CCM + Pain?

[Dam272]

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Was wondering out loud. Is there a future in pursuing ccm and chronic pain fellowship? Both. Is there a possibility of jobs with 2 weeks in pain clinic and rest icu?

 

[sevoflurane]

Pain is one of those specialities you should probably do full time.

I’m sure it can be done, just not sure it’s worth it.

 

[POW16]

Is there a future ? A bleak one at best. Is it possible? Probably. If you managed to work 1/2 weeks per month in an ICU and 2 weeks a month doing pain. Sounds like a guaranteed path to burnout though.

 

[Orin]

CCM + palliative might be a better fit, but either way you'd likely be locking yourself into an academic job if you're looking to do both, and only at places that have good relationships between the two divisions or two departments. I would think cancer centers might like it?

 

[2Fast2Des]

A very strange combination in general, knew one guy who was finishing his chronic pain fellowship after ICU and he felt he was God's gift to mankind for his total periop "ability".

 

[Hork Bajir]

I feel like ICU and pain generally attract people with fairly different personalities and mentalities... Hard to imagine someone who loves one of those fields also really enjoying the other, but to each their own. Agree with the above poster that ICU and pall care might be a more realistic combo, unless the procedural aspect of pain is what you drawn to.

Out of curiosity, OP, how far along are you in your training?

 

[Modanq]

ICU and palliative that's a nice combo.

 

[Dam272]

I feel like ICU and pain generally attract people with fairly different personalities and mentalities... Hard to imagine someone who loves one of those fields also really enjoying the other, but to each their own. Agree with the above poster that ICU and pall care might be a more realistic combo, unless the procedural aspect of pain is what you drawn to.

Out of curiosity, OP, how far along are you in your training?

I am finishing ca1

 

[Hoya11]

Was wondering out loud. Is there a future in pursuing ccm and chronic pain fellowship? Both. Is there a possibility of jobs with 2 weeks in pain clinic and rest icu?

ive seen a lot and ive never seen this combo, i would reevaluate

 

[psychbender]

I worked with one guy that was Anes/CCM, but also did Pain (no fellowship, just a lot of great hairs). He stopped doing CCM by the time I knew him, but before that he did pain clinic two days a week, then split the rest of his time between anesthesia and critical care, all at the same hospital (hospital employed). He's now at an academic center, and by far the rare exception that would make this combination work.

 

[deleted171991]

ICU and palliative that's a nice combo.

Except that one can seldom practice both at the same institution. So, then, why do them? Each of these fellowships is $250K (or more) in opportunity cost. Neither of them is worth that money. Palliative is semi-useless in many institutions; I can see it taken over by midlevels big time, in the future.

Anesthesia-CCM is for the maniacs who are passionate about it, or for losers who cannot get a better fellowship (and need one, for cacademic purposes). American critical care has been canibalized by infernal medicine (another genius move of the previous LAZY generation of anesthesiologists, the same who gave us the CRNA plague), so the Anesthesia-CCM job market sucks accordingly. It is another one of the many situations where anesthesiologists bring a lot to the table (airway, pain, resus skills), but the bean counters keep ignoring us (hence the pulmonologist cancer in American ICUs - when it should be anesthesia +/- EM, as in the entire civilized world, especially in the era of frequent subspecialty consults).

Also, a critical care fellowship won't help one gain new OR skills to the level it would command a salary premium (like cardiac). I am CCM and I myself have little respect for residents who go into it (unless I see the passion - rarely). To many anesthesiologists, CCM screams "sucks at anesthesia" (until proven otherwise). Pain, too, by the way. Palliative? That would be the kiss of death for an anesthesia career; I wouldn't hire one to change the tubing.

If one is interested in and good at pain, one should do pain (plus/minus anesthesia). There is no logic for another fellowship after pain. Why be somebody else's bitch when one could be an independent pain specialist? If I could make 150-200K for 40 hours of independent work that I like, I would quit tomorrow. Being one's own master is priceless. If you're interested in critical care, OP, keep reading about it, as a hobby. Do pain instead.

 

[deleted171991]

I worked with one guy that was Anes/CCM, but also did Pain (no fellowship, just a lot of great hairs). He stopped doing CCM by the time I knew him, but before that he did pain clinic two days a week, then split the rest of his time between anesthesia and critical care, all at the same hospital (hospital employed). He's now at an academic center, and by far the rare exception that would make this combination work.

And that's the textbook definition of not being really good at anything.

 

[repititionition]

Except that one can seldom practice both in the same institution. So, then, why do them? Each of these fellowships is $250K (or more) in opportunity cost. Neither of them is worth that money. Palliative is semi-useless in many institutions; I can see it taken over by midlevels big time, in the future.

Anesthesia-CCM is for the maniacs who are passionate about it, or for losers who cannot get a better fellowship (and need one, for cacademic purposes). American critical care has been canibalized by infernal medicine (another genius move of the previous LAZY generation of anesthesiologists, the same who gave us the CRNA plague), so the Anesthesia-CCM job market sucks accordingly. It is another one of the many situations where anesthesiologists bring a lot to the table (airway, pain, resus skills), but the bean counters keep ignoring us (hence the pulmonologist cancer in American ICUs).

Also, a critical care fellowship won't help one gain new OR skills to the level it would command a salary premium (like cardiac). I am CCM and I myself have little respect for residents who go into it (unless I see the passion - rarely). To many anesthesiologists, CCM screams "sucks at anesthesia" (until proven otherwise). Pain, too, by the way. Palliative? That would be the kiss of death for an anesthesia career; I wouldn't hire one to change the tubing.

If one is interested in and good at pain, one should do pain (plus/minus anesthesia). There is no logic for another fellowship after pain. Why be somebody else's bitch when one could be an independent pain specialist?

well god damn

 

[psychbender]

And that's the textbook definition of not being really good at anything.

I can't really judge. He was out of the unit rotation when I got there, and I can't assess his abilities in the Pain arena. He was an absolute nerd when it came to biochemical pathways of drugs, neuroanatomy, and anesthesia history. He loved doing everything under regional or a spinal, if he could do it that way, and really pushed the group and the surgeons into adopting multimodal analgesia before it became a thing with ERAS. He's one of those guys that really belongs in academics because of his passion for teaching both the science and the art of the practice of medicine, but he hated the BS of academia. Hence, his career path went between the private sector and academics every so many years, and he's back in academics now.

 

[Dam272]

Except that one can seldom practice both in the same institution. So, then, why do them? Each of these fellowships is $250K (or more) in opportunity cost. Neither of them is worth that money. Palliative is semi-useless in many institutions; I can see it taken over by midlevels big time, in the future.

Anesthesia-CCM is for the maniacs who are passionate about it, or for losers who cannot get a better fellowship (and need one, for cacademic purposes). American critical care has been canibalized by infernal medicine (another genius move of the previous LAZY generation of anesthesiologists, the same who gave us the CRNA plague), so the Anesthesia-CCM job market sucks accordingly. It is another one of the many situations where anesthesiologists bring a lot to the table (airway, pain, resus skills), but the bean counters keep ignoring us (hence the pulmonologist cancer in American ICUs).

Also, a critical care fellowship won't help one gain new OR skills to the level it would command a salary premium (like cardiac). I am CCM and I myself have little respect for residents who go into it (unless I see the passion - rarely). To many anesthesiologists, CCM screams "sucks at anesthesia" (until proven otherwise). Pain, too, by the way. Palliative? That would be the kiss of death for an anesthesia career; I wouldn't hire one to change the tubing.

If one is interested in and good at pain, one should do pain (plus/minus anesthesia). There is no logic for another fellowship after pain. Why be somebody else's bitch when one could be an independent pain specialist?

Do you mean to say there are no jobs out there in a non-academic setting that allow both ICU and OR practice?

 

[deleted162650]

Do you mean to say there are no jobs out there in a non-academic setting that allow both ICU and OR practice?

There are very few non-academic Anes CCM jobs period.

 

[AdmiralChz]

Do you mean to say there are no jobs out there in a non-academic setting that allow both ICU and OR practice?

They exist but they are exceedingly rare. Most groups want nothing to do with unit staffing and won’t be willing to share you with a separate ICU group given the time away from the OR if you want a full week off after a week of unit coverage. I suppose you could go 0.5 FTE with 2 groups but you run the risk of getting no benefits from either job and being mega screwed financially.

The vast majority of ACCM grads either go academic or go 100% ICU.

 

[Dam272]

They exist but they are exceedingly rare. Most groups want nothing to do with unit staffing and won’t be willing to share you with a separate ICU group given the time away from the OR if you want a full week off after a week of unit coverage. I suppose you could go 0.5 FTE with 2 groups but you run the risk of getting no benefits from either job and being mega screwed financially.

The vast majority of ACCM grads either go academic or go 100% ICU.

There are non-academic jobs with 100% icu for accm grads? That sounds like a recipe for burnout

 

[partydoc]

There are non-academic jobs with 100% icu for accm grads? That sounds like a recipe for burnout

Usually 26 weeks. Hospitalists type week on week off

 

[deleted171991]

Do you mean to say there are no jobs out there in a non-academic setting that allow both ICU and OR practice?

There are, just much fewer/worse than people would expect.

 

[Dam272]

Usually 26 weeks. Hospitalists type week on week off

That actually doesn’t sound too bad

 

[psychbender]

That actually doesn’t sound too bad

That's half of all weeks, including half of all weekends. Maybe up to a quarter of those weeks are nights, depending on how many are in the group, and how days/nights are staffed. Those are also all 12+ hour days, so at least 84hrs for the weeks worked. I haven't worked that schedule (my old group had less unit time, more OR time), but I can see it getting really old, really quickly, particularly with kids that have weekend or evening activities.