Anesthesiology vs Internal Medicine for eventual route to CC?

[NotTheOne]

(Versus Emergency Medicine as well I suppose)

hey guys I’m currently a 2nd year about to head into rotations and really want to find a path to ICU. I understand that Anesthesia trained CC docs mostly do Surg ICU vs Medince trained who do MICU. Is there one you guys would prefer or think is better than the other?

also while I do like the idea of anesthesiology I don’t have too much exposure to it since shadowing opportunists were very limited ever since last March. I’m not to sure what the field is like, but it seems nice.
Would love to get some thought. Thanks.

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[POW16]

I would recommend using the search function in this forum and in the critical care one. This has been discussed many times. You can do critical care via multiple paths including those you mentioned + neurology (to be a neurointensivist). There is no "better" path. CCM is a multidisciplinary field.

 

[Katheudontas parateroumen]

What is it about ICU that attracts you? I think that is an important question to answer. Although ICU is a multidisciplinary field, different units definitely have different patient populations. In general, anesthesia will care for SICU/CTICU, medicine and Pulm/cc generally have the most options for jobs/units, surgeons cover SICU/Trauma ICU, EM i think mostly surgical but probably have a slight edge into MICU compared to Anesthesia based. And then as mentioned, neurology basically only covers NeuroICU. But there's also Peds for PICU and Neonatal ICU.

In terms of anesthesia, critical care is definitely a broadening of our horizons. You will be great at airway/procedures, pressors, clinical pharm/physiology, taking care of sick patients acutely, resuscitation. But we lack longer term care perspectives, diagnostic workups, medical management of certain medical illnesses ID/rheum, etc. At the end of the day, you'll have to fill in gaps of knowledge no matter what base field you go into. I find that most people who like anesthesia tend not to give up their anesthesia practice (plenty of anesthesia CCM people only do anesthesia) so then that limits us to mostly academic practices if you want to do both. Anesthesiology is a really fun field and definitely a change of pace from the ICU. ICU complements what we are missing in anesthesia, but on the other hand, anesthesia allows you to do acute medicine for all the things we may like. No paperwork, no long term followup, not being primary so you can punt off issues, being able to focus on one patient at a time (if you're doing your own cases).

 

[NotTheOne]

What is it about ICU that attracts you? I think that is an important question to answer. Although ICU is a multidisciplinary field, different units definitely have different patient populations. In general, anesthesia will care for SICU/CTICU, medicine and Pulm/cc generally have the most options for jobs/units, surgeons cover SICU/Trauma ICU, EM i think mostly surgical but probably have a slight edge into MICU compared to Anesthesia based. And then as mentioned, neurology basically only covers NeuroICU. But there's also Peds for PICU and Neonatal ICU.

In terms of anesthesia, critical care is definitely a broadening of our horizons. You will be great at airway/procedures, pressors, clinical pharm/physiology, taking care of sick patients acutely, resuscitation. But we lack longer term care perspectives, diagnostic workups, medical management of certain medical illnesses ID/rheum, etc. At the end of the day, you'll have to fill in gaps of knowledge no matter what base field you go into. I find that most people who like anesthesia tend not to give up their anesthesia practice (plenty of anesthesia CCM people only do anesthesia) so then that limits us to mostly academic practices if you want to do both. Anesthesiology is a really fun field and definitely a change of pace from the ICU. ICU complements what we are missing in anesthesia, but on the other hand, anesthesia allows you to do acute medicine for all the things we may like. No paperwork, no long term followup, not being primary so you can punt off issues, being able to focus on one patient at a time (if you're doing your own cases).

I suppose what draws me to it is dealing with the worst of the worst outcomes. I think (?) I would be good with those types of patients. Managing multiorgan Complexities as well and I also find rounding fun. I think dealing with patients that have the potential to change how they’re progressing in an instant is fascinating. How the physiology of the body works in patients like this.
I don’t know if that’s naive though.

I read what you write about anesthesia and find it to be very fun sounding and certainly a good change of pace. I suppose what I’m asking in reality is if the balance of doing Anesthesia and CCM is better than doing perhaps a Hospitalist/ICU position which might be a bit more similar to each other . I don’t really know much about how hospitals go about hiring doctors to work in two separate specialties like that

 

[deleted162650]

I also find rounding fun

Said no anesthesiologist ever.


IM it is then.

 

[NotTheOne]

Said no anesthesiologist ever.


IM it is then.

Fun but not crucial 😉.

 

[Precedexx]

I'm about to start anesthesia residency and likely will do ICU fellowship. I am drawn to ACCM for many of the reasons you listed. If I had to summarize, I would say I want to be an expert in all aspects of the management of critically ill surgical patient. I also think that there is so much overlap between the ICU and anesthesiology (all forms of advanced life support, airway/vent management, lines of all kinds, acute bedside stabilization of the crashing patient, echo, etc). I rotated through the SICU and CTICU and greatly enjoyed both rotations, and personally I enjoy the pathology seen in those units more than in the MICU. I also think it is super cool to be able to truly understand/be an expert in the intraop management and then in the pre/post OP ICU care. At my institution, I have seen a lot of respect from the surgeons for the ACCM docs, I think because they are very good intraop (the ACCM docs I talk to say that the fellowship just makes you that much more confident with really sick patients in all settings) and also because the ACCM docs have an excellent understanding of the big picture for these patients. I also personally enjoy ICU rounds like you (IM rounds were ok but I enjoy the problems we deal with in the ICU more, the multidisciplinary nature of it, the complicated fam issues, etc). I also think the mix of 1 week ICU, 2-3 weeks OR per month sounds excellent and would keep me engaged in both. I also want to be in academics (blasphemy on SDN but it's true), so I don't worry about finding a job with a mix. I guess finally, and perhaps most importantly, I love anesthesiology and would be totally happy to do anesthesia full time and not do ICU if I change my mind as a resident. IM, not so much for me.

 

[Katheudontas parateroumen]

Haha. I totally overlooked that part about enjoying rounds. To be honest I enjoy rounds too because I like to know my patients both personally and medically. I definitely don’t fit the typical anesthesia personality as well haha. But I enjoy the job but I’d much rather do icu than anesthesia. Having said that, I would have done pulm/cc instead. Although IM residency is way less tolerable than anesthesia residency. I almost stayed in my prelim IM program to finish out.

 

[partydoc]

Said no anesthesiologist ever.


IM it is then.

Eh, I enjoy my ICU rounds.

 

[chessknt]

I suppose what draws me to it is dealing with the worst of the worst outcomes. I think (?) I would be good with those types of patients. Managing multiorgan Complexities as well and I also find rounding fun. I think dealing with patients that have the potential to change how they’re progressing in an instant is fascinating. How the physiology of the body works in patients like this.
I don’t know if that’s naive though.

I read what you write about anesthesia and find it to be very fun sounding and certainly a good change of pace. I suppose what I’m asking in reality is if the balance of doing Anesthesia and CCM is better than doing perhaps a Hospitalist/ICU position which might be a bit more similar to each other . I don’t really know much about how hospitals go about hiring doctors to work in two separate specialties like that

If complex medical disease management is your primary interest then internal medicine is going to be a far better choice than anesthesiology. Anesthesiology doesn't really 'manage' complex diseases beyond the hyperacute periop period. Same goes for em.

 

[Nivens]

I’ve elaborated on this in other posts so will keep this brief: over 2/3 of anesthesia applicants to our residency list ICU as their number one interest. We are averaging less than 1 graduating resident entering ICU in a coass of nearly 30 over the last 10 years. Yes, some of this is program-specific, but issues with our residency do not explain all of the unfilled anesthesia icu fellowship spots around the country every year.

Don’t do anesthesia unless you are interested in anesthesia, period.

 

[nimbus]

I’ve elaborated on this in other posts so will keep this brief: over 2/3 of anesthesia applicants to our residency list ICU as their number one interest. We are averaging less than 1 graduating resident entering ICU in a coass of nearly 30 over the last 10 years. Yes, some of this is program-specific, but issues with our residency do not explain all of the unfilled anesthesia icu fellowship spots around the country every year.

Don’t do anesthesia unless you are interested in anesthesia, period.

And even the ones who complete CCM fellowships and get CCM boarded often end up practicing 100% anesthesia. Most of the anesthesia/CCM trained doctors I know practice anesthesia only. Only a small fraction of a small fraction end up practicing CCM.

 

[chocomorsel]

Eh, I enjoy my ICU rounds.

Me too.

 

[chocomorsel]

If complex medical disease management is your primary interest then internal medicine is going to be a far better choice than anesthesiology. Anesthesiology doesn't really 'manage' complex diseases beyond the hyperacute periop period. Same goes for em.

And that is why he or she is talking of doing a fellowship. I don’t know about you but I managed complex diseases in my fellowship. And in the community setting, it is not a bunch of zebras. It’s straight forward horses over there.
Now there is a knowledge deficit as been mentioned above w certain sub specialties but that just requires reading and exposure to learn.
OP, you will likely face discrimination but less than I have by the time you are out in the real world community ICU. I have but I get job offers when I travel because people I guess are surprised that I am not an idiot in the ICU. That I am actually good at what I do even as a lowly gas passer without an IM background. Sure I don’t know how to do a slick bronch like the pulm guys, and some heme/onc/rheum stumps me but guess what? You can consult and learn till you are comfortable. And of course even then, never hurts to talk to the experts.

Good luck. And yeah, I also liked rounds as I like learning and hearing other peoples thought processes. Not the never ending four to six hour ones though in MICU as my feet hurt LOL. Don’t listen to the non ICU docs on that. We are all different.

 

[chocomorsel]

And even the ones who complete CCM fellowships and get CCM boarded often end up practicing 100% anesthesia. Most of the anesthesia/CCM trained doctors I know practice anesthesia only. Only a small fraction of a small fraction end up practicing CCM.

I know. I don’t get it. What a waste of a year and money. But it is a little difficult to find a CCM job so people probably just give up.
I almost gave up, then Covid came to save my ass!

 

[chessknt]

And that is why he or she is talking of doing a fellowship. I don’t know about you but I managed complex diseases in my fellowship. And in the community setting, it is not a bunch of zebras. It’s straight forward horses over there.
Now there is a knowledge deficit as been mentioned above w certain sub specialties but that just requires reading and exposure to learn.
OP, you will likely face discrimination but less than I have by the time you are out in the real world community ICU. I have but I get job offers when I travel because people I guess are surprised that I am not an idiot in the ICU. That I am actually good at what I do even as a lowly gas passer without an IM background. Sure I don’t know how to do a slick bronch like the pulm guys, and some heme/onc/rheum stumps me but guess what? You can consult and learn till you are comfortable. And of course even then, never hurts to talk to the experts.

Good luck. And yeah, I also liked rounds as I like learning and hearing other peoples thought processes. Not the never ending four to six hour ones though in MICU as my feet hurt LOL. Don’t listen to the non ICU docs on that. We are all different.

Unless I misread this is a student who hasnt started residency yet. Lots of things change in residency and if complex disease management and forming thoughtful differentials is interesting now then he/she may find heme/onc or rheum interesting and specialize in that from IM. From anesthesia that kind of exposure isnt going to exist but the flip side is there are opportunities for hands on acute management of very very sick people that doesnt exist in any other specialty. I would advise a student to pick a primary specialty for that specialty and not a fellowship because a lot can change during training.