Anesthesiology Critical Care Fellowship 2019-2020

[deleted171991]

You're right. Surgical internships are malignant by definition.

But a (community) IM internship is cush when compared to an anesthesia residency. Pity most anesthesiology programs are categorical nowadays.

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[dchz]

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.

The surg program where i'm from basically thrives on the ridiculously cheap labor this provides. I never understood why anyone would apply for one unless you're out of options.

 

[Fuzzyundercling]

Does anyone know a list of programs that now offer a combined CV and Crit Care fellowship? I hope this is within the scope of this thread. Thanks

 

[amandaeleven]

Does anyone know a list of programs that now offer a combined CV and Crit Care fellowship? I hope this is within the scope of this thread. Thanks

Having initially applied with the intent of doing a combined fellowship, I quickly learned that there is no such thing as an integrated program, though some programs are willing to offer out of the match offers allowing you to secure both fellowships [i.e. "combined"] to be done consecutively. Duke did the best job of providing cohesiveness for the group electing to do both fellowships [their dual fellows know each other and are readily accessible during the interview experience].

Most programs ask you to go through the process twice; generally an offer depends on how competitive the CT spots are in the program [i.e. how many of their own residents did they promise spots?]. CCM spots usually are easier to secure, though there are a few programs that fill with internal candidates.

Perhaps one day I'll actually sit down and update my blog with my experience going through the dual application process. Hope this helps!

 

[Fuzzyundercling]

Having initially applied with the intent of doing a combined fellowship, I quickly learned that there is no such thing as an integrated program, though some programs are willing to offer out of the match offers allowing you to secure both fellowships [i.e. "combined"] to be done consecutively. Duke did the best job of providing cohesiveness for the group electing to do both fellowships [their dual fellows know each other and are readily accessible during the interview experience].

Most programs ask you to go through the process twice; generally an offer depends on how competitive the CT spots are in the program [i.e. how many of their own residents did they promise spots?]. CCM spots usually are easier to secure, though there are a few programs that fill with internal candidates.

Perhaps one day I'll actually sit down and update my blog with my experience going through the dual application process. Hope this helps!

Thanks for your prompt response and sorry for the delayed reply. It makes sense that the "combined" fellowship is practically separate fellowships being secured simultaneously. I found a recent on the ASA Resident Component Archives that briefly explained the matching process. I will keep my eyes on your blog for your personal insight! Thanks,

 

[heyinternetman]

Hi folks, looking for some insider advice on these programs. EM resident applying anesthesia CCM in 4 weeks. Finally had the chance to sit down with the local ACCM PD today who advised me that getting ABA approval for a program to take an EM resident is more a formality than anything so I should try applying to anywhere I want to go. Don't know how that will be in practice but that opens up my list a lot. I have a research background and I'm interested in cardiac arrest physiology research so I want to do academics, looking for big emphasis on ECMO, CTICU etc in fellowship. I probably should've done anesthesia residency in hindsight, but I'm here now. I'd like to gain the skills necessary to run/start a smaller lung rescue/ECPR ECMO program in an academic hospital that doesn't have one yet. It seems like the programs that are considered good by ER docs aren't necessarily the programs that are considered good by anesthesiologists. Considering I want to work pretty much full time CTICU with research time (I know that's high hopes...) I should probably look into what is considered good to anesthesiologists. What programs would you folks consider good? What would you recommend I stay away from? (already read about U of Fl. and been warned away from UAB). I also have a family so cost of living is a factor too. Any help is appreciated, thank you.

 

[ElPais]

Hi is there a thread for Anesthesia CCM exam 2018? I just took it today and wanted to discuss the exam with anyone else who also took it today. Feel free to PM me or start a new thread. I couldn’t figure out how to start a new thread lol.

 

[psychbender]

Hi is there a thread for Anesthesia CCM exam 2018? I just took it today and wanted to discuss the exam with anyone else who also took it today. Feel free to PM me or start a new thread. I couldn’t figure out how to start a new thread lol.

Started a new thread for you. Aren't you glad you looked at dermatopathology slides before the exam? *sarcasm*

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[ElPais]

Started a new thread for you. Aren't you glad you looked at dermatopathology slides before the exam? *sarcasm*

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How many times can they ask about Stevens Johnson’s syndrome and GVHD?

 

[deleted171991]

How many times can they ask about Stevens Johnson’s syndrome and GVHD?

It wasn't the first time they asked either, despite being rare.

For future candidates: print out the Content Outline for the exam, and know everything there. Your fellowship will NOT prepare you for the exam. The only reason people pass is that the threshold is very low. I scored at about the 80th percentile, and I was convinced I hadn't passed.

 

[vector2]

How many times can they ask about Stevens Johnson’s syndrome and GVHD?

There's a whole spectrum of bacterial, viral, autoimmune/rheum, onc, and nephro related skin conditions that are all fair game. SJS/TEN is about the only one they don't ask about because it's so commonly tested, and even if they did the q wouldnt be a first order question- it'll be a picture of the rash and then a list of 5 drugs asking you which is the most common precipitating agent.

 

[ElPais]

There's a whole spectrum of bacterial, viral, autoimmune/rheum, onc, and nephro related skin conditions that are all fair game. SJS/TEN is about the only one they don't ask about because it's so commonly tested, and even if they did the q wouldnt be a first order question- it'll be a picture of the rash and then a list of 5 drugs asking you which is the most common precipitating agent.

Actually the only derm questions they asked were mostly SJS... btw see if anyone can answer this. When you biopsy SJS I know you see necrosis but do you see any IgG?

 

[deleted547339]

Hi folks, looking for some insider advice on these programs. EM resident applying anesthesia CCM in 4 weeks. Finally had the chance to sit down with the local ACCM PD today who advised me that getting ABA approval for a program to take an EM resident is more a formality than anything so I should try applying to anywhere I want to go. Don't know how that will be in practice but that opens up my list a lot. I have a research background and I'm interested in cardiac arrest physiology research so I want to do academics, looking for big emphasis on ECMO, CTICU etc in fellowship. I probably should've done anesthesia residency in hindsight, but I'm here now. I'd like to gain the skills necessary to run/start a smaller lung rescue/ECPR ECMO program in an academic hospital that doesn't have one yet. It seems like the programs that are considered good by ER docs aren't necessarily the programs that are considered good by anesthesiologists. Considering I want to work pretty much full time CTICU with research time (I know that's high hopes...) I should probably look into what is considered good to anesthesiologists. What programs would you folks consider good? What would you recommend I stay away from? (already read about U of Fl. and been warned away from UAB). I also have a family so cost of living is a factor too. Any help is appreciated, thank you.

You got some bad advice - having ABA/ABEM approval is more than a formality. A) if that formality isn’t perfectly executed, you won’t be board eligible. That a huge deal. Also B) if you’re an ER doc, you need to go to a program that wants you there. Going through the hoops of working with the ABEM shows that they want you, not simply that they want a warm body and will tolerate you. This is NOT the case of all, or even many, programs.

Don’t know what you heard about UAB, but they historically were one of the earlier programs to train EPs but aren’t known for being interdisciplinary which is becoming more and more important. Don’t know much about their anesthesia CCM program as I only applied to ABIM CCM fellowships.

As far as research time, you’d probably be better served in an ABIM spot rather than an ABA spot as the research time is more generous in the IM track.

And your statement about programs that are considered good by ER docs an good by anesthesiologists is a little confusing. I wouldn’t care if a program has a good EM or anesthesia residency, I would just care if they had a good CCM program. We’re you just referring to CCM programs, because if so, a good program is a good program.

Your biggest barrier to doing CTICU is simply finding a place that will hire you. You can get plenty of ecmo training at several places.

Hope this helps, feel free to PM with further questions.

 

[Iso4ane]

On a different note, how hard is it to snag one of the open spots after the match if you didn’t go through it. Lots of open spots, some at big name programs.

 

[psychbender]

On a different note, how hard is it to snag one of the open spots after the match if you didn’t go through it. Lots of open spots, some at big name programs.

Probably rather easy. They want to fill those spots to make the call schedule better, and to be able to tell their buddies that they filled this year. If you're interested, doesn't hurt to apply.

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[deleted547339]

On a different note, how hard is it to snag one of the open spots after the match if you didn’t go through it. Lots of open spots, some at big name programs.

Not hard.

 

[ElPais]

Not hard.

I agree... some of the open spots listed after the match are actually quiet good. UCLA, Wisconsin, UWash among others.

 

[ToKingdomCome]

How was the competitiveness for the most recent match - seems like if you want a position you can get one? Would you guys recommend going into CCM? Is it pretty easy to find like a 75% OR 25% ICU gig these days? I'm a PGY-1 remotely interested in CCM

 

[ElPais]

How was the competitiveness for the most recent match - seems like if you want a position you can get one? Would you guys recommend going into CCM? Is it pretty easy to find like a 75% OR 25% ICU gig these days? I'm a PGY-1 remotely interested in CCM

If you’re remotely interested I wouldn’t even apply. You need to have a real passion for CCM otherwise don’t bother. That’s my opinion.

 

[AdmiralChz]

On a different note, how hard is it to snag one of the open spots after the match if you didn’t go through it. Lots of open spots, some at big name programs.

The hidden truth is programs would love for any board-eligible/certified anesthesiology grad to take these spots. Otherwise they go to less competitive applicants who may not excel - like EM. No offense to those EM-CC people out there, but much of the applicant pool there is rough.

 

[deleted547339]

The hidden truth is programs would love for any board-eligible/certified anesthesiology grad to take these spots. Otherwise they go to less competitive applicants who may not excel - like EM. No offense to those EM-CC people out there, but much of the applicant pool there is rough.

I’m EM. This isn’t me being butt-hurt, but I’m honestly fairly shocked by your statement. The average EM resident nowadays was a very competitive med student and the ones that are going into CCM are usually self-selected to be hard workers who are motivated to excel. Maybe it was just my program, but our EM grads were always among the best. There are obviously some deficiencies that EM grads have with respect to anesthesiologists, but there are also some deficiencies anesthesiologists have compared to EPs - why we all need to do fellowship.

How much experience and what kind of experience do you have with EM grads? Are you academic faculty at a program that trains EM grads? I wonder if this is you having a low n or me having rose-colored glasses and going to a unique program.

 

[deleted547339]

The hidden truth is programs would love for any board-eligible/certified anesthesiology grad to take these spots. Otherwise they go to less competitive applicants who may not excel - like EM. No offense to those EM-CC people out there, but much of the applicant pool there is rough.

And that’s not hidden truth, there is pretty open bias against EM in CCM at many programs.

 

[Psai]

I’m EM. This isn’t me being butt-hurt, but I’m honestly fairly shocked by your statement. The average EM resident nowadays was a very competitive med student and the ones that are going into CCM are usually self-selected to be hard workers who are motivated to excel. Maybe it was just my program, but our EM grads were always among the best. There are obviously some deficiencies that EM grads have with respect to anesthesiologists, but there are also some deficiencies anesthesiologists have compared to EPs - why we all need to do fellowship.

How much experience and what kind of experience do you have with EM grads? Are you academic faculty at a program that trains EM grads? I wonder if this is you having a low n or me having rose-colored glasses and going to a unique program.

It's no secret that the em interns and residents are the weakest in the icu. And the way they hanker over procedures for patients they barely even know.

 

[psychbender]

It's no secret that the em interns and residents are the weakest in the icu. And the way they hanker over procedures for patients they barely even know.

Was not my experience in fellowship. The EM residents with whom I worked generally did better and were more motivated in the Trauma ICU than the IM residents in the MICU (barring those heading to Pulm/CC fellowships). Oddly, the best interns I dealt with were there ENT interns in our SICU. They were highly motivated, did what they were told, knew their ****, and were eager to learn more, even if totally unrelated to their final field.

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[AdmiralChz]

Yeah, I should have clarified before commenting - the main issue with EM is the ABA-approved pathway for them is 2 years rather than 1, so it creates problems with funding for programs sponsored by anesthesiology.

How much experience and what kind of experience do you have with EM grads? Are you academic faculty at a program that trains EM grads? I wonder if this is you having a low n or me having rose-colored glasses and going to a unique program.

I absolutely have bias, here. Ours was a program traditionally sponsored by Anesthesia - we had a very new EM program and only a handful of EM grads as fellows. It also was hyper malignant and only a few CCM spots filled at all, so the people we got weren’t all that solid. But the EM folks appeared to really struggle with the transition and the rounding required for CCM, subjectively.

 

[CCM-MD]

Found this interesting. Source: https://www.abms.org/media/194885/abms-board-certification-report-2017-2018.pdf (Table 3B: New Subspecialty Certificates Issued by ABMS Member Boards)

Only 11 EM via anesthesia-CCM in 2017 and 34 via IM-CCM last year. Always thought the number of EM trained CCM physicians was exaggerated on SDN, but didn't expect it to be this low.

 

[Ronin786]

WTH happened in 2012 and 2013 to increase the # from 300s into the 1000s for anesthesia? Did they just open the certification for older folks?

 

[ToKingdomCome]

If you’re remotely interested I wouldn’t even apply. You need to have a real passion for CCM otherwise don’t bother. That’s my opinion.

Haha, I’m still sussing our my interests. I’m only a PGY-1 and haven’t doen anesthesia yet. I do an ICU month staffed by anesthesiologists early next year so I get a better feel. It’s a real bummer that ACCM doesn’t get a lot of love especially since I think for me personally a 70-30 split of anesthesia/ccm would be my dream job - and not being pigeonholed by academics (not against it - just want all options on the table when I graduate)

 

[deleted547339]

View attachment 241030

Found this interesting. Source: https://www.abms.org/media/194885/abms-board-certification-report-2017-2018.pdf (Table 3B: New Subspecialty Certificates Issued by ABMS Member Boards)

Only 11 EM via anesthesia-CCM in 2017 and 34 via IM-CCM last year. Always thought the number of EM trained CCM physicians was exaggerated on SDN, but didn't expect it to be this low.

Yes, we’re very few and far between and highly concentrated in a few academic programs. There are likely just under 300 of us in the country.

 

[deleted547339]

Yeah, I should have clarified before commenting - the main issue with EM is the ABA-approved pathway for them is 2 years rather than 1, so it creates problems with funding for programs sponsored by anesthesiology.



I absolutely have bias, here. Ours was a program traditionally sponsored by Anesthesia - we had a very new EM program and only a handful of EM grads as fellows. It also was hyper malignant and only a few CCM spots filled at all, so the people we got weren’t all that solid. But the EM folks appeared to really struggle with the transition and the rounding required for CCM, subjectively.

Yea, the first couple months going from essentially outpatient acute care to inpatient subacute to chronic care can be tough. It something that probably takes 18 months to master, but not the full 2 years.

 

[deleted547339]

It's no secret that the em interns and residents are the weakest in the icu. And the way they hanker over procedures for patients they barely even know.

That may be the case where you practice, but it’s certainly not universal and varies greatly even from resident to resident. I’ve had poor EM residents who just want to do procedures and I’ve also had anesthesia residents who seem to actively try to kill people.

I, too, noticed that in residency and fellowship, ENT residents did seem to be some of the hardest working and knowledge.

(Sorry - the multi reply function isn’t working great on my phone).

 

[Modanq]

From the Editor at JACC Last Month Oct 2018 ICU Cardiac
The (R)Evolution of the CICU

Where will the CV Anesthesiologists and Anesthesiology Intensivists fall on this one? Lets not get marginalized.

 

[ElPais]

Hi couldn’t find a thread for this but anyone have any idea when CCM exam results post? Took it on Oct 13th.

 

[DO class of 2018]

Can anyone comment on the logistics of the upcoming application period? It says application registration begins Nov. 1st. Currently, you cannot register. Is it something you should work on, have ready to go on Nov 1st, then submit? This isn't quite clear to me on the sf match website. Thanks in advance!

 

[Dam272]

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.

Sad to say I agree from personal experience now

 

[Dam272]

sfmatch has updated post-match vacancies for 2020 CCM-anesth fellowship. Are the match results out? Many big-name places out there with vacancies

 

[2buckchuck]

sfmatch has updated post-match vacancies for 2020 CCM-anesth fellowship. Are the match results out? Many big-name places out there with vacancies

Yeah match results came out earlier this week. Over the past few years plenty of good places have had vacancies.

 

[Laryngophed]

My old practice only did a little over a hundred hearts a year, three of the six anesthesiologists did hearts. We didn't have a specific cardiac call, because the odds of a callback when one of us was not on call was so low. There were, I believe, only two occasions in the four years I was there that we did a heart after hours when one of the non-CT guys was on call, and in both of those, the surgeon just called one of us directly and asked for help. If none of us were available, it would have been sent across town.

Another practice I was looking to join did about 250 hearts a year (no transplant or advanced heart failure). The cardiac guys did roughly Q8 cardiac call, and q30 general call. They said that maybe a half-dozen times a year, a cardiac guy will get called in at night or on a weekend for a case. That's far better than general OR/L&D call.

Now, the guys at my fellowship hospital... Yeah, they get called in a lot, but that's because we do transplants, ECMO, VADs, and complex cases on people that should probably have just been left alone to die without our assistance.View attachment 229788

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OMG, the feels.

 

[AdmiralChz]

sfmatch has updated post-match vacancies for 2020 CCM-anesth fellowship. Are the match results out? Many big-name places out there with vacancies

Yep this is the case every year and speaks to the competitiveness of CCM (nonexistent). It’s a stark contrast to the other mainstream fellowships (peds, pain, CT).

 

[ToKingdomCome]

Anyone have a list of open programs?

 

[psychbender]

Anyone have a list of open programs?

SF Match - Residency and Fellowship Matching Services

www.sfmatch.org

Scroll down to Immediate Vacancies.

 

[deleted171991]

SF Match - Residency and Fellowship Matching Services

www.sfmatch.org

Scroll down to Immediate Vacancies.

Even worse than usual. People must be reading SDN (and wising up).

 

[Modanq]

Even worse than usual. People must be reading SDN (and wising up).

I disagree. The total number of applicants that matched are staying steady with an up tick of 1 to 2 per year but the acgme has approved many more spots at the same time. So the interest is about the same. They just have many more spots available.

What I see is 149, 150, 151 matched 2016, 2017, 2018 and total positions available 186, 202, 209 in those years which is a much faster growth than applicants.

The thought is from the program side there is a huge need in intensivists but from the applicant side the same number are interested.

You will find the same with job options. Hopefully people Read the data closely before making a judgment.

 

[Modanq]

Yep this is the case every year and speaks to the competitiveness of CCM (nonexistent). It’s a stark contrast to the other mainstream fellowships (peds, pain, CT).

And I agree that this increase in ICU spots available decreases ths competitiveness of ICU. Which, in my opinion, is great because I think every anesthesiology resident should just be required to do icu, or cardiac or peds, pain. Ie just like a ca4 year tacked on... on the other hand we have 59, 66 (2017, 2018) unmatched ca3 for cardiac.

Such is a shame because they tend to be the hardest working and some of the brightest in the overall anesthesiology resident cohort. The ICU match should flip their match date to go after the cardiac match date and fill the empty spots with dual ICU + cardiac offers. Many of those places allow for moonlighting during ICU year and the applicant will then be gaurunteed cardiac after that. Because at minimum the unmatched applicant had to wait for another year if they want a cardiac spot. It's a Win win for institution and applicant and likely for anesthesiologists as a physician group in the broader sense.

 

[chocomorsel]

Well, all I have to say is I have immensely enjoyed being out of the cold meat locker, “move the meat”, environment of the OR and having a lunch break daily.

And oh yeah, the knowledge I picked up is awesome too. Lol

It has had its bumps, but it’s opened up lots of opportunities for me.

 

[deleted171991]

I disagree. The total number of applicants that matched are staying steady with an up tick of 1 to 2 per year but the acgme has approved many more spots at the same time. So the interest is about the same. They just have many more spots available.

What I see is 149, 150, 151 matched 2016, 2017, 2018 and total positions available 186, 202, 209 in those years which is a much faster growth than applicants.

The thought is from the program side there is a huge need in intensivists but from the applicant side the same number are interested.

You will find the same with job options. Hopefully people Read the data closely before making a judgment.

I am glad to be wrong. Although this just proves that academia will do anything for free labor. It's not like we are bombarded with good job offers left and right. I have never been contacted by a recruiter about an ICU job.

There is NOT a huge demand for SURGICAL intensivists. Outside of academia, most jobs are for trauma surgeons and midlevels, and that's because many community SICUs are just extended PACUs. Also, generally, there are much easier ways to earn a living than CCM, practicing anesthesia. That's why the subspecialty requires true passion, because it's SO much easier just to forget about it and be a good anesthesiologist instead.

As for the community MICUs, where the real ICU pathology tends to be, most hospitals don't even consider anesthesiologist-intensivists for them, because many MICU jobs are coupled either with pulm or with residency programs (where non-internists are still personae non grata).

I would be happy to be proven wrong about these ideas, too, by the way.

 

[ToKingdomCome]

Well, all I have to say is I have immensely enjoyed being out of the cold meat locker, “move the meat”, environment of the OR and having a lunch break daily.

And oh yeah, the knowledge I picked up is awesome too. Lol

It has had its bumps, but it’s opened up lots of opportunities for me.

I'm very interested in CCM and thinking about pursuing it. Can you discuss a little more what opportunities it opens up? Ideally hoping to get a 75/25 OR/ICU private practice gig. Would be my absolute dream job but I know those are hard to come by

 

[chocomorsel]

I'm very interested in CCM and thinking about pursuing it. Can you discuss a little more what opportunities it opens up? Ideally hoping to get a 75/25 OR/ICU private practice gig. Would be my absolute dream job but I know those are hard to come by

They are not hard to come by in academics.
It’s opened up opportunities for me to get out of the OR.

 

[psychbender]

Ideally hoping to get a 75/25 OR/ICU private practice gig.

Hahahaha!! That's a good one. Those jobs are very, very, very few and far between. If you have any substantial geographic limitations, you very well may never find one in your area right out of training. I actually do that at my new job now, but I created my position through luck, and a special convergence of needs with the private anesthesia group and the hospital-employed intensivists.

 

[psychbender]

I am glad to be wrong. Although this just proves that academia will do anything for free labor. It's not like we are bombarded with good job offers left and right. I have never been contacted by a recruiter about an ICU job.

There is NOT a huge demand for SURGICAL intensivists. Outside of academia, most jobs are for trauma surgeons and midlevels, and that's because many community SICUs are just extended PACUs. Also, generally, there are much easier ways to earn a living than CCM, practicing anesthesia. That's why the subspecialty requires true passion, because it's SO much easier just to forget about it and be a good anesthesiologist instead.

As for the community MICUs, where the real ICU pathology tends to be, most hospitals don't even consider anesthesiologist-intensivists for them, because many MICU jobs are coupled either with pulm or with residency programs (where non-internists are still personae non grata).

I would be happy to be proven wrong about these ideas, too, by the way.

I actually have received a lot of emails from recruiters with 100% CCM jobs (usually in places I don't want to work, including major cities). Then again, this may be because I reached out to some locums agencies while my previous hospital was imploding, and I needed some part-time work.

There is starting to be some demand outside of academia for non-Pulmonary intensivists, just not a lot. Where I am now, several of the surgeons are excited with the prospect of having one of the anesthesiologists in the units. Also, while I have a lot of negative things to say about my last job, the surgeons very much appreciated our presence in the unit, and went to bat for us with hospital administration when they were deciding who gets let go.

Additionally, while I know you hate cardiac, as more and more community programs start VAD and ECMO programs, they will need someone that actually has experience with those in the unit. Most Pulmonologists don't get much exposure to mechanical support during their fellowships.