Board certification for MICU/SICU/NSICU

[Encrypted]

Medical Student here. I only have experience rotating in a SICU but may not want to go the surgery route to become an intensivist.

I was wondering if anyone can shed some light on who works where. For example, if I am board certified by the American Board of Internal Medicine in critical care, would it be possible to land a job in a SICU? And on the other hand, if I'm board certified by the American Board of Surgery in surgical critical care, would it be possible to work in a MICU?

Do internists/EM critical trained docs only work MICU's? Do surgeons/anesthesiologists/EM critical trained docs only work SICU's?

---

Members don't see this ad.

 

[dotcb]

Your best bet is to train in a multidisciplinary critical care fellowship, which has more to do with the individual fellowship than the certifying board. You will be trained to function in the breadth of ICU settings. That being said, you do have to pick a certifying body, and for the most part - certifying bodies do have an impact on what setting you end up in. Med ICU fellowship -> more likely to work in MICU. Surgical critical care -> SICU. Anesthesia -> SICU

You should choose your field/residency based on the field you'd most enjoy practicing in the event you DON'T do a fellowship. A lot can change in your life in 3-5 years.

 

[secants]

Your best bet is to train in a multidisciplinary critical care fellowship, which has more to do with the individual fellowship than the certifying board. You will be trained to function in the breadth of ICU settings. That being said, you do have to pick a certifying body, and for the most part - certifying bodies do have an impact on what setting you end up in. Med ICU fellowship -> more likely to work in MICU. Surgical critical care -> SICU. Anesthesia -> SICU

You should choose your field/residency based on the field you'd most enjoy practicing in the event you DON'T do a fellowship. A lot can change in your life in 3-5 years.

I'm an MS4 and applying for a field that will allow me to enter a CC fellowship. Just to add-on on what you said about training in a multi-specialty setting, these are places that seem to focus on this type of training: Stanford, Pitt, WashU.

Feel free to add any other programs, those were the only ones on my trail that kept popping up.

 

[VA Hopeful Dr]

At my local teaching hospital, the IM intensivists attend for the surgery residents in the SICU. They've apparently had trouble finding a true trauma surgeon.

 

[jdh71]

Critical care is critical care is critical care BUT it's nuanced - reflexes are a bit different in each of the big areas of critical care. I also agree getting exposure to a broad range of critical care in training will be good for anyone. With the right reflexes you can work effectively in any ICU area as long as you have a grip on the basics of critical care.

All of the jobs I looked at, even those with true in-house trauma surgeons, have the medical intensivists co-managing on adult trauma patients and also any intubated cardiology patient. The CVT surgeons handled their own ICU patients unless they had a specific question. Based on other practice models I am familiar with from friends and acquaintances, almost exclusively MICU is attended by a pulmonary and or medical critical care trained person, with the occasional original EM trained person tossed into the mix. SICUs are a much more mixed bag - and in some places are covered by the MICU people, or the anesthesia trained people, if not the surgeons themselves. CVT ICUs tend to be watched by the surgeons themsleves, but if not them directly then usually someone from an anesthesia background, but I do know of a spot or two where these patients are co-managed by MICU as well.

So, it really seems like a lot of this isn't "set in stone", and I agree with the other poster who suggested going into the initial training you like or prefer because it doesn't seem to matter too much on the practical side.

I think the MOST well rounded guy right out of training in the unit would come out of an EM/IM background, with the full three years of pulmonary and critical care medicine. Most people will simply not tolerate the 8 years of training for that though. The question is given the practice patterns, which you will pick up when you get to where you work, all of the extra training may amount to very little at the end of a year, maybe even six months, when you cross-compare to folks who didn't do the extra, extra years. We're all pretty smart people (those who go into a career as a physician) and if you have an interest and a willingness, you can work wherever.

 

[chmd]

It's true that medical ICUs are generally covered with IM physicians but many places in both academics and private practice have a significant anesthesiology presence. SICU and NSICUs are very mixed in private practice but in academics are generally the purview of surgeons and anesthesiologists. CTICUs are also either surgeons or anesthesiologists.

The answer is simple: a good fellowship will train a smart and motivated individual from any specialty to be a capable intensivist. If you want to focus on MICUs and want to spend at least 50% of your time in pulmonology clinic then do IM. If you want to be a surgeon then do surgery and if you like anesthesia do anesthesia because you can't last long doing ICU work 100% of the time and very few people try it.

Btw it's absurd to postulate that the IM route produces better intensivists than anesthesiology or surgery. My personal experiences have shown me that, at least as residents and fellows, IM gets smoked by anesthesiologists and surgeons. I'm biased of course.

 

[jdh71]

Btw it's absurd to postulate that the IM route produces better intensivists than anesthesiology or surgery. My personal experiences have shown me that, at least as residents and fellows, IM gets smoked by anesthesiologists and surgeons. I'm biased of course.

No one said IM produces "better" intensivists. When your surgeon and gas friends rotate over in my unit they appear rather lost as well . . . hmm . . .

Get the basics in fellowship, learn your practice environment.

 

[VJWDO]

Agree with jdh71. When the anesthesia, neuro, surgical CC folks rotate through our unit they need some hand holding. The patients are just way more sick and complicated than they are used to. IM is not better, we just have the IM background that allows us to have a little more experience with medical nightmares. I am not going to profess to be the queen of the SICU or NeuroICU so it goes both ways.

 

[Hamhock]

The patients are just way more sick a.

What makes you say "more sick"? I have found that not to be true at all.

Yes, the PMHx column is often deeper...and the MICU often has patients with relatively "rare" diseases more often (more consultants too), but I wouldn't say sicker...CTICU heart and especially lung transplant patients, for example, are often some the sickest in the hospital.

Chronic illness, old age, and recidivism do not necessarily equate with "sick".

(this is coming from someone who has no "skin" in the traditional "who's better prepared" game)

HH

 

[redy]

It's true that medical ICUs are generally covered with IM physicians but many places in both academics and private practice have a significant anesthesiology presence. SICU and NSICUs are very mixed in private practice but in academics are generally the purview of surgeons and anesthesiologists. CTICUs are also either surgeons or anesthesiologists.

The answer is simple: a good fellowship will train a smart and motivated individual from any specialty to be a capable intensivist. If you want to focus on MICUs and want to spend at least 50% of your time in pulmonology clinic then do IM. If you want to be a surgeon then do surgery and if you like anesthesia do anesthesia because you can't last long doing ICU work 100% of the time and very few people try it.

Btw it's absurd to postulate that the IM route produces better intensivists than anesthesiology or surgery. My personal experiences have shown me that, at least as residents and fellows, IM gets smoked by anesthesiologists and surgeons. I'm biased of course.

I think the settings are different enough that anesthetists/ surgical intensivists are not comfortable in micu and IM intensivists are not comfortable in sicu or cticu. I don't think that makes either better. I just think they bring different approaches or reflexes as jdh stated above.

 

[jdh71]

What makes you say "more sick"? I have found that not to be true at all.

Yes, the PMHx column is often deeper...and the MICU often has patients with relatively "rare" diseases more often (more consultants too), but I wouldn't say sicker...CTICU heart and especially lung transplant patients, for example, are often some the sickest in the hospital.

Chronic illness, old age, and recidivism do not necessarily equate with "sick".

(this is coming from someone who has no "skin" in the traditional "who's better prepared" game)

HH

Define "sick". That long list of past medical history you simply dismissed is all part of the ongoing disease process and needs to be factored in and dealt with all within the context of whatever is causing the critical illness in the first place. So if "sicker" means more crap wrong with them that will require you to deal with them PLUS their critical illness then "sicker" usually applies to the MI. As someone who also has experience with lung transplant (we co-manage vent and immunosuppression post-op), and I know that @VJWDO does too, I know that MOST of these cases are rather straight-forward, most extubate the next day, and are out of the unit and off of the CTI service and on the pulmonary service fairly soon. This is the way it usually goes because we don't just approve transplants in just anyone. You actually have to be reasonably healthy outside of your pulmonary disease to get a lung transplant. With that said, I also know that when the lung transplant goes bad, especially with acute graft dysfunction those are nights you just don't sleep. So in this context if you mean "sick" as in "could easily die, very soon and needs a lot of constant attention" then I see your point, even concede it. Usually the MI patients once you've got them tucked in, tend not to decompensate in as acute manner as things like when post-transplants go to crap.

This is one of the reasons I'm glad I had experience with transplant, but will be happy to never see much of it again.

 

[ORL10]

Im in a multi-disciplinary CC program, I do find that initially anesthesia/EM/Surgery people have a harder time adjusting to the MICU as compared to IM guys in the SICU/CVICU, although airways tend to not be managed by most IM/Surgery-trained fellows alone. In the CVICU, most fellows seem out of sorts their first month as not many have taken care of post-op VADs complicated heart- lung-kidneys, total artificial hearts etc..

That being said 8 months in everyone knows the pulmonary complications in the BMT disasters by date of transplant, knows how to manage post-op lungs, pre-op train wreck liver bombs, and VADs. As you say CC is CC is CC. Highest learning curve for me as a non-IM guy was MICU without a doubt, but many sleepless nights lots of reading and painful calls make it a pretty even playing field for most fellows after a year of fellowship.

 

[Dwindlin]

Any other way to find these "multi-disciplinary" programs other than brute googling skills?

 

[Hamhock]

Any other way to find these "multi-disciplinary" programs other than brute googling skills?

Not really, as there isn't an official definition of "multi-disciplinary" CCM programs...there are so few CCM programs vs. PulmCCM programs it is worth the time looking each of them up.

"Multi-disciplinary" (MD -CCM) means different things to different people and likely has varying degrees of importance to people from different specialties.

MD-CCM could mean a program through a Department of CCM (as opposed to a division of IM or a part of PulmCCM or anesthesiology) preparing graduates for CCM certification in surgery, anesthesiology, and internal medicine; like in Pittsburgh. It could mean that units are closed and covered by CCM docs from many different base specialities. It could mean a "joint" program with input from both internal medicine and anesthesiology. It could mean a program that rotates its fellows through surgical and medical units in a more balanced fashion that is demanded by the governing bodies. It could mean a program that accepts graduates of different base specialties but trains them all the same way for the same CCM certification (see Shock Trauma for EM grads in the past).

It all depends on what you mean by "multi-disciplinary". So, you gotta Google.

HH

 

[Dwindlin]

Yeah figured. Thanks for the reply though.


Sent from my iPhone using Tapatalk

 

[ihearttriangles]

Not really, as there isn't an official definition of "multi-disciplinary" CCM programs...there are so few CCM programs vs. PulmCCM programs it is worth the time looking each of them up.

"Multi-disciplinary" (MD -CCM) means different things to different people and likely has varying degrees of importance to people from different specialties.

MD-CCM could mean a program through a Department of CCM (as opposed to a division of IM or a part of PulmCCM or anesthesiology) preparing graduates for CCM certification in surgery, anesthesiology, and internal medicine; like in Pittsburgh. It could mean that units are closed and covered by CCM docs from many different base specialities. It could mean a "joint" program with input from both internal medicine and anesthesiology. It could mean a program that rotates its fellows through surgical and medical units in a more balanced fashion that is demanded by the governing bodies. It could mean a program that accepts graduates of different base specialties but trains them all the same way for the same CCM certification (see Shock Trauma for EM grads in the past).

It all depends on what you mean by "multi-disciplinary". So, you gotta Google.

HH

I think we should use a strong definition of "multi-disciplinary". It would require that a program trains IM/EM/gas/surg fellows together, in a non-hierarchical manner, in a variety of types of ICU. To my knowledge there are two programs that fit this bill: Pitt and Stanford. Some people say shock trauma too but I believe they almost exclusively train surgery or EM fellows and don't train in the MI. But, obviously, I could be mistaken on either of these points.

Baystate is another name I've heard mentioned but don't really know anything about.
If anyone knows about any other multi-disciplinary programs please share.

 

[Hair Police]

I think we should use a strong definition of "multi-disciplinary". It would require that a program trains IM/EM/gas/surg fellows together, in a non-hierarchical manner, in a variety of types of ICU. To my knowledge there are two programs that fit this bill: Pitt and Stanford. Some people say shock trauma too but I believe they almost exclusively train surgery or EM fellows and don't train in the MI. But, obviously, I could be mistaken on either of these points.

Baystate is another name I've heard mentioned but don't really know anything about.
If anyone knows about any other multi-disciplinary programs please share.

At STC, they train all backgrounds (EM, IM, GS, gas) and will put you through the MICU at UMD. That program is hosted by the ACS and will let you sit for the surgery CC board.

That being said, the IM (and EM) folks going for the IM-hosted program at UMD also get to rotate through STC.

 

[Hamhock]

At STC, they train all backgrounds (EM, IM, GS, gas) and will put you through the MICU at UMD. That program is hosted by the ACS and will let you sit for the surgery CC board.

That being said, the IM (and EM) folks going for the IM-hosted program at UMD also get to rotate through STC.

STC/UMD really points out a find distinction between multi-disciplinary programs as defined by ihearttriangles and programs with grads from a couple of base specialites (but not all) and training in multiple ICUs (but not all and the ratios dependent on base specialty -- that is, not all fellows are treated equally).

I think STC/UMD would be multidisciplinary if the STC program combined with the UMD program. Now that would be a great Department of CCM and a great fellowship.

HH

 

[deleted547339]

1. Sorry to bump a semi-old thread.

2. I'm an EM resident who's going to go into CC (academics). I've read a lot and can't seem to find a great answer (maybe because there isn't one?) . I want to do a multidisciplinary CC fellowship - I'm just trying to figure out anesthesia vs. medicine. If I do anesthesia but end up preferring the MICU, are there universities that would hire an EM--> anesthesia CC attending? And vice versa, if I go IM but decide I want to work in a SICU/NICU/CVICU/whatever, are there universities that would hire me?

I know there are ACGME rules about non-ABIM faculty, but my read of the rules is that a non-ABIM faculty simply can't be considered "core" faculty.

Thanks. And sorry if this has been addressed previoulsy.

 

[Hamhock]

TNR -

I am not going to be much help regarding the EM-anesthesia CCM route.

However, you should know -- and I can confirm with published documentation if needed -- EM to CCM via an ABIM-approved CCM program will certainly allow an EM-based CCM grad to be "core" faculty in at an ACGME IM residency as long as the EM-CCM grad is working in the ICU and has completed an ABIM CCM fellowship and is board-certified through ABIM (really it's through ABEM with ABIM sponsorship).

HH

 

[deleted547339]

TNR -

I am not going to be much help regarding the EM-anesthesia CCM route.

However, you should know -- and I can confirm with published documentation if needed -- EM to CCM via an ABIM-approved CCM program will certainly allow an EM-based CCM grad to be "core" faculty in at an ACGME IM residency as long as the EM-CCM grad is working in the ICU and has completed an ABIM CCM fellowship and is board-certified through ABIM (really it's through ABEM with ABIM sponsorship).

HH

Thanks. That's helpful to know. If i were to go the IM-route, but get strong multidisciplinary training, do you think it would be feasible to get a job working in a SICU/NICU/CVIVU in academics?

Thanks again.

 

[namethatsmell]

Thanks. That's helpful to know. If i were to go the IM-route, but get strong multidisciplinary training, do you think it would be feasible to get a job working in a SICU/NICU/CVIVU in academics?

Thanks again.

My n=2 but at our two main hospitals there are IM-trained CC docs working in the SICU, NICU, and CVICU. My sense is this is doable in many markets (NICU being the toughest to cross into).

 

[deleted547339]

My n=2 but at our two main hospitals there are IM-trained CC docs working in the SICU, NICU, and CVICU. My sense is this is doable in many markets (NICU being the toughest to cross into).

Thanks. Any thoughts on anesthesia to MICU? Maybe should just ask in the anesthesia forum...

 

[namethatsmell]

Thanks. Any thoughts on anesthesia to MICU? Maybe should just ask in the anesthesia forum...

Possible in the community but more difficult in academics as I think you need to be boarded via an IM-CC pathway to supervise IM residents though I'm hearing this may change.

For what its worth I'm strongly considering CC fellowship and am torn between IM and Anesthesia based CC programs. I want the ability to work primary in a MICU if I choose which makes the IM path appealing but some of the Anesthesia CC programs for EM grads seem pretty darn robust. Not sure if this is your dilemma but if so I can relate.

 

[deleted547339]

Possible in the community but more difficult in academics as I think you need to be boarded via an IM-CC pathway to supervise IM residents though I'm hearing this may change.

For what its worth I'm strongly considering CC fellowship and am torn between IM and Anesthesia based CC programs. I want the ability to work primary in a MICU if I choose which makes the IM path appealing but some of the Anesthesia CC programs for EM grads seem pretty darn robust. Not sure if this is your dilemma but if so I can relate.

Same.

 

[deleted547339]

Possible in the community but more difficult in academics as I think you need to be boarded via an IM-CC pathway to supervise IM residents though I'm hearing this may change.

For what its worth I'm strongly considering CC fellowship and am torn between IM and Anesthesia based CC programs. I want the ability to work primary in a MICU if I choose which makes the IM path appealing but some of the Anesthesia CC programs for EM grads seem pretty darn robust. Not sure if this is your dilemma but if so I can relate.

FYI, I just started a similar thread in the anesthesia forum. Mods, please don't bring down the hammer.

 

[rollininthedeep]

Would you mind sharing the thread as I'm interested in the answer as well? Thanks.