Best Critical Care Programs

[michigangirl]

I assume this only accounts for med/ccm and not anes/ccm?

I'm contemplating doing 2 fellowships. Peds and CCM. who knows.

What are you going to do with those two fellowships if you do them? Spend half your time in the adult ICUs and half your time as a pediatric anesthesiologist? It's feasible, but highly likely you will get tired of splitting your time and won't want to do one of them eventually. It's hard to be excellent at taking care of two completely different populations day in day out. It's hard enough for me to do only pediatrics and split time between the picu and peds anesthesia.

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[Doctor4Life1769]

What are you going to do with those two fellowships if you do them? Spend half your time in the adult ICUs and half your time as a pediatric anesthesiologist? It's feasible, but highly likely you will get tired of splitting your time and won't want to do one of them eventually. It's hard to be excellent at taking care of two completely different populations day in day out. It's hard enough for me to do only pediatrics and split time between the picu and peds anesthesia.

At this point, I'm not sure.

I do like being able to deal with ALL types of patients. Be primarily in the OR, but spend some part time in the ICU to get away from the OR and deal with acutely ill patients.

 

[michigangirl]

At this point, I'm not sure.

I do like being able to deal with ALL types of patients. Be primarily in the OR, but spend some part time in the ICU to get away from the OR and deal with acutely ill patients.

I highly suggest you go with adults only if that's where you're headed. That's why i did a pediatrics and anesthesia residency, so i could do pediatric icu and get away from it to the OR. or if you decide to do a peds fellowship, keep doing some adult anesthesia, OB, etc. to break it up. But peds anesthesia and adult ICU-- near impossible, in my opinion.

 

[Doctor4Life1769]

I highly suggest you go with adults only if that's where you're headed. That's why i did a pediatrics and anesthesia residency, so i could do pediatric icu and get away from it to the OR. or if you decide to do a peds fellowship, keep doing some adult anesthesia, OB, etc. to break it up. But peds anesthesia and adult ICU-- near impossible, in my opinion.

Thanks for the advice.

 

[draks]

I'm doing pulm/crit. I only know SLU by reputation and gossip (which is good). Doing critical care just about anywhere that does it will be fine for almost any academic job. As far as their standing, I think based on what I've heard they are well respected, they aren't Pitt, or Vandy, or UWash, or UCSF - but, you know . . . solid.

Let me put it this way, I do not think you are doing yourself a disservice by training there, not in the least. If you're asking about Pitt vs SLU, you should go to Pitt if you have the chance, IMHO, but SLU is a good program.

Hi. One more question. Do you know anything about the CC program at Clevland clinic and how do you compare it to SLU.

Thanks

 

[jdh71]

Hi. One more question. Do you know anything about the CC program at Clevland clinic and how do you compare it to SLU.

Thanks

CCF will have a lot more transplant - decide if you would like that. That have arguably the sickest MICU by apacheII scores, or they did at one time. Just taking care of those patients will be good training. The environment is borderline malignant by gossip. It's a private money making beast and you are their bitch. Make sure you know what you're signing up for.

SLU a nice multi-disciplinary bread and butter program. The gossip is heavy procedural training, including bedside trachs. Can't go wrong with a program like this if you're planning a future community practice. Probably a dead end for academic medicine unless you're interested in clinical or instructor tracks.

 

[canadia22]

One more thought on those IMG docs: Starting medical school out of high school means six years of medical school in Europe. Critical Care is not a sub-specialization and is five years after that - at least where I am. Since when do American doctors have an intellectual monopoly? I hear the French have some amazing ICU docs and every country in Europe has its own solid base of intensivists. A good doctor is a good doctor anywhere in the world. As far as I can tell, we study the same textbooks and read the same journals.

 

[jdh71]

One more thought on those IMG docs: Starting medical school out of high school means six years of medical school in Europe. Critical Care is not a sub-specialization and is five years after that - at least where I am. Since when do American doctors have an intellectual monopoly? I hear the French have some amazing ICU docs and every country in Europe has its own solid base of intensivists. A good doctor is a good doctor anywhere in the world. As far as I can tell, we study the same textbooks and read the same journals.

It's a little unclear what you're arguing about here? What's the point?

 

[canadia22]

I'm trying to make a point, since someone commented on a program being less-then-stellar because it was filled with IMG's - that irregardless of where they started out, they are likely more than qualified for the positions they are in. Training outside of America does not equate with a physician being less skilled or less qualified in many cases.

 

[jdh71]

I'm trying to make a point, since someone commented on a program being less-then-stellar because it was filled with IMG's - that irregardless of where they started out, they are likely more than qualified for the positions they are in. Training outside of America does not equate with a physician being less skilled or less qualified in many cases.

And sometimes it does . . . but that's neither here nor there . . .

Generally a program is not less desirable because there are FMGs there, but rather you can tell the program itself is less desirable because AMGs didn't want to match there and they had to rely on FMGs to fill their fellowship spots. If the program was awesome AMGs would be there. It's just the nature of the competitive environment. Th best programs fill with best AMGs and everyone else fights for what's left over.

 

[draks]

CCF will have a lot more transplant - decide if you would like that. That have arguably the sickest MICU by apacheII scores, or they did at one time. Just taking care of those patients will be good training. The environment is borderline malignant by gossip. It's a private money making beast and you are their bitch. Make sure you know what you're signing up for.

SLU a nice multi-disciplinary bread and butter program. The gossip is heavy procedural training, including bedside trachs. Can't go wrong with a program like this if you're planning a future community practice. Probably a dead end for academic medicine unless you're interested in clinical or instructor tracks.

Thanks,

Are you currently doing PCCM from a big program? So, you would choose SLU compared to CCF it seems. Why do you feel that SLU would be dead end for academics??

 

[jdh71]

Thanks,

Are you currently doing PCCM from a big program? So, you would choose SLU compared to CCF it seems. Why do you feel that SLU would be dead end for academics??

You could find an instructor gig out of SLU, sure, but if you want tenured research tracks, you need to have a base of research, funding, and mentorship - I don't think SLU has that. You could still find work teaching residents and students.

If I had to choose between SLU and CCF. I think I'd go SLU, yes.

 

[sineapse]

Generally a program is not less desirable because there are FMGs there, but rather you can tell the program itself is less desirable because AMGs didn't want to match there and they had to rely on FMGs to fill their fellowship spots. If the program was awesome AMGs would be there. It's just the nature of the competitive environment. The best programs fill with best AMGs and everyone else fights for what's left over.

This. Why go with an unknown quantity when you have safety and security in US school products?
Some things you just have to accept in life, this is one of them...I'd feel the same way as an AMG about IMGs coming to the UK to work.

 

[Hamhock]

xxx

 

[CharmCityRunner]

Someone said Duke's ICU leaves much to be desired?

Any thoughts on UNC or Wake? How about U maryland?

I'm just applying to IM residency so I have some time, but I want to go somewhere that will give me quality CC training.

 

[Mrishi]

You could find an instructor gig out of SLU, sure, but if you want tenured research tracks, you need to have a base of research, funding, and mentorship - I don't think SLU has that. You could still find work teaching residents and students.

If I had to choose between SLU and CCF. I think I'd go SLU, yes.

Hey, I was wondering if you could tell me what you know about Mt Sinai NY CCM program s reputation. Just got an interview there and not sure if I really want to interview in NY.

 

[jdh71]

Hey, I was wondering if you could tell me what you know about Mt Sinai NY CCM program s reputation. Just got an interview there and not sure if I really want to interview in NY.

I honestly don't know anything about it.

 

[Mrishi]

Hey, does anybody know about the Mayo clinic CCM program?

 

[DTUD]

4th year medical student heavily considering PCC here. Sounds like Pitt is a great program especially for those more interested in the CC aspect of PCC, and I'd imagine it might be a bit easier to get in to their fellowship as a Pitt resident. My question is though, can anyone comment on the ICU training you get there as a resident ? Is it one of those programs where the fellowship is where it really shines, perhaps taking away from some of the resident autonomy/procedure opportunities ? Or is it a great place to get a strong CC foundation during residency as well ?

 

[KaoticMessiah]

Residents can Tailor their experience to get the ICU experience they desire. You'll do time in the MICU with some of the sickest patients in the world, some time in the CICU with the end stage CHF patients and post-arrest patients, and can do many other electives as well. I'm not a medicine resident at Pitt, but have worked with many of them, and those that are critical care-inclined seem very happy with their experience in residency. There's no question that the patients here are on the extreme end of the illness spectrum. The pulm-CCM program is one of the best in the country and is very competitive, so coming here for residency and starting some research in the department would definitely help get your foot in the door.

 

[NYDO2014]

how about U-Florida?

 

[yellow]

...on the East Coast.

U Washington is probably the best program in the country.

BE

Why is U Washington the best program in the country?

 

[bashwell]

Why is U Washington the best program in the country?

@gutonc made this comment back in 2006. Not sure if he'd still hold to the same opinion given a lot could have changed in the past nearly decade. Although I'm sure UDub is still a solid program, maybe even a great program, just not sure if it's "the best". But maybe I'll be surprised.

 

[Doctor Bob]

"Best" is relative.

The best CCM program for an anesthesiologist looking to work in a CTICU might be different than the best CCM program for an EM person looking to work in a MICU which might be different than the best CCM program for a surgeon looking to work in a SICU.

Best will also be different for someone who wants a wide-variety of CCM versus someone who wants to focus on surgical versus medical ICU. Best will also be different for someone who is a book learner versus a hands-on learner.

Trying to rank programs has always been infuriating for everyone involved. There is no consensus.

 

[happylunchbox]

I'll be applying for straight CC. Things I value highly are solid clinical training and a non-malignant environment (in terms of attending/staff personality, I have no issue working hard). Does anybody have any recent thoughts on the following places:

Brown
Cooper
George Washington
Maryland
Mayo (MN)
Montefiore/Einstein
OHSU
Pitt
SLU/Mercy
University of Washington

Please PM if you're more comfortable doing that. Thanks in advance!

 

[Hamhock]

and just to clarify, UPMC may be the best CCM program but the pulmonary is not the best there

.

birdstruck

 

[Laryngophed]

Does anyone have any knowledge of or thoughts on WashU's multi-d CCM program?

 

[psychbender]

PD2B, this response is more for the general public, since we've talked about this before.

All shift work (no traditional in-house call or home call), lots of day-night cycling, almost half your fellowship will be nights. The units looked great, very fellow-led, seemed like solid didactics and academic expectations. Most of my interviewers were also easy to speak to, especially the PD. The biggest drawbacks for me were the rapid cycling (with small kids, I'd like to occasionally be home for dinner) and the fact that I'm not a fan of St Louis (or cities in general, to be fair).

Does anyone have any knowledge of or thoughts on WashU's multi-d CCM program?

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[happylunchbox]

PD2B, this response is more for the general public, since we've talked about this before.

All shift work (no traditional in-house call or home call), lots of day-night cycling, almost half your fellowship will be nights. The units looked great, very fellow-led, seemed like solid didactics and academic expectations. Most of my interviewers were also easy to speak to, especially the PD. The biggest drawbacks for me were the rapid cycling (with small kids, I'd like to occasionally be home for dinner) and the fact that I'm not a fan of St Louis (or cities in general, to be fair).



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Almost half of the fellowship (i.e. ~8 mos) is nights?? For reals?

 

[psychbender]

Almost half of the fellowship (i.e. ~8 mos) is nights?? For reals?

Well, when you do five nights, two days off, four days, one day off, four nights,...and repeat for a full year, you'll spend about half of your ICU time doing 12-hour night shifts. So, not half of one full year, but half of your nine or ten months of ICU. I would assume that your electives would be mostly day time.

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[psychbender]

So, I should correct my previous post. I was contacted by a fellow there who says that the actual amount is closer to one third of your shifts during your ICU months, not half. I guess the schedules I was shown were not necessarily representative of the full year. Still, that's a hell of a lot of nights spent at the hospital.

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