. I went back to do a CCM fellowship after years as an attending, and, let me tell you, it was a walk in the park responsibility-wise when compared to being an attending. It's very easy to switch off the ownership "gene", and just chillax. So It took me a conscious effort not to do that.

One place where I let my attending deal with all the crap, though, was the SICU. I just couldn't take the arrogance of most surgeons, and I was afraid my mouth would end my fellowship (once an attending, always an attending). So, in the SICU, I was as hands-off as possible. I did what my attending told me to, and otherwise just put out the fires and stayed away from ANY interaction with attending surgeons. You can't argue with fools, and I didn't want to have to execute bad plans.

This is why I’m going to work in an academic MICU. I can’t stand the **** measuring that goes on in surgical icus when surgeons are convinced they are intensivists.

I had to somewhat check out at the end of my fellowship in the cticu because they deferred to the surgeons so often.

 

[teacher2md]

This is why I’m going to work in an academic MICU. I can’t stand the **** measuring that goes on in surgical icus when surgeons are convinced they are intensivists.

I had to somewhat check out at the end of my fellowship in the cticu because they deferred to the surgeons so often.

Did you do an Anesthesia residency or are you pulm/cc?

Do you think doing Anes/CC will give you enough experience with medical patients to work primarily in a MICU?

I’m interested in CCM, and like the idea of being able to do an academic MICU as well as SICU, but Im concerned that my training won’t be sufficient.

 

[deleted547339]

Did you do an Anesthesia residency or are you pulm/cc?

Do you think doing Anes/CC will give you enough experience with medical patients to work primarily in a MICU?

I’m interested in CCM, and like the idea of being able to do an academic MICU as well as SICU, but Im concerned that my training won’t be sufficient.

I’m EM. I don’t know if training would be inadequate, per se, but there aren’t a lot of academic micus that will hire a non-internist even if you are competent. That being said, I believe that the ACGME requires anesthesiologists spend no more than 3 months of non-surgical icus. I don’t think 3 months is enough time to learn about weird things things like TTP, HLH, legionella, diffuse alveolar hemorrhage, etc to be competent to practice in a referral center. I think there are some programs set up so this can be blurred a little bit, but this is the exception.

For the most part, critical care is critical care is critical care - you’ll be treating hemorrhage, sepsis, renal failure, resp failure, etc in any icu. I think a well-trained intensivist should be able to take care of all bread and butter cases regardless of etiology (medicine, surgery, ct, neuro, etc), but I think that it would be hard to practice at a referral center in a specialized icu without spending a decent amount of concentrated time with that patient population.

 

[deleted171991]

I’m EM. I don’t know if training would be inadequate, per se, but there aren’t a lot of academic micus that will hire a non-internist even if you are competent. That being said, I believe that the ACGME requires anesthesiologists spend no more than 3 months of non-surgical icus. I don’t think 3 months is enough time to learn about weird things things like TTP, HLH, legionella, diffuse alveolar hemorrhage, etc to be competent to practice in a referral center. I think there are some programs set up so this can be blurred a little bit, but this is the exception.

For the most part, critical care is critical care is critical care - you’ll be treating hemorrhage, sepsis, renal failure, resp failure, etc in any icu. I think a well-trained intensivist should be able to take care of all bread and butter cases regardless of etiology (medicine, surgery, ct, neuro, etc), but I think that it would be hard to practice at a referral center in a specialized icu without spending a decent amount of concentrated time with that patient population.

It's the first time I hear about this. (QED: https://www.acgme.org/Portals/0/PFA...anes_2017-07-01.pdf?ver=2017-05-17-155711-140 speaks about 9 months in ICUs and transitional care units. No word about MICUs.)

I honestly think that an anesthesiology-CCM fellowship should be centered on the sickest patients, regardless where they are. Where I trained, they were in the MICU, so that's where I tried to spend most of my time.

To the date, I consider the best CCM programs those that allow at least 2-3 months in the MICU as an active fellow (not just an observer). I think most medical intensivists could function very well in a SICU (all they need to look up is what complications can be associated with the patient's surgery), but not the other way round (one can't just look up internal medicine, if one doesn't have a solid foundation in it).

 

[deleted547339]

It's the first time I hear about this. (QED: https://www.acgme.org/Portals/0/PFA...anes_2017-07-01.pdf?ver=2017-05-17-155711-140 speaks about 9 months in ICUs and transitional care units. No word about MICUs.)

I honestly think that an anesthesiology-CCM fellowship should be centered on the sickest patients, regardless where they are. Where I trained, they were in the MICU, so that's where I tried to spend most of my time. The MICU side is also vital for developing triage skills (surgeons like to treat the SICU as their fief), also because it typically gets more transfers.

I think the two months we spend in the SICU as anesthesiology residents is more than enough for our education. One may need a couple more months of SICU as a refresher, otherwise it should be all MICU and types of ICUs one hasn't experienced before. The sicker the patients the better. That's the recipe to cook a good anesthesiologist-intensivist.

That requirement must have been (appropriately) removed. When I was deciding between IM based CCM programs and anesthesia based CCM programs, the previous iteration of that document limited the amount of time taking care of non-surgical patients to 2-3 months (don’t remember which) which was one of the reasons I picked an IM CCM program.

I tend to agree. I think 1-2 months of SICU, neuro, cticu, +/- any specialty icus with the remainder MICU should maximally prepare you. I think a year of neuro is crazy. It would be reasonable to adjust your electives and maybe do an extra 1-2 months of whatever icu you will attend in.

 

[deleted171991]

My program, gods bless them and their loved ones, was a mixed anesthesia-IM-pulm-EM. Everybody rotated everywhere, same faculty, same in-house calls. I didn't have toys like ECMO and VADs, but, boy, did I learn bread and butter (medical) critical care and proper thinking. And echo.

 

[vector2]

Even as an observer in the micu, the amount you get out of it will vary depending on what you put in. Some of my cofellows would just play on their phone during rounds and then leave. I, otoh, would get there early, make a list, go see the 3-4 sickest/most interesting patients, chat with the fellow about what's going on, do some research on topics I was unfamiliar with, and then actually participate in rounds, lectures, grand rounds, supervising or doing procedures etc. Even as a fresh anesthesia CCM fellow, you have a lot of knowledge and experience which the pulm guys and their residents are lacking, so I taught them and they in turn taught me.

If you can get 2-3 months of micu and actually read voraciously during that time, there's no reason you couldn't staff all but the highest acuity micus. When you get in a pinch with zebras, even if you know what to do you're still gonna consult pulm, id, nephro, hemeonc etc anyway because the pt needs acute expert management and long-term followup...

 

[deleted547339]

Even as an observer in the micu, the amount you get out of it will vary depending on what you put in. Some of my cofellows would just play on their phone during rounds and then leave. I, otoh, would get there early, make a list, go see the 3-4 sickest/most interesting patients, chat with the fellow about what's going on, do some research on topics I was unfamiliar with, and then actually participate in rounds, lectures, grand rounds, supervising or doing procedures etc. Even as a fresh anesthesia CCM fellow, you have a lot of knowledge and experience which the pulm guys and their residents are lacking, so I taught them and they in turn taught me.

If you can get 2-3 months of micu and actually read voraciously during that time, there's no reason you couldn't staff all but the highest acuity micus. When you get in a pinch with zebras, even if you know what to do you're still gonna consult pulm, id, nephro, hemeonc etc anyway because the pt needs acute expert management and long-term followup...

I disagree that 2 months would be enough to see what you need to see. Obviously, you can’t see everything in training, but there’s a lot of weird stuff that shows up in the MICU. And I have frequently seen consultants be very wrong in the care of icu patients because they’re just not used to critically ill patients like we are. “Oh, this isn’t X”....two days later positive titer for strange disease that we sent that they didn’t want.

Please be aware - this is not me bashing anesthesia or anyone else. I just think you’re going to miss erlichia or some other random disease because it’s not on your differential because you’ve never seen it if you don’t spend enough time in the MICU. I agree that someone who reads more and is more motivated can do it in less time than someone who isn’t, but it still takes experience.

 

[deleted171991]

I disagree that 2 months would be enough to see what you need to see. Obviously, you can’t see everything in training, but there’s a lot of weird stuff that shows up in the MICU. And I have frequently seen consultants be very wrong in the care of icu patients because they’re just not used to critically ill patients like we are. “Oh, this isn’t X”....two days later positive titer for strange disease that we sent that they didn’t want.

Please be aware - this is not me bashing anesthesia or anyone else. I just think you’re going to miss erlichia or some other random disease because it’s not on your differential because you’ve never seen it if you don’t spend enough time in the MICU. I agree that someone who reads more and is more motivated can do it in less time than someone who isn’t, but it still takes experience.

Agree, but remember a lot of that experience is not MICU (i.e. CCM), it's IM. Hence all one needs is a subspecialty consult. The CCM part is not much different knowledge-wise, just the acuity (bad heart failure/MI etc., bad respiratory failure/ARDS/COPD/PNA etc., bad sepsis, bad liver failure, bad DIC etc.). Most of the stuff once sees in the MICU (CCM-wise) one will also encounter in the SICU, just maybe at a different acuity level.

I only had one year of IM before my MICU rotations in fellowship, and I functioned very well in the MICU. (Zebras are rare.) Then I went back to the OR, had one patient go into a crazy post-intubation bronchospasm that went on for 20 minutes and needed everything but the kitchen sink, and it felt just like the MICU. I was so calm I couldn't believe it.

I am still a greenhorn in CCM, so maybe my opinions will change once I shed a few skins. But I still dream of practicing only medical intensive care and nothing else (best days of my professional life).

 

[vector2]

I disagree that 2 months would be enough to see what you need to see. Obviously, you can’t see everything in training, but there’s a lot of weird stuff that shows up in the MICU. And I have frequently seen consultants be very wrong in the care of icu patients because they’re just not used to critically ill patients like we are. “Oh, this isn’t X”....two days later positive titer for strange disease that we sent that they didn’t want.

Please be aware - this is not me bashing anesthesia or anyone else. I just think you’re going to miss erlichia or some other random disease because it’s not on your differential because you’ve never seen it if you don’t spend enough time in the MICU. I agree that someone who reads more and is more motivated can do it in less time than someone who isn’t, but it still takes experience.

Your point is definitely taken, but I'd venture to say your example is the exception rather than the rule. Especially when you've gotten to the point where you are disagreeing with your consultant, then missing that rare diagnosis from some random titer is something that could easily happen to any intensivist, medicine trained or not.

I staff trauma/surgical icu at my level I trauma center but I frequently get called by MICU for procedures or for anesthetics. It's not crazy high acuity here (no ECMO, sick onc), and when I look through the charts and ICU plans for most of these patients, I very rarely run into pts where I'd hesitate to take over management of their icu care. Of course, I'd need to hit the books again and refresh myself on some heme, pulm, rheum, and weird ID, but I think its within the scope of most well trained anesthesia intensivists.

 

[deleted547339]

Your point is definitely taken, but I'd venture to say your example is the exception rather than the rule. Especially when you've gotten to the point where you are disagreeing with your consultant, then missing that rare diagnosis from some random titer is something that could easily happen to any intensivist, medicine trained or not.

I staff trauma/surgical icu at my level I trauma center but I frequently get called by MICU for procedures or for anesthetics. It's not crazy high acuity here (no ECMO, sick onc), and when I look through the charts and ICU plans for most of these patients, I very rarely run into pts where I'd hesitate to take over management of their icu care. Of course, I'd need to hit the books again and refresh myself on some heme, pulm, rheum, and weird ID, but I think its within the scope of most well trained anesthesia intensivists.

I think we agree more than we disagree. A good intensivist should be able to take care of a bad DKA, septic shock, exsanguinating hemorrhage, etc. I think any community med surg ICU would be well-served by a good intensivist as above. I think the branch point is once you get to being a tertiary/quarternary referral center.

 

[dchz]

Unless it changed in the past year it’s 3 months. You get junior attending pay and can take call for extra $$$, CV fellows make north of $120K which goes pretty far in Gainesville plus no state taxes. You can also take weekend call shifts as staff during fellowship for $$$.

Can confirm this is the deal offered with CT/CCM at gainesville from the mouth of the director himself. it's 3 months and not 6.

I would have taken it if it wasn't such a bad CCM fellowship.

 

[harrisonsIM]

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

New to this thread and saw this relatively old post. Since my friend graduated from the program, I can feed you in with some recent info. What I heard it is essentially designed to make you a CT intensivist, so if you are looking for some future job in MICUs, this is not your place. They are very focused on cardiac (I think it is about 6 months) with electives encouraged on cardiac related (TTE/TEE/Heart failrue) with tons of ECMO/Impella/Tandem heart/LVADs/Transplants in heart, lung, liver. They don't offer that much MICU(just the minimum ACGME requirements), one month of NICU which he loved it and 1 month TICU (busy thoracic service) and SICU...
I am not sure if they offer only CCM or it is combined with their CTA. They already hired all their fellows so far and my friend staying after his CTA training.

 

[Katheudontas parateroumen]

New to this thread and saw this relatively old post. Since my friend graduated from the program, I can feed you in with some recent info. What I heard it is essentially designed to make you a CT intensivist, so if you are looking for some future job in MICUs, this is not your place. They are very focused on cardiac (I think it is about 6 months) with electives encouraged on cardiac related (TTE/TEE/Heart failrue) with tons of ECMO/Impella/Tandem heart/LVADs/Transplants in heart, lung, liver. They don't offer that much MICU(just the minimum ACGME requirements), one month of NICU which he loved it and 1 month TICU (busy thoracic service) and SICU...
I am not sure if they offer only CCM or it is combined with their CTA. They already hired all their fellows so far and my friend staying after his CTA training.

Hi Thank you for your reply! I just finished my prelim IM year and started CA-1. Honestly, IM year beat me up where my brain tells me I dont want to do any more training than i have to at this point but my heart still wants the challenge. So thanks for your insight!

 

[bigdan]

Hi Thank you for your reply! I just finished my prelim IM year and started CA-1. Honestly, IM year beat me up where my brain tells me I dont want to do any more training than i have to at this point but my heart still wants the challenge. So thanks for your insight!

K -

Let things settle out. Prelim IM (and Prelim surg) is an intern year designed to f*ck you up. The IM program owes you nothing, since you vanish on July 1st, never to be heard from again. And if you had no anesthesia elective during the year, it would be easy to lose sight of the end goal. Now, in CA1 year, you go from being an ace at transferring gomers to SNFs to having to being expected to start IVs, intubate, and make decisions in high risk situations. RIGHT NOW can be particularly overwhelming. Think things through once your head is back above water.

I did both ICU and CT (not at THI, however) and it was the best professional decision I ever made. You absolutely will have a high opportunity cost, but (if you can find them) there are places that value (in terms of $, time, and respect) your fairly unique training. Not easy to find, per se, but I am told those jobs are out there. And it is, for me at least, intellectually very rewarding.

Congrats on starting CA years. I still think I we have the best jobs in the world, and I welcome you to the club!

 

[deleted171991]

@Katheudontas parateroumen, at the end of my last ICU rotation, as a CA-2, I swore I would never step into another ICU again, except for dropping off a patient. That's how much I hated that rotation.

It didn't last long. The heart wants what the heart wants.

 

[chocomorsel]

@Katheudontas parateroumen, at the end of my last ICU rotation, as a CA-2, I swore I would never step into another ICU again, except for dropping off a patient. That's how much I hated that rotation.

It didn't last long. The heart wants what the heart wants.

I hated my SICU rotation where I did residency. Where I am doing it now, totally different beast. Most of the units are Anesthesia run, which makes a huge difference. Plus they do every type of transplant here. I wish I had done residency here instead. These residents come out superiorly trained.

 

[Katheudontas parateroumen]

@bigdan Thank you for the kind words and the empathy haha. I appreciated it! I've been trying to get started on some cardiac early this week to see if it's a fit. So we will see!

@chocomorsel I've never done SICU, only MICU so far. Do you mind sharing where you are? Thanks

 

[deleted697535]

I'm looking at a combo 2 year cardiac anesthesia/ICU fellowship. Am I nuts? 2 more years!?!

 

[chocomorsel]

Where I am, the SICU has some very sick patients. Way more than where I did residency. They do lots of livers/pancreas transplants here and those liver patients are sick. But haven't experienced the MICU or CVICU yet as I just began the journey.

 

[deleted171991]

I'm looking at a combo 2 year cardiac anesthesia/ICU fellowship. Am I nuts? 2 more years!?!

It's better than just one year of CCM.

 

[deleted697535]

It's better than just one year of CCM.

Thanks lol!
I'll have to think about it... Maybe I can moonlight a bit to kick myself along

 

[Modanq]

Number of CCM Anesthesia vacancy spots are increasing per year 23, 30, 32, 57...Over the last four years per the SF match. Im sure 2018 was worse considering big name programs have open positions. Are we heading in the wrong direction? Will we rue the day that Anesthesiologists leave the ICU? Personally I am a big fan of the European model of scope of practice. They cover EMS, ED, OR, ICU, The whole supply chain etc. Swiss army knife or are we not making the ICU attractive enough? I believe it should it become more procedural like the cardiology route. Do our own PEGs, Trachs, Bronchs, ECMO lines, IABP, PICCs, Plurexs, Bolts, EVDs, etc. Make it attractive. Any thoughts on how to turn this around or should we just let it go? Im dual ICU Cardiac so strongly believe in both and believe that either in Gas residency you go the pain route, the peds route or ICU/CV route and it should be combined i.e. all residents must be dual boarded ICU and Anesthesia or Anesthesia Pain. etc. Is that too extreme?

 

[psychbender]

Yeah, that's a little extreme. A lot of interested residents are dissuaded by the poor job market for dual positions. Unless one wants to commit to academics or full-time critical care, the market is pretty poor. In academics, there's also more of a push for triple Anes/CCM/CT certification, which requires yet another year of near minimum wage income with long work hours. If we want more anesthesiology residents to commit to CCM fellowships, then there need to be more private sector jobs for Anesthesia/CCM.

Sent from my SM-G930V using SDN mobile

 

[AdmiralChz]

Number of CCM Anesthesia vacancy spots are increasing per year 23, 30, 32, 57...Over the last four years per the SF match.

This is true, and so shocking I went to SF Match to confirm.

The MOST strange thing is the number of positions offered jumped from 150 to over 200 in this time frame so it’s a net wash in terms of interest I believe. Anyone have any insight into why 50 more positions magically opened, 30 last year alone?

At my fellowship institution, we had 5:1 EM:Anesthesia applicants for CCM, and for them it’s a 2 year deal (and my program didn’t even accept EM). It was even worse in residency.

 

[psychbender]

This is true, and so shocking I went to SF Match to confirm.

The MOST strange thing is the number of positions offered jumped from 150 to over 200 in this time frame so it’s a net wash in terms of interest I believe. Anyone have any insight into why 50 more positions magically opened, 30 last year alone?

At my fellowship institution, we had 5:1 EM:Anesthesia applicants for CCM, and for them it’s a 2 year deal (and my program didn’t even accept EM). It was even worse in residency.

They desire cheap labor.

Do the SF stats take into account spots that aren't in the match for a given year because they are occupied by EM grads? Example: a program has four spots. It matches two EM grads, two anesthesiology grads. The following year, the two EM grads are still there, and only the two spots previously occupied by the anesthesiology grads are open to fill in the match. If those two spots fill, does SF record that as two matched, with two unfilled?

Sent from my SM-G930V using SDN mobile

 

[deleted547339]

They desire cheap labor.

Do the SF stats take into account spots that aren't in the match for a given year because they are occupied by EM grads? Example: a program has four spots. It matches two EM grads, two anesthesiology grads. The following year, the two EM grads are still there, and only the two spots previously occupied by the anesthesiology grads are open to fill in the match. If those two spots fill, does SF record that as two matched, with two unfilled?

Sent from my SM-G930V using SDN mobile

I’m fairly certain they don’t count them. E. G. If a program takes 4/y and has 2 EM grads sticking around for a second year and filled (I.e. took 2 anesthesia candidates for two spots), I believe they would be listed as filling 2 out of two spots.

 

[CCM-MD]

Anes/CCM combined jobs are rare, but full CCM jobs are increasing in number and pulm/CCM combination gigs are decreasing - although this might be regional. If CCM paid more... perhaps anesthesiologists would be more likely to do full time CCM. AMGA 2017: ccm 400k, anes 415k, pain - 420k

More procedural training would be a great thing during training but in practice there may be "politics". I am a community intensivist - I do my own trachs and bronchs. Don't do PEG - GI/surgery does them. CTS does our ECMO cannulations. There are hospitals in the area where intensivists cannulate themselves.

 

[chocomorsel]

This is true, and so shocking I went to SF Match to confirm.

The MOST strange thing is the number of positions offered jumped from 150 to over 200 in this time frame so it’s a net wash in terms of interest I believe. Anyone have any insight into why 50 more positions magically opened, 30 last year alone?

At my fellowship institution, we had 5:1 EM:Anesthesia applicants for CCM, and for them it’s a 2 year deal (and my program didn’t even accept EM). It was even worse in residency.

Probably because now that EM can do their CCM boards in the states, they figured they could get more interest from their residents? I am just guessing here.
Did your program just not accept EM that year or has never accepted them? Does your program always fill?

 

[Modanq]

This is true, and so shocking I went to SF Match to confirm.

The MOST strange thing is the number of positions offered jumped from 150 to over 200 in this time frame so it’s a net wash in terms of interest I believe. Anyone have any insight into why 50 more positions magically opened, 30 last year alone?

At my fellowship institution, we had 5:1 EM:Anesthesia applicants for CCM, and for them it’s a 2 year deal (and my program didn’t even accept EM). It was even worse in residency.

Agree I didn't see the concurrent increase in positions available. Overall looks like an increase in total number of matches. Agree with more ED interested in ccm.

 

[dchz]

There are a whole spectrum of motivation for a certain fellowship.

When I was a med student, I always thought it was weird that practically all Peds fellowships are not worth the opportunity cost. Some of them down right pays less than general peds.

As an economist I understood it as marginal utility of income. Sometimes the enjoyment outweigh the income lost.

With regard to CCM, I really thought ensuring my pt did well post op would outweigh the lost income. And it still does - if the decision was purely based on those two factors.

However, there is so much more to it to CCM than that: the politics of mid levels, being marginalized by most people that make the real decisions on how the unit is runned, and all the other misc stuff. That's what made it way less attractive as a fellowship.

I don't see a quick fix to make people want to do it more, the economics that led anes to leave the domain of CCM (even though I think we are easily best suited for it given our acute care expertise) still exists today, but with way more baggage to keep potential fellows away.

 

[chocomorsel]

Work in a closed unit and you don't have to worry about "being marginalized by most people that make the real decisions on how the unit is run"

 

[CCM-MD]

Work in a closed unit and you don't have to worry about "being marginalized by most people that make the real decisions on how the unit is run"

In non-surgical patients this isn't an issue to begin with. And I don't find this to be a problem in non-academic settings regardless of whether the unit is truly closed or not.

 

[harrisonsIM]

Number of CCM Anesthesia vacancy spots are increasing per year 23, 30, 32, 57...Over the last four years per the SF match. Im sure 2018 was worse considering big name programs have open positions. Are we heading in the wrong direction? Will we rue the day that Anesthesiologists leave the ICU? Personally I am a big fan of the European model of scope of practice. They cover EMS, ED, OR, ICU, The whole supply chain etc. Swiss army knife or are we not making the ICU attractive enough? I believe it should it become more procedural like the cardiology route. Do our own PEGs, Trachs, Bronchs, ECMO lines, IABP, PICCs, Plurexs, Bolts, EVDs, etc. Make it attractive. Any thoughts on how to turn this around or should we just let it go? Im dual ICU Cardiac so strongly believe in both and believe that either in Gas residency you go the pain route, the peds route or ICU/CV route and it should be combined i.e. all residents must be dual boarded ICU and Anesthesia or Anesthesia Pain. etc. Is that too extreme?

Can't agree more. I strongly believe that CCM is a crucial political choice for our future practice. To stay relevant in our practice/health care leadership.

 

[harrisonsIM]

Yeah, that's a little extreme. A lot of interested residents are dissuaded by the poor job market for dual positions. Unless one wants to commit to academics or full-time critical care, the market is pretty poor. In academics, there's also more of a push for triple Anes/CCM/CT certification, which requires yet another year of near minimum wage income with long work hours. If we want more anesthesiology residents to commit to CCM fellowships, then there need to be more private sector jobs for Anesthesia/CCM.

Not sure what a poor job market means. I personally know many programs across the country(private/academics), actively looking to hire a dual trained if they are lucky enough to find any. Some are looking for years and still open. There is growing trend among cardiac/surgical ICUs to have dual trained anesthesiologists with extensive knowledge of TTE/TEE to run their units. So if anything, there is no better time to be a CT/CCM anesthesiologist in this market

 

[psychbender]

Dual as in anesthesiology/CCM, splitting time in the OR and ICU, not CT/CCM. I saw plenty of interest on the academic side, scant private on the east coast and eastern midwest. I'm sure that there were more non-academic jobs out there, but they either weren't looking for people, or I don't know the right people to establish those connections. If you have more information about the job market in other areas of the country, please share, so that this year's fellows can start looking, and lock down those jobs soon.

Sent from my SM-G930V using SDN mobile

 

[SloeDOwn]

This is true, and so shocking I went to SF Match to confirm.

The MOST strange thing is the number of positions offered jumped from 150 to over 200 in this time frame so it’s a net wash in terms of interest I believe. Anyone have any insight into why 50 more positions magically opened, 30 last year alone?

At my fellowship institution, we had 5:1 EM:Anesthesia applicants for CCM, and for them it’s a 2 year deal (and my program didn’t even accept EM). It was even worse in residency.

There is a higher demand nationally for intensivists. Therefore, there are more slots AND unfilled slots. The ratio remains similar.

On a different note if anyone matched in Philly for CCM please PM me.

 

[deleted697535]

Anyone know is the Canadian ccm fellowship/exam recognized in the US?

 

[CCM-MD]

Anyone know is the Canadian ccm fellowship/exam recognized in the US?

In general Royal College accredited training is considered equivalent to ACGME accredited training. You should be able to sit for ABA examination but their website doesn't explicitly mention this like other boards do. I would recommend reaching out to them to find out more.

 

[Silo004]

Prelim IM (and Prelim surg) is an intern year designed to f*ck you up. The IM program owes you nothing, since you vanish on July 1st, never to be heard from again.

Month into CA1 and still licking my wounds from intern year.

 

[deleted171991]

Month into CA1 and still licking my wounds from intern year.

Unless it was a malignant one, one year from now you may remember it fondly. I got more respect as an intern than as a CA-2.

 

[AdmiralChz]

Unless it was a malignant one, one year from now you may remember it fondly. I got more respect as an intern than as a CA-2.

Maybe true for IM, but there’s no more bottom of the barrel (lack of) respect than for surgical prelims. Minimal education, and mostly just exist to provide coverage for services. There’s a reason next to zero US med grads apply for them, unless they are stuck having to scramble.