Anesthesiology Critical Care Fellowship 2019-2020

[ToKingdomCome]

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

What’s the pay like in academics as anesthesia/ccm, and would you still recommend the fellowship?

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[Modanq]

What’s the pay like in academics as anesthesia/ccm, and would you still recommend the fellowship?

There is a trend emerging for anesthesiology groups to take their trained intensivist and have them branch into the ICU because it entrenches them within hospitals, politics, and collaborators with various surgical groups. It makes it more difficult for CMG's to undercut the anesthesiologists in the hospital and adds value to the entire enterprise in addition to breaking even financially. I have seen recently some private practice groups working into the ICU n= 5 in the midwest. What we do really need to work on is improving reimbursement which could involve procedural services such as ECMO, device management and procedure teams, ultrasound billing.

The other thing to remember is as the anesthesiology training evolves so does surgical training. All the sub specialties are requiring less and less ICU time ENT, plastics, vascular they are all moving away from requiring the time in the iCU because they have many other rotations to cover and back end operative learning. We all know that in the community and midsize hospitals the surgeon haven't done ACLS or critical care management for years let alone the current trainees.

In the end its about money generation and like most of American medicine money is in procedures which to be honest Anesthesiologists are neck and neck with in comparison to all of the medical specialities. We just have to ensure that the future services provided in the ICU aren't bundled into "critical care time"

 

[deleted171991]

In the end its about money generation and like most of American medicine money is in procedures which to be honest Anesthesiologists are neck and neck with in comparison to all of the medical specialities. We just have to ensure that the future services provided in the ICU aren't bundled into "critical care time"

The real money is not in billing, it's in referrals. An internist generates 10x his salary in revenues for the hospital. That's also how an intensivist makes money for the system (just on a worse payer-mix), and an anesthesiologist cannot come close to that. Critical care time (which is about $500/day) and procedures (which are paid peanuts) are just the icing on the cake.

 

[McPoyle]

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 agree with a lot (ie easier ways to make more money, and assessment of community “SICUs”), but at least anecdotally I’m finding this statement to be becoming less and less true as specialties move towards being hospital employed. Prior to taking my academic job (mix of MICU and CTICU) I talked to maybe 6 community practices that covered the ICU as well. Most of them were mixed Med/Surg ICUs but I can recall at least two hospitals that were more than open to having me cover the MICU (one was fairly lucrative in a moderately desirable city too) in addition to practicing anesthesia. I think as community plum/CC practices start becoming hospital employees you will see more opportunity to do real MICU work. Again, this is obviously anecdotal but the jobs are definitely there if you like MICU and still want to practice anesthesia. There are probably even more jobs if you’re willing to give up the OR.

 

[chocomorsel]

What’s the pay like in academics as anesthesia/ccm, and would you still recommend the fellowship?

It’s academic pay so not that fabulous.
I would recommend it, but I am also a little different in my views.

 

[psychbender]

What’s the pay like in academics as anesthesia/ccm, and would you still recommend the fellowship?

Pay is often about the same as a generalist, maybe more to start. When I was interviewing in fellowship, some places wanted to start me the same as the guy fresh out of residency, others gave a little extra (maybe $25k) for the extra year of training. As with everything pertaining to the academic market, though, there is a lot of regional variation. In the part of the country where I am now, academic jobs start in the mid to high 200s, even for those with fellowships. I have a colleague in the Midwest, though, who's total comp is closer to 500.

 

[ToKingdomCome]

Pay is often about the same as a generalist, maybe more to start. When I was interviewing in fellowship, some places wanted to start me the same as the guy fresh out of residency, others gave a little extra (maybe $25k) for the extra year of training. As with everything pertaining to the academic market, though, there is a lot of regional variation. In the part of the country where I am now, academic jobs start in the mid to high 200s, even for those with fellowships. I have a colleague in the Midwest, though, who's total comp is closer to 500.

Ah gotcha. I'm guessing anything east coast would be tough to top $350k which for academics I would be thrilled with even if I had to work 50-60 hours a week and honestly that's a number I'd like to top. With academics, I just don't want to be capped with a salary which often seems what happens and with that I think I'd be losing a lot more money then I could actually make. It's a bummer. I'm guessing community programs with private attendings, most likely wouldn't allow me to do the split OR/CCM gig as part of the contract.

 

[psychbender]

Ah gotcha. I'm guessing anything east coast would be tough to top $350k which for academics I would be thrilled with even if I had to work 50-60 hours a week and honestly that's a number I'd like to top. With academics, I just don't want to be capped with a salary which often seems what happens and with that I think I'd be losing a lot more money then I could actually make. It's a bummer. I'm guessing community programs with private attendings, most likely wouldn't allow me to do the split OR/CCM gig as part of the contract.

One cannot make too many generalizations about academics, because some may be pure salary with benefits, some add an hourly component after X, some have additional call or other work that can be taken for extra pay, etc. Example: one place I interviewed started CCM staff at about $315k for 26 weeks of OR (M-F 7-5pm, no OR call/nights/weekends/holidays) and 13 weeks of ICU (standard 12hr shifts), with post-ICU weeks off. I think there were a few extra vacation weeks thrown in there, too. During post-ICU weeks, no clinical or administrative work was expected, but you could pick up evening shifts in the OR or take transplant call for extra money.

In the private sector, it can be really difficult to find a mixed practice. They do exist, but they are scattered around the country, and probably are not hiring every year. Making a regular private practice see value in allowing you out of the OR to work in the ICU can depend on how badly they need someone with your skillset, and how they think that they can benefit from your presence. I think there is good value in demonstrating the group's willingness to provide service outside of the OR, and can strengthen relationships with surgeons and medical specialists on staff. Not everyone sees it this way, however. In general, if you are not working in the OR, you are not earning money for the practice. There are arrangements that can change that, though. The group can negotiate with the hospital to provide a stipend for ICU coverage to cover your salary and benefits for those days (hospital collects your billing for time and procedures), for example.

 

[Katheudontas parateroumen]

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.

Will you never divulge where you did fellowship?? Give us a hint!

 

[deleted171991]

Will you never divulge where you did fellowship?? Give us a hint!

Are you sure I actually did one? Aren't I the one saying that an ICU fellowship is not worth it?

 

[mudderMD]

Hello. Does anyone know of any cases of IM trained docs completing ACCM fellowship? I sent emails to those programs asking if I am eligible but and some had me send my application, but now im not sure if I will be able to be ABIM certified.

 

[deleted171991]

Hello. Does anyone know of any cases of IM trained docs completing ACCM fellowship? I sent emails to those programs asking if I am eligible but and some had me send my application, but now im not sure if I will be able to be ABIM certified.

The answer should be No, unfortunately. Due to various geniuses on both sides, we don't officially cross-pollinate. AFAIK, the ABA doesn't have an arrangement with ABIM.

However... there are some mixed programs, where there are separate IM and anesthesia fellowships (on paper), but the fellows train together and cover the same ICUs with the same multidisciplinary attendings. I think that's the best kind of training for a future intensivist.

 

[ShockIndex]

The answer should be No, unfortunately. Due to various geniuses on both sides, we don't officially cross-pollinate. AFAIK, the ABA doesn't have an arrangement with ABIM.

However... there are some mixed programs, where there are separate IM and anesthesia fellowships (on paper), but the fellows train together and cover the same ICUs with the same multidisciplinary attendings. I think that's the best kind of training for a future intensivist.

I start to wonder if the ABA/SCCA will start thinking outside of the box when it comes to filling the high number of anesthesia-CCM fellowship vacancies. I understand that it’s a funding issue, but it seems like programs with 2 open spots could perhaps roll that funding into a single 2-year spot for an EM or IM applicant.

 

[mudderMD]

I wonder how they are even considering my application... very interesting

 

[CCM-MD]

I wonder how they are even considering my application... very interesting

Likely someone who has no idea what is going on.

Keep in mind that some of these open programs might just be looking to take anyone on... they need warm bodies to get the work done. They may not care whether or not you end up board eligible afterwards.

 

[deleted171991]

Likely someone who has no idea what is going on.

Keep in mind that some of these open programs might just be looking to take anyone on... they need warm bodies to get the work done. They may not care whether or not you end up board eligible afterwards.

+100.