Cardiac and CCM

[Boujee]

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Hey guys...

Longtime reader here with minimal posts....currently a CA2...

So, I am interested in doing both a Cardiac and CCM fellowship....

I was wondering which you guys think would be more beneficial to do first?

Would i be a better Cardiac Anesthesilogist if i did CCM first?
Would i be a better intensivist if I did a Cardiac fellowship and got TEE certification?

Thank you in advance

 

[aredoubleyou]

Hey guys...

Longtime reader here with minimal posts....currently a CA2...

So, I am interested in doing both a Cardiac and CCM fellowship....

I was wondering which you guys think would be more beneficial to do first?

Would i be a better Cardiac Anesthesilogist if i did CCM first?
Would i be a better intensivist if I did a Cardiac fellowship and got TEE certification?

Thank you in advance

You've got issues dude 😀

But since this isnt a pyschological evaluation of why you want to do 2 extra years of residency, there are combined CCM/CT fellowships which are only a year and a half long...such as at wash u.

 

[Coastie]

You've got issues dude 😀

But since this isnt a pyschological evaluation of why you want to do 2 extra years of residency, there are combined CCM/CT fellowships which are only a year and a half long...such as at wash u.

The 1.5 yrs tracks are gone..

It's 1 & 1 now..

 

[Masseter Spasm]

Do you really want to do two fellowships?

possible alternatives:

Get enough cardiac/TEE experience during your CA-3 year to get TEE certified (I do not think you need to do an actual cardiac fellowship to get certified in TEE. You just need to pass an exam.) Then do a CCM fellowship

or

Do a CCM fellowship with TEE exposure. I think they exist

or

Do a CCM fellowship and gain cardiac/TEE competency out in practice. Many groups will get a junior attending up to speed with cardiac cases once you start working.

 

[seinfeld]

If you dont plan on doing academics no point in doing 2 fellowships. Your opportunity cost of doing 2 fellowships is at least $400,000.

CCM and Pain are the only 2 fellowships for which you can become a different kind of doctor, both of which you can get board certified in.

If you plan on being the go to cardiac guy and spend most of your life in the Cardiac OR then do a cardiac fellowship. Otherwise do like i did. I did CCM fellowship, spent free time/elective time to build TEE numbers doing my CCM fellowship. Went into private practice where i spend 30% of time in the ICU and the rest split between cardiac and regional anesthesia.

good luck with your soul searching.

 

[Bertelman]

Get enough cardiac/TEE experience during your CA-3 year to get TEE certified (I do not think you need to do an actual cardiac fellowship to get certified in TEE. You just need to pass an exam.) Then do a CCM fellowship

You don't need a fellowship to get basic TEE cert.

You do need a fellowship to get advanced cert.

 

[Mista Suprane]

You don't need a fellowship to get basic TEE cert.

You do need a fellowship to get advanced cert.

this is a common misconception.

a CCM fellowship counts for this. per the american society of echocardiography, you just have to spend some time in your fellowship taking care of critically ill cardiac patients (which is fulfilled by a cardiac fellowship and many CCM fellowships). as long as you get your numbers (which takes some doing), you are eligible to sit for the advanced exam having only done CCM.

in fact, duke's CCM 1-year program guarantees that you will get enough numbers.

http://anesthesiology.duke.edu/wysiwyg/downloads/CCMFellowship2-2010.pdf

 

[RT2MD]

See... I thought this had changed. I thought that the class that graduated in 2009 was the last one to be able to get TEE cert w/o a cardiothoracic fellowship. If not, though, that would be great!

 

[Bertelman]

this is a common misconception.

a CCM fellowship counts for this. per the american society of echocardiography, you just have to spend some time in your fellowship taking care of critically ill cardiac patients (which is fulfilled by a cardiac fellowship and many CCM fellowships). as long as you get your numbers (which takes some doing), you are eligible to sit for the advanced exam having only done CCM.

in fact, duke's CCM 1-year program guarantees that you will get enough numbers.

http://anesthesiology.duke.edu/wysiwyg/downloads/CCMFellowship2-2010.pdf

I wouldn't call it a misconception at all. The statement below sounds pretty clear to me. Duke and a few other programs have just happened to find a way to entice people to their CCM fellowship by offering echo cert.

That does sound like a great way to squeeze 2 yrs of fellowship into one, though.

Per the NBE:

Fellowship Pathway:
Applicants must have a minimum of 12 months of clinical fellowship training dedicated to the perioperative care of surgical patients with cardiovascular disease. Training obtained during the core residency (anesthesiology, internal medicine, or general surgery) may not be counted toward this requirement. Fellowship training in cardiothoracic or cardiovascular anesthesiology must be obtained at an institution with an ACGME or other national accrediting agency accredited training program in anesthesiology.
For applicants finishing their core residency after June 30, 2009, fellowship training must be obtained in an ACGME accredited fellowship program.

 

[proman]

The Duke CCM fellows can do 3 months of cardiac OR time + dedicated TEE time. Easy to meet the requirements.

 

[cfdavid]

If you dont plan on doing academics no point in doing 2 fellowships. Your opportunity cost of doing 2 fellowships is at least $400,000.

CCM and Pain are the only 2 fellowships for which you can become a different kind of doctor, both of which you can get board certified in.

If you plan on being the go to cardiac guy and spend most of your life in the Cardiac OR then do a cardiac fellowship. Otherwise do like i did. I did CCM fellowship, spent free time/elective time to build TEE numbers doing my CCM fellowship. Went into private practice where i spend 30% of time in the ICU and the rest split between cardiac and regional anesthesia.

good luck with your soul searching.

that sounds like a really great balance. good to hear.

 

[seinfeld]

that sounds like a really great balance. good to hear.

I feel i have a great setup. My groups case load along with the ICU has made it a great job coming out of training.

 

[Mista Suprane]

I wouldn't call it a misconception at all.

my point was that the misconception that people seem to share is that you have to do a cardiac fellowship to be allowed to sit for the advanced TEE exam, and this is not true. a CCM fellowship will qualify you, although most CCM programs can't/won't give you enough numbers.

 

[Bertelman]

my point was that the misconception that people seem to share is that you have to do a cardiac fellowship to be allowed to sit for the advanced TEE exam, and this is not true. a CCM fellowship will qualify you, although most CCM programs can't/won't give you enough numbers.

I understand your point, I was just arguing semantics. I don't consider it a misconception if a few CCM programs have chosen to define themselves as "fellowship training in cardiothoracic or cardiovascular anesthesia".

That's an exception in my book, not a misconception.

 

[Boujee]

hey thanks guys for all the insight...

seinfeld, that is a dope setup you got. What kind of hospital/practice are you in?

 

[Mista Suprane]

I understand your point, I was just arguing semantics. I don't consider it a misconception if a few CCM programs have chosen to define themselves as "fellowship training in cardiothoracic or cardiovascular anesthesia".

That's an exception in my book, not a misconception.

reread the original NBE statement you posted. the part of that statement that you are referring to is only saying the following: in order to sit for the advanced echo exam, IF you do a fellowship in cardiothoracic anesthesia it MUST be at an ACGME accredited program.

so CCM programs are NOT defining themselves as "fellowship training in cardiothoracic or cardiovascular anesthesia" because this is not required. rather, they are fulfilling the requirement that they are "a clinical fellowship training dedicated to the perioperative care of surgical patients with cardiovascular disease."

semantics, yes, but you would not believe how many people have the MISCONCEPTION (and actually say the exact words) - "you have to do a cardiothoracic anesthesia fellowship in order to sit for the TEE exam" and they are WRONG. that is ALL I was saying. provided you have the numbers, any CCM fellowship ALONE is enough. they do not need to, nor are they, making special statements or defining themselves in an a way that you perceive is an exception. simply by their existence, ANY CCM FELLOWSHIP fulfills the requirements to sit for the exam and the NBE agrees.

 

[proman]

Here's the blurb from the NBE applications for the advanced exam:

Applicants must have a minimum of 12 months of clinical fellowship training dedicated to the perioperative care of surgical patients with cardiovascular disease. Training obtained during the core residency (anesthesiology, internal medicine, or general surgery) may not be counted toward this requirement. Fellowship training in cardiothoracic or cardiovascular anesthesiology must be obtained at an institution with an ACGME or other national accrediting agency accredited training program in anesthesiology.

The NBE advanced PTE certification (and the above requirement) is not specific to anesthesiology. It also applies to surgeons. I'd imagine a fellowship trained cardiac surgeon with appropriate numbers would be eligible for the NBE board certification. The NBE is likely vague on purpose. I'd imagine most ACCM fellowships take care of surgical patients with cardiovascular disease in the perioperative period (but IM doing a MICU fellowship would not qualify).

 

[sunset823]

Hey guys...

Longtime reader here with minimal posts....currently a CA2...

So, I am interested in doing both a Cardiac and CCM fellowship....

I was wondering which you guys think would be more beneficial to do first?

Would i be a better Cardiac Anesthesilogist if i did CCM first?
Would i be a better intensivist if I did a Cardiac fellowship and got TEE certification?

Thank you in advance

I've been thinking about this too. I came into my summer anesthesia fellowship loving critical care, and yesterday during my required weekly clinical day I saw a cardio case, which was totally awesome. The attending did fellowships in both cardiac and CCM, at Columbia (so opportunity cost + manhattan prices) (and he's not that old, mid 30s).

So I guess I'd recommend looking at programs that have both fellowships and then discuss if there is a way to integrate them. I could tell you the former based on my research (yes, I'm only a rising M2, I love anesthesia and I'm anal):

University of Alabama
Loma Linda University
Stanford University
University of Florida
Jackson Memorial Hospital (Miami)
Emory University
McGaw Medical Center of Northwestern University
University of Chicago
Brigham & Women's Hospital
Massachusetts General Hospital
Beth Israel Deaconess Medical Center
Johns Hopkins University
University of Maryland
University of Michigan
Mayo Clinic (Rochester)
Washington University/Barnes Jewish Hospital
Duke University
New York Presbyterian (Columbia Campus)
New York University
Mount Sinai School of Medicine
University of Rochester
Cleveland Clinic Foundation
University of Cincinnati
University of Pennsylvania
Medical University of South Carolina
Vanderbilt University
University of Texas - Southwestern
University of Texas Medical Branch - Galveston
University of Washington

 

[ejs064]

I feel i have a great setup. My groups case load along with the ICU has made it a great job coming out of training.

Seinfeld, I imagine your career path is wanted by many. In my academic setting, I've had a tough time figuring out how feasible mixing CCM and OR anesthesia is in private practice. Did you find a number of opportunities similar to yours around the country? Are there any pay cuts associated with doing some CCM instead of all OR?

 

[seinfeld]

Seinfeld, I imagine your career path is wanted by many. In my academic setting, I've had a tough time figuring out how feasible mixing CCM and OR anesthesia is in private practice. Did you find a number of opportunities similar to yours around the country? Are there any pay cuts associated with doing some CCM instead of all OR?

Honestly did not have to look to much. The area my wife and i wanted to live on had this opportunity. So i cant tell you how the rest of the country is. I do not take any pay difference for doing icu. My group doesnt bill. The hospital stipends a salary and they bill.