Can you combine CC with ID and Renal?

[Kakarrott]

From a couple of my previous posts and my "research" on Reddit I found out that Critical Care is a great speciality that offers variety, you can diagnose, you can do procedures, people are collapsing out of various reasons, it just seems to be a great anti-boring speciality.
On the other hand, Nephrology is an incredibly interesting field and from what I've seen or read here or there it is also quite cerebral, not so much repetitive and it connects to CC quite well because every second patient has something wrong with kidneys.
ID, on the other hand, has always interested me, there is something beautiful in Microbiology and how those little creatures can mutate and become more and more advanced even trough vaccines or antibiotics. Some can even seem like something else so it takes a lot of "puzzling" work to make a good call/diagnosis/treatment. Also somewhere was stated that ICU/CC patients and patients, in general, are dying mostly due to Infectious Diseases. (That article even said there's a need for good brains in ID. ) I also know this can be combined with CC.

What is on my mind is if I could be a CC specialist who is also specialist on ID and Nephrology so I don't have to consult so much and I can save time doing more work. I've never been interested in hours or lifestyle so I wouldn't mind working a lot.

I just wanted to know if this combo is possible,
Also if it even makes sense, I know as a CC I can always call a specialist but I also know the time is precious.
And lastly, I wanted to know, in a case this combo was possible and made sense if a person can still be a Consultant in Renal and ID even though he is a CC in some big tertiary academic centre. (that's just my wish, to boost that variety.)

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[spacegun]

It's definitely possible to do the combo because I have seen nephro/CC and ID/CC. They are not as common as pulm/CC but they are possible.

I am just a med student but my understanding is the main problem isn't doing CC but it's what you want to do when you are not doing CC. For example a hospital can have you do a week (7 days) of CC in a month, but then you fill the rest of your time in the month with pulm, ID, nephro, or even other specialties (e.g. anesthesia, neurology). It just depends what you want to do when you are not in the unit. Or you can just do straight CC and work approximately half the month.

People like @jdh71, @CCM2017, and @Nephro critical care would have a lot more insight. And maybe see if you can ask a mod to move this question to the CC forum as you might get more help there.

 

[Kakarrott]

I kinda already knew you can do ID+CC and Nephro+CC.

I ment if one could do a wombo combo of all of those, ID+Nephro+CC

I know it is not usual to be tripple boarded so I ask people with more exp.

 

[NewYorkDoctors]

I kinda already knew you can do ID+CC and Nephro+CC.

I ment if one could do a wombo combo of all of those, ID+Nephro+CC

I know it is not usual to be tripple boarded so I ask people with more exp.

I am combining CC + Pulm + Renal (and keeping GIM) .

There is No acgme rule stopping you frOm doing every single fellowship out there . The key is usually how long do you want fellows pay? Who will hire a multi boarded doctor? (I have that part taken care of ) and can you convince the next fellowship to take you ?

It’s usuall easier to go from a more competitive fellowship to a less ...


Further a hospitals renal department will be very territorial and likely not allow you to do icu HD or CRRT without their consultation as it’s big money / RVUs for them

ID and abx is whatever I suppose

 

[cbrons]

I kinda already knew you can do ID+CC and Nephro+CC.

I ment if one could do a wombo combo of all of those, ID+Nephro+CC

I know it is not usual to be tripple boarded so I ask people with more exp.

Lol.... are you a premed student?

 

[CCM-MD]

From a couple of my previous posts and my "research" on Reddit I found out that Critical Care is a great speciality that offers variety, you can diagnose, you can do procedures, people are collapsing out of various reasons, it just seems to be a great anti-boring speciality.
On the other hand, Nephrology is an incredibly interesting field and from what I've seen or read here or there it is also quite cerebral, not so much repetitive and it connects to CC quite well because every second patient has something wrong with kidneys.
ID, on the other hand, has always interested me, there is something beautiful in Microbiology and how those little creatures can mutate and become more and more advanced even trough vaccines or antibiotics. Some can even seem like something else so it takes a lot of "puzzling" work to make a good call/diagnosis/treatment. Also somewhere was stated that ICU/CC patients and patients, in general, are dying mostly due to Infectious Diseases. (That article even said there's a need for good brains in ID. ) I also know this can be combined with CC.

What is on my mind is if I could be a CC specialist who is also specialist on ID and Nephrology so I don't have to consult so much and I can save time doing more work. I've never been interested in hours or lifestyle so I wouldn't mind working a lot.

I just wanted to know if this combo is possible,
Also if it even makes sense, I know as a CC I can always call a specialist but I also know the time is precious.
And lastly, I wanted to know, in a case this combo was possible and made sense if a person can still be a Consultant in Renal and ID even though he is a CC in some big tertiary academic centre. (that's just my wish, to boost that variety.)

You can do anything. Be the first IM+Nephro+ID+GI+Cardio+Pulm+Endocrine... + CCM. Do it all!

 

[Nephro critical care]

Three specialities is 1 too many. The problem is that since the conventional pathway is pulm/cc , people who are outliers like neph/cc , ID/cc have a harder time getting jobs. I did neph and then CC and then found I was unable to get a Neph/cc job. I went into a hospital as an intensivist that also had employed nephrologists and for the first 2 1/2 yrs did straight CC with a little bit of hospitalist thrown in. Now finally there is a nephrology opening and I am getting the chance to do neph/CC. Even now I can’t get a 0.5/0.5 FTE and still have to add neph on top of a full 1 FTE CC job which means a lot of slogging for me.
ID/Neph/CC it will be a nightmare finding a combo job. Most likely you will waste one of the 3 fellowships.

 

[Kakarrott]

Nephro Critical - thanks so much for your insight even bad news are still a news

 

[NewYorkDoctors]

Though back to the initial poster's question, Renal/ID might be a very unique opportunity. Skip the CCM in that case.
Renal/ID would be a transplant team's best friend (ID for any post transplant issues, renal for the eventual Prograf toxicity that many other organ transplants may encounter... for instance cardiac transplant uses high prograf trough levels that would squeeze the fight out of any afferent arteriole).

With Renal and ID both in such low supply of fellows, one can easily get BOTH of these at a top academic center with transplant and then get comfy with both departments.

Just a thought.

Plus Dr. Gregory House from the TV show was "dual certified in nephrology and infectious disease RESIDENCIES." You can have a blast at parties I guess.



In addition, ICU related ID is rather straightforward. It's probably a fungus or ehrlichia at the rarest, if you have to scratch your head.

Your ID knowledge on paracocciodiomycosis, on visceral larva migrans, and on the life cycle of the various nematodes is probably not needed in the ICU nearly enough to warrant yourself having the ID board certification

 

[drfunktacular]

As others have noted--you can do anything you want to. However, the system works the way the system works, so you should understand that the more "outside the box" a thing you're trying to do, the less easy it will be for you to find your perfect job in the real world.

So if you're extremely passionate about something that would require particular expertise gained through multiple subspecialty trainings, then by all means pursue that. If you just think it would be kind of cool, it's probably not worth the extra trouble, and you'll probably end up primarily practicing one thing or another. You see this a lot in people coming out of the combined allergy/immunology/rheumatology programs--eventually they settle on A/I or rheum because the way the system works makes it hard to do both. If you're primarily interested in CC, you'll learn enough ID, renal, etc in your fellowship to do 90% of what a CC doc needs to do, and you have consultants to handle the 10% of things you can't or don't want to figure out.

Also note, your annual opportunity cost in terms of salary differential of an extra year of fellowship vs "real job" may exceed $150k

 

[Raryn]

What's interesting is per a strict reading of the ACGME rules, if you've done any IM fellowship, you qualify for a 1 year CC fellowship (rather than 2 years if you do it standalone).

So you could theoretically do ID/CC, nephro/cc, or even rheum/cc or endo/cc in 3 years. Good luck finding a CC program that will accept you for a one year track though.

 

[CCM-MD]

What's interesting is per a strict reading of the ACGME rules, if you've done any IM fellowship, you qualify for a 1 year CC fellowship (rather than 2 years if you do it standalone).

So you could theoretically do ID/CC, nephro/cc, or even rheum/cc or endo/cc in 3 years. Good luck finding a CC program that will accept you for a one year track though.

Just to add on to this. To be board eligible for CCM after 1 year requires any 2 or 3 year IM subspecialty fellowship. Doing a 1 year fellowship like sleep medicine or hospice will still require 2 years of training in critical care medicine to become board eligible for CCM.

 

[drfunktacular]

What's interesting is per a strict reading of the ACGME rules, if you've done any IM fellowship, you qualify for a 1 year CC fellowship (rather than 2 years if you do it standalone).

So you could theoretically do ID/CC, nephro/cc, or even rheum/cc or endo/cc in 3 years. Good luck finding a CC program that will accept you for a one year track though.

bwahahahahahahahhaahaaaaaa