CC Fellowships

[jumpin bean]

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When is comes to medicine, my favorite is OR anesthesiology and my second favorite is critical care. Do you think that it is wiser to do a fellowship in CCM in anticipation of anesthesia becoming more of a perioperative field or go out into private practice and secure a partnership track ASAP?

Here are some of my thoughts

Pros for CCM fellowship
- more well-rounded peri-op physician
- most certainly has excellent job security

cons for CCM fellowhship
- Another year of training
- In order to practice CCM, would most definitely have to move my family to a different part of the country to find an established group to join. Other option is to stay academic.
- If I did a CCM fellowship and then got a job in an OR, I couldn't jump into the ICU 10 years later because of a fellowship I did a decade ago because the field changes so rapidly.

Pros for going into Private practice
- I like providing anesthesia more than CCM and it makes more money, so why not do it? If it becomes impossible to continue as an OR only doc in the future, I can cross that bridge when i come to it and do a fellowship then.

cons for going into private practice
- theoretical fear that OR only practice will be phased out

Any advice appreciated!

 

[militarymd]

I don't think anyone has a crystal ball, but I will say this, there are no guarantees in the high pay in anesthesia. The minute the insurance companies start decreasing reimbursements, CCM could be more lucrative.

 

[ThinkFast007]

I don't think anyone has a crystal ball, but I will say this, there are no guarantees in the high pay in anesthesia. The minute the insurance companies start decreasing reimbursements, CCM could be more lucrative.

Hey militarymd et al

question....

I was talking to this trauma surgeon/chief of critical care at my school the other day. I"m only an MSIII and expressed to him that I wanted to do Anes and in particular CCM. He told me that although ANES docs used to head ICUs, etc, they're really trying to get rid of Anes docs as CCM docs and instead pulmonologists are 'taking over'.

is this just his bias? The reason I ask is because he literally made it sound as though Anes Docs will NEVER be allowed to practice CCM in the future...

Thanks

 

[gaslady]

You could always go back and do a CC fellowship afterwards if you changed your mind. In reality it would be so tough to do once you started making an attending salary. The financial issue isn't just because you make more passing gas, you lose money doing the fellowship too. That's one more year that you aren't making an attending salary.

That's ridiculous. Anesthesiologist's skills and training makes them very qualified to attend in ICUs. It is true though that there are many more pulmonary trained docs in CCM.

 

[militarymd]

Hey militarymd et al



is this just his bias? The reason I ask is because he literally made it sound as though Anes Docs will NEVER be allowed to practice CCM in the future...

Thanks

Maybe, maybe not. Very regional dependent and center dependent. If you go to Europe/UK....only anesthesiologists do CCM...Come over here....anesthesiologists don't want to do it......reason....reimbursements. If insurance companies change how they pay, I'm sure there'll be a lot more anesthesiologists doing CCM.

 

[jumpin bean]

Hey militarymd et al

question....

I was talking to this trauma surgeon/chief of critical care at my school the other day. I"m only an MSIII and expressed to him that I wanted to do Anes and in particular CCM. He told me that although ANES docs used to head ICUs, etc, they're really trying to get rid of Anes docs as CCM docs and instead pulmonologists are 'taking over'.

is this just his bias? The reason I ask is because he literally made it sound as though Anes Docs will NEVER be allowed to practice CCM in the future...

Thanks

Who is trying to get rid of Anes docs as CCM docs? I don't think that is true. The hard part is getting anesthesia residents to go into CCM. You might run into a problem finding an existing Anes CCM group to join in many parts of the country, but you could always start your own. There are a lot of open units (no dedicated intensivist) that your newly formed CCM group could lobby to take over. I think the hard part will be finding partners. I often search gaswork for anes/critical care groups . . . they are out there. If you aren't a trail blazer and don't want to start an intensivist-run unit from scratch, you may have to move. Also, you'll always have a home in academics as an anesthesiologist-intensivist, because the requirement for ICU for anes residents is increasing from 2 months to 6 months.

 

[allendo]

Hey just a question! How long is a cc fellow after a combined Im/Er residency?

 

[jumpin bean]

Hey just a question! How long is a cc fellow after a combined Im/Er residency?

After 3 years of IM, the critical care fellowship is 3 years. After 4 years in anesthesia, the critical care fellowship is one year. I don't know how many years it is after a 5 year surgery residency.

 

[KGUNNER1]

Hey just a question! How long is a cc fellow after a combined Im/Er residency?

Actually, the critical care only portion is 2 years. If you want to bundle it with a subspeciality like pulmonary or nephrology, it is then another year (or 3 total).

Some of my friends petitioned the ABIM to try an shave one year off (so only 1 year after an EM/IM) since there are approved 6 year programs out there now (Ford in Detroit and U. Pitt - no slots or funding for Pitt yet though). However, the majority of us did the 2 year gig, so total of 7 years (5 EM/IM, 2 CCM)

Peds - 3 years - regardless what you've done during your peds residency
Anesth - 1 yr
Surgery - 1 yr (usually along with some trauma work)
OB (yes OB) 1 yr.

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