ketamix2020

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Hey all,

Just wanted to get a thread started for all of us applying right now. Feel free to share any info you have on programs!

Anyone interview at UPenn, UCLA, Michigan, OHSU or Vandy yet? Have limited time and I can't interview at all of them, so I was wondering if anyone had any feedback on the fellowship? Call schedule? Core rotations? Primary fellow on non-anesthesia services? Anything!

Thanks and good luck to everyone!
 

bigdan

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I'm a Michigan ACCM alum.

Single best year of medical education I had. I think I may have posted on program specifics at some point; it was a great year.
 
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DrGasPasser

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Michigan seemed like a great program. The faculty is excellent and Dr. Engoren is a research stud (helluva nice guy too). The PD is soft spoken but seems appropriately engaged and supportive. It sounds like he just got done strengthening the communication between CCM and surgery lines in the CVICU - the CT surgeons at any shop can be like hearding cats. It sounds like he made significant progress.

Their schedule in the CVICU and SICU is a little non-traditional. They work you hard for 3 weeks of the block and then you have an admin week to recover, perform research, or reintroduce yourself to your family. Some of the residents use that week to moonlight or go see their families if living apart.

There MICU block is pretty light on responsibility. However, you will get plenty of exposure managing medically ill patients in the Emergency Critical Care Center which manages many ICU patients admitted from the ED for the first 24 hours.
 
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ToKingdomCome

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How important is research for getting a good CCM fellowship?
 

psychbender

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How important is research for getting a good CCM fellowship?
It's not. Interest and completing residency will get you a spot somewhere. Good scores, interview, LOR will get you a spot at a well-regarded program. Just remember that a big name program isn't always the best for what you ultimately want to do.
 

dchz

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Some big names out there go unfilled all the time
 
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AdmiralChz

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Far more spots than (anesthesia) applicants. It’s not competitive in the least, so your research should be focused on where you would do best for a year.
 
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Steege305

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I'm not sure that the feedback you're getting here is entirely accurate. Yes, big names have spots that go unfilled, but I think you could also stratify the programs as Strong/Desirable location, Strong/Undesirable location, etc. My experience was that strong programs in desirable locations were competitive.
 
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DrGasPasser

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This X1000. Desirable location has become part of the “curriculum” for many fellowship applicants even though they are considering just a 1-2 year commitment. From a purely academic perspective, some of the strongest programs in the country (NIH dollars, presence of prominent faculty, clinical exposure) also happen to be in cities with some measure of weather, socioeconomic, and cost of living issues. These programs will continue to struggle to fill their anesthesia spots as long as half the applicant pool is uninterested in academics or feels that a top 10 name is unnecessary to land the job they want.

The calculus is a little different for EM applicants applying for ACCM spots. On one hand, most of these applicants know they want to practice academic medicine. They are also competing for a much smaller pool of spots since most programs only fund 1 or 2 spots for 2-year EM-CCM. So, while places like WashU, Michigan and Seattle have open 1-year spots for anesthesia applicants, I do not think there are any unfilled 2-year spots for EM applicants.
 
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deleted547339

This X1000. Desirable location has become part of the “curriculum” for many fellowship applicants even though they are considering just a 1-2 year commitment. From a purely academic perspective, some of the strongest programs in the country (NIH dollars, presence of prominent faculty, clinical exposure) also happen to be in cities with some measure of weather, socioeconomic, and cost of living issues. These programs will continue to struggle to fill their anesthesia spots as long as half the applicant pool is uninterested in academics or feels that a top 10 name is unnecessary to land the job they want.

The calculus is a little different for EM applicants applying for ACCM spots. On one hand, most of these applicants know they want to practice academic medicine. They are also competing for a much smaller pool of spots since most programs only fund 1 or 2 spots for 2-year EM-CCM. So, while places like WashU, Michigan and Seattle have open 1-year spots for anesthesia applicants, I do not think there are any unfilled 2-year spots for EM applicants.

This is pretty accurate. I don’t think the anesthesia vs. EM spots have to be allocated specifically, so sometimes programs that take EM folks won’t fill with anesthesia, then EM docs can scramble into them. I know some EM folks who have snagged up good spots this way.
 
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deleted171991

Unfortunately, applicants are choosing programs based on brand and convenience, and not as much on education. It's the difference between the outer scorecard and the inner scorecard, as Buffett likes to say.

“I say ‘Lookit. Would you rather be the world’s greatest lover, but have everyone think you’re the world’s worst lover? Or would you rather be the world’s worst lover but have everyone think you’re the world’s greatest lover?'” — Warren Buffett

If one gives up one year of attending-level income (plus the decades of compounding which would increase its real value 2-3 times), one had better know why. It's one of the most expensive investments in one's life, and one should treat it accordingly, not just throw out the money blindly. One should get the best education one can for that money, with the best return on investment, both in happiness and income. Most anesthesiology fellowships have an abysmal ROI (critical care included).

One more secret: there is no rush! One can go back and do a fellowship 5-10 years after graduation, if it's truly important for one's career. It may be inconvenient, but it's doable, and it's probably much wiser than jumping blindly into one, after residency, like most greenhorns do, based on whatever stories they hear during residency from ivory tower academics, instead of their own real-life attending experience.

On topic:
OP, I don't know any of these programs except from hearsay. I would drop Vandy (and any other program that is too involved with midlevel education). I would definitely interview at a program I hear good things about from former grads, and/or one that tends to attract fellows from big name residencies. It seems that Michigan ticks those two boxes (besides the impressive education).

Most (but not all) anesthesiology-CCM programs offer a decent education, because the best education comes from self-study and experience, so all they have to do is to not overwork the fellow, and have enough pathology and well-educated faculty.

Forget location, focus on brand and education. And if you cannot get into a good program this year, wait. Don't just list/accept any CC fellowship. Critical care is not competitive, and you may get into a better one post-match.
 
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dchz

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One more secret: there is no rush! One can go back and do a fellowship 5-10 years after graduation, if it's truly important for one's career. It may be inconvenient, but it's doable, and it's probably much wiser than jumping blindly into one, after residency, like most greenhorns do, based on whatever stories they hear during residency from ivory tower academics, instead of their own real-life attending experience.

I agree with rest of the post. Save this comment.

There is 0 chance that 95% of the people out there will come back to do a fellowship after being an attending. The opportunity cost alone is not worth it.

Sure, there are some @pgg out there... but 99% of people wont.
 

chocomorsel

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I agree with rest of the post. Save this comment.

There is 0 chance that 95% of the people out there will come back to do a fellowship after being an attending. The opportunity cost alone is not worth it.

Sure, there are some @pgg out there... but 99% of people wont.
Lots of us on this board have done this.
But yeah, I suspect the number is 30% or less.
I have met quite a few hospitalists now back doing fellowships. I suspect it’s more common in primary care.
 

nimbus

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I agree with rest of the post. Save this comment.

There is 0 chance that 95% of the people out there will come back to do a fellowship after being an attending. The opportunity cost alone is not worth it.

Sure, there are some @pgg out there... but 99% of people wont.


I think that is a good argument to wait. They would only do it if it is truly worthwhile to them. I know several CCM trained doctors who don’t do any CCM.
 
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deleted171991

I think that is a good argument to wait. They would only do it if it is truly worthwhile to them. I know several CCM trained doctors who don’t do any CCM.
Bingo! And that applies to many fellowships, not just CCM.

I wouldn't wait to do cardiac ("boys to men"), pain (especially if one wants to give up anesthesia), and maybe peds (there are only so many children's hospitals, and I am not sure how many kids actually have good private insurance). I also wouldn't wait to do CCM if one has decided 100% to practice only in the ICU.
 
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psychbender

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Lots of us on this board have done this.
But yeah, I suspect the number is 30% or less.
I have met quite a few hospitalists now back doing fellowships. I suspect it’s more common in primary care.
At least three of us here have gone back for CCM after being out in the real world, at least two regular posters went back for CT, one for Peds. This place makes up a very small minority of anesthesiologists, so I think it's interesting that we have so many that went back into training in this group. Military service, though, want likely a factor for three of the mentioned ones. In the interview trail, and when interviewing candidates while a fellow, I did see several others that were going back in for fellowship after being out in practice for several years. At one program, almost all of the fellows there had several years of experience before going back to train.
 
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DrGasPasser

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OP, I don't know any of these programs except from hearsay. I would drop Vandy (and any other program that is too involved with midlevel education). I would definitely interview at a program I hear good things about from former grads, and/or one that tends to attract fellows from big name residencies. It seems that Michigan ticks those two boxes (besides the impressive education).

I think Michigan is hard to beat. The faculty is amazing and they don’t farm you out to the VA. As someone who has seen the VA from a provider and patient perspective, I feel comfortable saying that any CCM program sending its fellows there is doing it for manpower, not education reasons. My only real criticism is that the trauma exposure is a little light since there is no Trauma/Burn block unless it’s done as an elective. There is some exposure when the TBICU is full (only 10 beds) and trauma patients board in the SICU. Moreover, there is a fair amount of trauma in the Emergency Critical Care Center. However, the trauma exposure is light compared to WashU or UWash/Harborview since Ann Arbor is pretty granola-hipster rather than gangsta.

For EM applicants wanting an academic career in resuscitation research, Michigan is a no-brainer. Both anesthesia and EM at Michigan dominate the NIH funding. Both departments have high-level research/academic mentors and the structure of the program facilitates scholarly work if desired (a administrative week free of most clinical duties at the end of every SICU/CVICU block). Honorable mentions go to WashU, UPMC, and UWash - all of those places are pretty solid.
 

Steege305

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OP, I don't know any of these programs except from hearsay. I would drop Vandy (and any other program that is too involved with midlevel education). I would definitely interview at a program I hear good things about from former grads, and/or one that tends to attract fellows from big name residencies. It seems that Michigan ticks those two boxes (besides the impressive education).

Or you could apply, go see them both for yourself, and then make an informed decision. I interviewed at Vandy, it was wonderful.

An internal conversation that sounds something like "I didn't interview at a stellar program because some dude on SDN talked some trash about it" is.....
 

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psychbender

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Really, most candidates need to spend some time figuring out what they value in further training, before applying. Then, apply broadly to programs that one thinks will meet those desires (eg all programs in a given geographic region, those with heavy CVICU/ECMO/VAD numbers, multidisciplinary programs with MICU time, programs with little call or weekends, etc). Maybe throw some dark horse programs in there, because one can be surprised by a program that doesn't have a big name at the moment. If interview time and money are not issues, interview everywhere one is offered. If one or more is an issue, then try to answer as many questions as possible via whatever resources one can (PD emails, current/former fellows, recs from people on SDN), and set up an interview priority list. After interviewing, agonize over the options, and create a list. Then, wait.

I interviewed at Vandy several years ago. They offer exceptional training. After interviewing them, they became the program to beat at every other interview. I ultimately dropped them down the list a bit because while the training was great, they are a meat grinder. I looked at their fellow schedules, and they really were right at 80hrs/wk pretty much every week. For an older guy with small kids, that was less than ideal. Additionally, I do not support training midlevels as physician replacements, which is something on which Vandy seems to pride itself.
 
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Dam272

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May posts and many attendings mentioning very little ccm opportunities in private. So who mans the CTICUs in non academic setups?
 
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deleted171991

May posts and many attendings mentioning very little ccm opportunities in private. So who mans the CTICUs in non academic setups?
APRNs and PAs, supervised by the surgeons.
 
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AdmiralChz

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So who mans the CTICUs in non academic setups?

Here, it’s medicine CCM with help from Cards. For our smaller community hospital, it’s a combined med/surg ICU. Surgeons don’t do much of anything in the unit here. Heavy doses of NP/PA, not the best care so we do everything we can intraop to set our patients up to fly as much as possible postop (which basically means get them ready to fast track to extubation within a couple of hours).
 
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deleted171991

So is critical care a mid-level sport? Is the CCM + TEE/TTE certs still a thing at all?
The bean counters (and the midlevels) would definitely love to turn it into a midlevel sport. But it's much harder done than said. While certain programs, e.g. Vanderbilt, are invested in midlevel "fellowships" in critical care, there is still a long way to go. And, regardless, no "fellowship" can fix the lack of knowledge in basic medical science one needs to practice critical care independently. Anybody who thinks in protocols, without thinking in the context of the patient's particular physiology, will SUCK as an intensivist (i.e. will do unnecessary harm to patients).

Unfortunately the future looks like this: every midlevel covering about 5 (+/-) ICU patients, every intensivist covering 2-3 midlevels. That's clearly coming (not only in critical care, but in many specialties). Also, most (M)ICU patients are Medicare patients, which means community hospitals are being paid peanuts (be VERY afraid of Medicare For All). Hence, without midlevels, the hospitals would not afford paying physicians. So midlevels are here to stay, wherever the service cannot be covered with residents.

I don't know about critical care echo certifications. I don't have one (they cost thousands and are basically worthless) , nor have I ever been asked for one. I do have TTE/TEE and lung ultrasound skills (which are very important for any intensivist in 2019, TEE less than the others), and some of my colleagues are also proficient in abdominal ultrasound. Whenever I really need to cover my butt, I ask for formal exams.

If you're wondering about covering the CTICU, cardiac surgeons prefer intensivists with cardiac anesthesia training (whom they work with in the cardiac ORs), or at least with significant CTICU experience during fellowship. This is important, FOR NOW, as long as cardiac surgery is still one of the big money makers; that's slowly going away with interventional valve procedures (with postop care by cardiologists, in the CCU). Also, somebody who's not happy in the cardiac OR will probably not be happy in a cardiac SICU either.
 
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Man o War

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The bean counters (and the midlevels) would definitely love to turn it into a midlevel sport. But it's much harder done than said. While certain programs, e.g. Vanderbilt, are invested in midlevel "fellowships" in critical care, there is still a long way to go. And, regardless, no "fellowship" can fix the lack of knowledge in basic medical science one needs to practice critical care independently. Anybody who thinks in protocols, without thinking in the context of the patient's particular physiology, will SUCK as an intensivist (i.e. will do unnecessary harm to patients).

Unfortunately the future looks like this: every midlevel covering about 5 (+/-) ICU patients, every intensivist covering 2-3 midlevels. That's clearly coming (not only in critical care, but in many specialties). Also, most (M)ICU patients are Medicare patients, which means community hospitals are being paid peanuts (be VERY afraid of Medicare For All). Hence, without midlevels, the hospitals would not afford paying physicians. So midlevels are here to stay, wherever the service cannot be covered with residents.

I don't know about critical care echo certifications. I don't have one (they cost thousands and are basically worthless) , nor have I ever been asked for one. I do have TTE/TEE and lung ultrasound skills (which are very important for any intensivist in 2019, TEE less than the others), and some of my colleagues are also proficient in abdominal ultrasound. Whenever I really need to cover my butt, I ask for formal exams.

If you're wondering about covering the CTICU, cardiac surgeons prefer intensivists with cardiac anesthesia training (whom they work with in the cardiac ORs), or at least with significant CTICU experience during fellowship. This is important, FOR NOW, as long as cardiac surgery is still one of the big money makers; that's slowly going away with interventional valve procedures (with postop care by cardiologists, in the CCU). Also, somebody who's not happy in the cardiac OR will probably not be happy in a cardiac SICU either.

This is absolutely true of the CTICUs. We have gone round and round trying to figure out how to cover the ICU patients. The cardiac surgeons are begging us for that. Right now the plan is to try and recruit some dual fellowship trained guys/gals when we are hiring again, but those are hard to come by at baseline, and then trying to find them wanting to work in PP is an even taller order.
 

Dam272

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This is absolutely true of the CTICUs. We have gone round and round trying to figure out how to cover the ICU patients. The cardiac surgeons are begging us for that. Right now the plan is to try and recruit some dual fellowship trained guys/gals when we are hiring again, but those are hard to come by at baseline, and then trying to find them wanting to work in PP is an even taller order.

Why is doing PP after dual CC-CCM an issue? If there is demand as to what you are saying.
 

CUBR

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This is absolutely true of the CTICUs. We have gone round and round trying to figure out how to cover the ICU patients. The cardiac surgeons are begging us for that. Right now the plan is to try and recruit some dual fellowship trained guys/gals when we are hiring again, but those are hard to come by at baseline, and then trying to find them wanting to work in PP is an even taller order.

I would love to get that kind of opportunity. Haven't heard of any private groups that are looking for that. As long as the practice model is profitable for all parties involved, I think it will become more and more common.
 

Man o War

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Why is doing PP after dual CC-CCM an issue? If there is demand as to what you are saying.

We have found most of those folks want to stay in academics. Our comp is high, but the cases are all acute(relatively speaking vs the rest of the group) for the guys/gals hired for cardiac in our group and the hours can be tough. Many want more ICU time than we would likely be able to provide. Probably like any other PP where you make the higher end of MGMA.
 
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Man o War

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I would love to get that kind of opportunity. Haven't heard of any private groups that are looking for that. As long as the practice model is profitable for all parties involved, I think it will become more and more common.

Comp is excellent, but there’s going to be a good amount of OR time. I will keep your name. What’s your timeline for completion of both fellowships or are you done already?
 
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deleted171991

Why is doing PP after dual CC-CCM an issue? If there is demand as to what you are saying.
Because few people waste one extra year of time and money, out of the OR, on a critical care fellowship, just to take care of uncomplicated cardiac surgical patients.

Most folks who do a critical care fellowship want to take care of really sick ICU patients, which PP groups rarely offer. Hence the prejudice from PP groups: when they see a critical care anesthesiologist they assume s/he won't stick around for long.
 
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psychbender

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I would love to get that kind of opportunity. Haven't heard of any private groups that are looking for that. As long as the practice model is profitable for all parties involved, I think it will become more and more common.
For a private anesthesia practice, any time that you spend outside of the OR is time in which you are not earning money for the practice. As such, most are reluctant to bring on anyone that wants more time outside of the OR to do anything else.

There are exceptions, of course. My last practice was hospital-employed, and we had five of us that were dual Anes-CCM. There was a need for both CT anesthesia and critical care at my next hospital, and the private anesthesia group figured out a way to still make money off of me working in the unit, so they made me an offer that included almost 0.5 FTE of ICU time. Of course, that means that my partners are profiting off of my work in the ICU, but I'll consider that the cost of doing business, since finding an arrangement like this is so rare.
 
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CUBR

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For a private anesthesia practice, any time that you spend outside of the OR is time in which you are not earning money for the practice. As such, most are reluctant to bring on anyone that wants more time outside of the OR to do anything else.

There are exceptions, of course. My last practice was hospital-employed, and we had five of us that were dual Anes-CCM. There was a need for both CT anesthesia and critical care at my next hospital, and the private anesthesia group figured out a way to still make money off of me working in the unit, so they made me an offer that included almost 0.5 FTE of ICU time. Of course, that means that my partners are profiting off of my work in the ICU, but I'll consider that the cost of doing business, since finding an arrangement like this is so rare.
what part of the country was this in? And what was the secret to making this arrangement profitable?
 

chocomorsel

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Because few people waste one extra year of time and money, out of the OR, on a critical care fellowship, just to take care of uncomplicated cardiac surgical patients.

Most folks who do a critical care fellowship want to take care of really sick ICU patients, which PP groups rarely offer. Hence the prejudice from PP groups: when they see a critical care anesthesiologist they assume s/he won't stick around for long.
For me, it's not even the straight forward, sometimes boring CV patients. It's the surgeons. CV surgeons are notorious for not letting anyone else manage their patients and will often try to micromanage their patients from the OR instead of letting the intensivists do their thing.

For that reason, I am out. I am going to end up in a community ICU and I will happily leave the CVICU to whomever is running it now. Let them be micromanaged.
 
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deleted547339

For me, it's not even the straight forward, sometimes boring CV patients. It's the surgeons. CV surgeons are notorious for not letting anyone else manage their patients and will often try to micromanage their patients from the OR instead of letting the intensivists do their thing.

For that reason, I am out. I am going to end up in a community ICU and I will happily leave the CVICU to whomever is running it now. Let them be micromanaged.

I’m EM/CCM. A cticu group wanted me, but I hated having to justify my decisions for sedation/fluids/feeding/whatever that falls into the purview of CCM to a Ct surgeon that knew less about it than I did. I’m now working in a closed unit - I’m much happier.
 
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hununuh

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I’m EM/CCM. A cticu group wanted me, but I hated having to justify my decisions for sedation/fluids/feeding/whatever that falls into the purview of CCM to a Ct surgeon that knew less about it than I did. I’m now working in a closed unit - I’m much happier.

But how often will anesthesia trained intensivists have the luxury of working in a closed unit? My understanding is that they pretty much only get hired for SICU or CTICU which are mostly open units.
 
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psychbender

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But how often will anesthesia trained intensivists have the luxury of working in a closed unit? My understanding is that they pretty much only get hired for SICU or CTICU which are mostly open units.
Highly variable. Of my cofellows, one is in a closed SICU, another in a comanaged CTICU. I used to be in an open med-surg ICU, new job will have closed MICU and SICU in which I can spend some weeks, but most of my unit time will be in a "comanaged" CTICU. Where I am doing some ICU moonlighting now offered a full-time position where I can pick closed MICU or comanaged CCU/CVICU shifts.
 

chocomorsel

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But how often will anesthesia trained intensivists have the luxury of working in a closed unit? My understanding is that they pretty much only get hired for SICU or CTICU which are mostly open units.
Your understanding is a little flawed. Plenty of private places now hiring anesthesiologists who are CCM trained. We still get discriminated against especially in the MICU, but things are changing. I will be working in a mixed CC floor with all type of patients besides cardiac.
One of our smaller hospitals right now has an ICU that is anesthesia run. It's mostly medical patients. Our NICU is run by our departments as well. This is an academic institution. And of course we have the usual SICU.

I went on five interviews and got offers from three. None of them were strictly SICU or CTICU. No thank you. The other two were not used to anesthesiologists but were more MICU focused. In two of the practices I would have been the first or second anesthesia hire. It's nice to have the Pulm people to help you with the zebras that we may not see much of in the SICU, but for the most part, we can handle it.

I have a little more of a multidisciplinary fellowship as far as patient population. Like my PD says, physiology does not change.
 
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Dam272

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Your understanding is a little flawed. Plenty of private places now hiring anesthesiologists who are CCM trained. We still get discriminated against especially in the MICU, but things are changing. I will be working in a mixed CC floor with all type of patients besides cardiac.
One of our smaller hospitals right now has an ICU that is anesthesia run. It's mostly medical patients. Our NICU is run by our departments as well. This is an academic institution. And of course we have the usual SICU.

I went on five interviews and got offers from three. None of them were strictly SICU or CTICU. No thank you. The other two were not used to anesthesiologists but were more MICU focused. In two of the practices I would have been the first or second anesthesia hire. It's nice to have the Pulm people to help you with the zebras that we may not see much of in the SICU, but for the most part, we can handle it.

I have a little more of a multidisciplinary fellowship as far as patient population. Like my PD says, physiology does not change.

That sounds very promising. But how does this kind of setup fare for a CT/CC dual trained physician? Eggs call schedule? Compensation?
 

ToKingdomCome

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How much OR time do you get during CCM fellowship if any? I wouldn’t want my OR skills to atrophy as I’d still want to be in the OR the majority of the time
 

POW16

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Depends on the fellowship. For example at Duke you spend most of your elective time in the cardiac ORs. At other places you can do an anesthesia elective.
 

chocomorsel

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How much OR time do you get during CCM fellowship if any? I wouldn’t want my OR skills to atrophy as I’d still want to be in the OR the majority of the time
I think the ABA requires you to spend a majority of your time in the ICU. Something like 8 or 9 months, but don’t quote me on exact number.
 

dr.doe

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Anyone basic TEE certified.....I am getting confused about the time line. When can/should you sit for the written part? some people say it is really difficult to obtain a basic certificated because you have to do 25 cases in the year in which you are officially being board certified which is only after passing the oral boards....is this true? help would be appreciated.
 
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deleted171991

Skip the basic. It's too easy and useless. Save your money, or rather go for the advanced testamur.

There are various pathways to certification. Look it up on echoboards.org.
 
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dr.doe

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thx for replying...I have read the guidelines on echo-boards however it is still not entirely clear to me. I am not sure yet whether or not I will do a CT fellowship but I think it is a great skill to have either way. I also think that your TEE experienced in your residency program would be enhanced if you are aiming for a certain goal..... Advanced testamur is definitely a good thought. Am I allowed to take it during residency?
 
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deleted171991

thx for replying...I have read the guidelines on echo-boards however it is still not entirely clear to me. I am not sure yet whether or not I will do a CT fellowship but I think it is a great skill to have either way. I also think that your TEE experienced in your residency program would be enhanced if you are aiming for a certain goal..... Advanced testamur is definitely a good thought. Am I allowed to take it during residency?
This is your friend: http://echoboards.org/docs/AAdvPTE_Cert_App-2017.pdf .

It seems that they require the applicants to have an unrestricted medical license. I don't know if a training license qualifies.
 

psychbender

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thx for replying...I have read the guidelines on echo-boards however it is still not entirely clear to me. I am not sure yet whether or not I will do a CT fellowship but I think it is a great skill to have either way. I also think that your TEE experienced in your residency program would be enhanced if you are aiming for a certain goal..... Advanced testamur is definitely a good thought. Am I allowed to take it during residency?
You can take the tests whenever (the Basic is still only offered every other year, though, right?), you just cannot become certified until you meet all of the criteria, one of which is completing residency. If your residency is really echo heavy, and you think you can pull off studying for both the echo and anesthesia boards at the same time, then go for it. It would probably be a better idea, however, to take the echo boards the following year.
 
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