CCM in the Community

[deleted725838]

I'm EM and debating CCM pathways. I love the physiology, I love the science, I enjoy the practice of ICU medicine. I also still think EM is worthwhile and instead of doom and gloom the residents a year above me are all finding good jobs.

My question is specifically for those practicing CC in the community. Will there be job options if I'm EM to Anesthesia Crit? Is it better to go IM-CCM?

Finally, and perhaps most importantly. When you're in the community. What is your 7 days on like? I'm only familiar with the Academic context where the attending is there 8-3 ish and available by phone. If I'm in the community am I both the attending, AND the resident answering a page about ducolax at 3 am?

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[chocomorsel]

You get a job that is only 12 hour shifts and no call. Or if there is call you can take a chance on random NPs at night calling since they are all so varied in training and experience. My part time job with NP coverage at night let’s me sleep all night as they are strong NPs. My full time job does not do night call as we all rotate.
I am Anesthesia CCM and have not had a hard time finding work since Covid became a thing.

 

[chessknt]

I'm EM and debating CCM pathways. I love the physiology, I love the science, I enjoy the practice of ICU medicine. I also still think EM is worthwhile and instead of doom and gloom the residents a year above me are all finding good jobs.

My question is specifically for those practicing CC in the community. Will there be job options if I'm EM to Anesthesia Crit? Is it better to go IM-CCM?

Finally, and perhaps most importantly. When you're in the community. What is your 7 days on like? I'm only familiar with the Academic context where the attending is there 8-3 ish and available by phone. If I'm in the community am I both the attending, AND the resident answering a page about ducolax at 3 am?

If you work in a real ICU and not a stepdown unit in disguise your nurse wont call you about stupid **** at 3 AM. ICU RNs have to be some of the chillest people around and dont get worked up over dumb stuff (usually). I have never worked in a real ICU where I got called about anything asinine on a regular basis overnight.

 

[deleted725838]

Obviously my experience is very limited. But where I am....we've had fairly fresh RN's becoming ICU nurses.

To the point where I've explained the DKA orderset a couple of times.

 

[PTPoeny]

Obviously my experience is very limited. But where I am....we've had fairly fresh RN's becoming ICU nurses.

To the point where I've explained the DKA orderset a couple of times.

Agree. We have nurses who have been out of nursing school for less than a year training the brand new nurses...

 

[chocomorsel]

If you work in a real ICU and not a stepdown unit in disguise your nurse wont call you about stupid **** at 3 AM. ICU RNs have to be some of the chillest people around and dont get worked up over dumb stuff (usually). I have never worked in a real ICU where I got called about anything asinine on a regular basis overnight.

So there is no NP/PA or residents on at night? If so, who does admissions? You gotta come in for that? What if someone is crashing? Curious as I know this used to be very common in the past and I know bad things had to have happened at night.

 

[chessknt]

So there is no NP/PA or residents on at night? If so, who does admissions? You gotta come in for that? What if someone is crashing? Curious as I know this used to be very common in the past and I know bad things had to have happened at night.

We use an eicu for cross-cover at one hospital and cover it ourselves at night as a dedicated float. A different hospital I worked at would only call me for serious concerns not asinine orders.

 

[CCM-MD]

I would only take a gig where intensivist is primary (closed ICU) if there is 24/7 in house intensivist presence. Otherwise, the next best set up is open ICU with intensivist consult and home call at night, hospitalists/other services remain the admitting. This is my set up right now and I only get called for major issues and only have to go in for something like a chest tube or bronch.

All of the other set ups where CCM is primary and there’s night NP/PA/eICU coverage with intensivist home call are not worth it IMO.

 

[Ccm1215]

I would only take a gig where intensivist is primary (closed ICU) if there is 24/7 in house intensivist presence. Otherwise, the next best set up is open ICU with intensivist consult and home call at night, hospitalists/other services remain the admitting. This is my set up right now and I only get called for major issues and only have to go in for something like a chest tube or bronch.

All of the other set ups where CCM is primary and there’s night NP/PA/eICU coverage with intensivist home call are not worth it IMO.

For such setups where you take calls from home and may have to come in occasionally for crashing pts or procedures do you typically get like a call pay overnight or it is expected for all day time intensivists to split night calls with no extra compensation?

 

[CCM-MD]

For such setups where you take calls from home and may have to come in occasionally for crashing pts or procedures do you typically get like a call pay overnight or it is expected for all day time intensivists to split night calls with no extra compensation?

Probably all kinds of contracts out there. We get per shift pay plus wRVU bonus and the night call is part of the deal. I’m sure there are places that pay for call but may pay a lower shift rate and at the end of the day it might come out to the same total compensation.

The nocturnists handle most things at night including codes so we don’t usually have to come in for “crashing patients”. We get called if they want to run something by us - usually a ventilator issue, or if someone needs a procedure that can’t be done by someone in houses. It would be a weird set up to require someone at home to come in for a “crashing patient” since most truly crashing patients would be dead by the time someone gets out of bed and comes in from home.

Bottom line is, the best model is 24/7 in house intensivist coverage, which is what most reputable institutions are implementing. I work in a >400 bed hospital in the “middle of nowhere” where it’s very challenging to recruit which is why we have the model we have.

 

[Siggy]

I would only take a gig where intensivist is primary (closed ICU) if there is 24/7 in house intensivist presence. Otherwise, the next best set up is open ICU with intensivist consult and home call at night, hospitalists/other services remain the admitting. This is my set up right now and I only get called for major issues and only have to go in for something like a chest tube or bronch.

All of the other set ups where CCM is primary and there’s night NP/PA/eICU coverage with intensivist home call are not worth it IMO.

One thing to note is that every hospital I've been at has had an "open" ICU on paper... but in actual practice it's treated as a closed ICU for medical patients.

 

[The kitchen sink]

Probably all kinds of contracts out there. We get per shift pay plus wRVU bonus and the night call is part of the deal. I’m sure there are places that pay for call but may pay a lower shift rate and at the end of the day it might come out to the same total compensation.

The nocturnists handle most things at night including codes so we don’t usually have to come in for “crashing patients”. We get called if they want to run something by us - usually a ventilator issue, or if someone needs a procedure that can’t be done by someone in houses. It would be a weird set up to require someone at home to come in for a “crashing patient” since most truly crashing patients would be dead by the time someone gets out of bed and comes in from home.

Bottom line is, the best model is 24/7 in house intensivist coverage, which is what most reputable institutions are implementing. I work in a >400 bed hospital in the “middle of nowhere” where it’s very challenging to recruit which is why we have the model we have.

I use to hate nights, but now as an attending i like doing some night shifts per diem for these institutions switching to 24/7, the caveat being I negotiated like my life depended on it. Know that they need you more than you need them