GassmanMD

ASA Member
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Sep 10, 2011
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CA-2 here at the point in residency when everyone is starting to apply for fellowships. I would want to do a fellowship if it made me stand out and be more marketable to the broadest number of groups and job settings (pp, academics, kaiser,etc). I do not want to narrow my scope to just cardiac, I can't see myself doing peds and chronic pain is not for me. Out of the ACGME accredited fellowships, this leaves me with critical care as something I could see myself doing.

My question is: will a critical care fellowship make me marketable outside of academics? Will it help me get a private practice job within a competitive marketplace ?
 

Ezekiel2517

Anesthesiologist
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Jan 21, 2005
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yah
 

Femtochemistry

Skunk Works
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Academics: yes
PP: probably not

From my experience, doing CCM helped me get the job I wanted. But I went into academics where fellowships are much more appreciated. It's only 1 year and it can only help!
 

kazuma

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Nov 8, 2009
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Disclaimer, I'm a CA3 so I haven't done an extensive round of PP interviews yet. One job that I did interview for wanted me to forgo my CCM fellowship because they had a need for someone next year and they thought I would be a good fit. It was a though decision (excellent pay/vacation/benefits and 90%+ doing my own cases) but ultimately I had to pass on the job for next year but they will likely have a spot for me after my fellowship. Historically PP groups haven't been interested in subsidizing/supporting CCM services within a hospital as ICU is usually a money loser, although the place I'm going for fellowship somehow has a profitable Anes CCM division. Some of the intensivists in PP groups I've talked to do CCM on their own time during some of their 8-12 vacation weeks either through locum CCM jobs or by negotiating a deal with the medicine CCM groups. Other CCM trained folks don't do any ICU time in PP, but they are usually the go to guys for really sick patients and many of them do hearts (from my observations, the majority of PP cardiac anesthetics are not given my cardiac fellowship trained folks).

However, the landscape is changing and I've seen PP groups become more interested in hiring CCM trained folks in hopes of gaining a stronger foothold within hospitals and provide ICU services that an AMC can't easily offer. A CCM fellowship gives you more flexibility in where you will be able to practice in the future especially with the advent of the surgical home and ACO's.

I don't know how you feel about supervision, but IMO I would rather do 100% ICU time (24 weeks on/24 off is considered full time) with perhaps some locum OR gigs doing my own ASA 3-4's than supervise 4+ rooms. Doing your own cases in the future is going to become more and more rare and unless you are dealing with sick neonates, hearts, or complex/sick patients, chances are you may end up "supervising" 4+ rooms.

As a side note, doing any fellowship gives you 5 years of training which would allow you to bug out to Canada in the future if practicing medicine here in the US becomes too malignant and hostile.

I had a tough time deciding what fellowship to do because I like doing everything from OB, Peds, Hearts, Regional, ICU etc. I felt that CCM will give me the most flexibility in my practice to do a variety of cases without narrowing my interests to primarily peds and cardiac cases.
 
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GassmanMD

ASA Member
7+ Year Member
Sep 10, 2011
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Thanks for the reply kazuma. Sounds like you went through the same dilemma I am currently going through. I like everything also and do not want to be pigeon holed into a sub specialty which may narrow my scope. I agree, CCM will only broaden my scope.

I am also hearing about groups expanding services into the IcU to get a bigger piece of the pie when bundled payments arrive and also fits into a perioperative surgical home model. This could make Ccm trained anesthesiologists a hot commodity in the future.

Are you planning to go into private practice after fellowship?
 
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IlDestriero

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Nov 24, 2007
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10 years ago CCM was the red headed step child, its funny that some think it is the future.
I say just go get a job and make hay while the sun is shining.
 
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BLADEMDA

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Apr 22, 2007
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10 years ago CCM was the red headed step child, its funny that some think it is the future.
I say just go get a job and make hay while the sun is shining.

The easy money has been made. These days the new graduate is likely to find a different environment prior to recertification in Anesthesiology (in other words 10 years out). AMCs are eveRywhere and the pressure is to cut costs as well as salaries. I commend Kazuma for looking down the road and buying some insurance along with AN ENHANCED SKILL SET.
 
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