CCM worth the extra year?

[intensivista]

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I'm a senior anesthesia resident and I'm having what I call matcher's remorse after matching to CCM in May. I like CCM and my ideal job would be doing CCM and my own cases in the OR, the % time in each is negotiable and I would consider a ~80-90% CCM job too. As of now, I am not interested in an academic job. Private practice CCM-Anes jobs are available, particularly on the east coast and a few on the west coast, but they seem to be exceedingly rare. On the other hand, non-amc, OR anesthesia private practice jobs with decent partnership tracks are still available. Some of the private groups have told me to skip fellowship and sign with their group. They say CCM is a waste of time, and this is coming from at least one private CCM-anes doc that does general OR and cardiac, no ICU.

there are dozens of Pulm-CCM jobs available across the country. I have heard that some CCM grads have split contracts with pulm-ccm groups and anesthesia groups, but the jobs I have looked at are interested in medicine trained CCM grads that will also do pulm consults outside of the ICU.

It's depressing to think of uprooting my S.O. and moving us to an expensive city for CCM if I won't be practicing CCM at least part time. I would gain a lot of experience in CCM that would help me in the OR but that's not the reason I'd be doing the fellowship. I'm training at an excellent program and I'm comfortable doing most cases including neonates (not peds hearts) and adult hearts. Two of the three private groups I could sign with this year would have me doing adult hearts and general OR without a CCM fellowship.

It's not about the money, I'm ok with the sacrifice of a 1 year salary to do the fellowship and the possible salary decrease for doing CMM-anes. But I'm not OK with the high possibility that I won't be practicing CCM in private practice. It seems superfluous to do a ccm year and only do private practice anesthesia.

Any advice from CCM-anes trained private practice anesthesiologists?

 

[Mman]

My only thought is to reiterate that doing CCM with a private anesthesia group is exceedingly rare and will greatly limit your job search. If you want to do both CCM and anesthesia, I'm guessing you will most likely be doing it in an academic setting. If you want more to be in a private group, you will probably be doing anesthesia.

Groups that have suggested you skip the fellowship probably need you to start working ASAP upon completion of residency and may not need you if you took another year for the fellowship. Timing is everything. The fellowship in and of itself can't be a bad thing, but for a particular job the timing might be bad.

 

[seinfeld]

You are attempting to have complete strangers tell you what is best for your life. I am interpreting your prose to imply that at the end of the day you are not willing to go the extra mile to be in a job situation where you would be practicing CCM regularly. If that is the case don't do it. Find the area you want and the group you want to work for and then sign up.

I am biased toward CCM but doing year of fellowship in a miserable state is a miserable existence.

If i could sway you any bit toward a fellowship it would be to consider what your life goals are, what type of flexibility you may want down the road, could you see an academic appointment in the future? Would you get bored in the OR? If the practice landscape changes in 10 years would you go back and do a fellowship?

I tend to miss the ICU more than I miss the OR after being away for a time. Do you have that personality?

 

[Stank811]

"But I'm not OK with the high possibility that I won't be practicing CCM in private practice. "

Part time anesthesia and part time critical care private practice positions are rare and likely you would be entering unchartered territory if you decide to pursue that path with a PP group. I recently did a CC fellowship and then joined a PP group and currently doing OR only. Do I feel like a wasted a year...I don't personally and would do the same thing over again.

"It seems superfluous to do a ccm year and only do private practice anesthesia."

Can you be a great anesthesiologist in any setting without doing a fellowship...without question...I currently work with many of them. Do I feel like I am personally a better physician and anesthesiologist after doing the fellowship...absolutely.
Spend a year doing the most challenging inductions and procedures in the ICU while taking care of the sickest patients without question made the transition into being a independent anesthesiologist easier. It did take me a little bit to get back into the flow of the OR setting but for the most part the transition was no issue. After the fellowship I find myself having more in depth discussion with our surgical colleagues regarding the care of the patient in regards to appropriate management going forward.
I did and still feel like I would have regretted not going forward with the fellowship. Based on what you said it seems like you would regret doing the fellowship if you don't become a practicing intensivist as soon as you graduate so based on that assessment I think I would pursue the PP jobs without the fellowship unless you have a solid lead on a job that splits both positions.

 

[Triple AAA]

CCM aside, jobs where you are able to do your own OR cases are, in an of themselves, becoming more and more sparse.

 

[deleted87051]

Your chance of practicing CCM is zero without a fellowship so do the fellowship if that's what you want.

If you can be happy doing OR work skip it. You will learn a lot during your first years of practice too. It's not as if your cohorts who go straight into practice stop learning and don't mature as clinicians. I don't think "becoming a better anesthesiologist" is a reason to do CCM fellowship.

 

[deleted171991]

Your chance of practicing CCM is zero without a fellowship so do the fellowship if that's what you want.

If you can be happy doing OR work skip it. You will learn a lot during your first years of practice too. It's not as if your cohorts who go straight into practice stop learning and don't mature as clinicians. I don't think "becoming a better anesthesiologist" is a reason to do CCM fellowship.

Are you CCM-trained?

 

[vaibh]

i think doing CCM fellowship makes you better doctor and anesthesiologist , doing bread and butter cases at outpt. center just atrophies your skills, anesthesia should not just be gas, propofol and phenylephrine !

 

[Mman]

i think doing CCM fellowship makes you better doctor and anesthesiologist , doing bread and butter cases at outpt. center just atrophies your skills, anesthesia should not just be gas, propofol and phenylephrine !

There is a world of jobs between a CCM job and doing outpatient only. Plenty of us work in major medical centers doing all sorts of crazy cases that keep your skills and mind razor sharp.

 

[vaibh]

I know the difference, I was just replying to topic of this post if "CCM worth extra year" .And having worked at major medical centers myself I do know there are excellent anesthesiologist around and I also know that once it comes to job many will prefer doing 10 outpt. cases / day then 1 complex vascular case. May be i am biased but definitely icu experience is invaluable.

 

[deleted87051]

Are you CCM-trained?

No. But a few of my partners are. A couple of them are above average and a couple aren't.

 

[urge]

i think doing CCM fellowship makes you better doctor and anesthesiologist

Can you explain how it makes you a better anesthesiologist?

Let's say you are an OB attending, or regional, or peds, or cardiac.

 

[Mman]

I know the difference, I was just replying to topic of this post if "CCM worth extra year" .And having worked at major medical centers myself I do know there are excellent anesthesiologist around and I also know that once it comes to job many will prefer doing 10 outpt. cases / day then 1 complex vascular case. May be i am biased but definitely icu experience is invaluable.

What does what cases somebody would prefer to do have to do with anything? I'd prefer to have ASA 1 patients all the time. It'd be easier and I'd probably make more money. That doesn't mean I'm not as good at my job as somebody that would prefer to have half dead patients and unfortunately I take care of way too many sickos but that's the job and somebody has to do it.

 

[gasdoc77]

Not critical care trained. Self trained echo with advanced board. I do the biggest of cases in PP daily and, despite teaching residents in the past, remain a student of the craft. I feel that I approach cases with a CCM perspective despite lack of formal CC training.

 

[Mman]

Not critical care trained. Self trained echo with advanced board. I do the biggest of cases in PP daily and, despite teaching residents in the past, remain a student of the craft. I feel that I approach cases with a CCM perspective despite lack of formal CC training.

Agreed. It's not like I didn't spend months and months in the ICU as a resident. I still remember what happens to a patient postoperatively when I take care of them in the OR. I'll still put CVPs in for patients that I don't need in the OR but because they are going to need it postop. I'll run them on ARDS style ventilation in the OR if appropriate.

 

[vaibh]

What does what cases somebody would prefer to do have to do with anything? I'd prefer to have ASA 1 patients all the time. It'd be easier and I'd probably make more money. That doesn't mean I'm not as good at my job as somebody that would prefer to have half dead patients and unfortunately I take care of way too many sickos but that's the job and somebody has to do it.

I never commented on your skills , may be you know lot of stuff but everyone is not same and additional training never makes anyone dumb it can only help 🙂 In europe and most of world most ICUs are managed by anesthesia folks here in US anesthesia is loosing its grip in ICUs and we all know whats going on in OR's. CCM training also adds value to your presence in hospital.

Can you explain how it makes you a better anesthesiologist?

Let's say you are an OB attending, or regional, or peds, or cardiac.

CCM just expands the knowledge base in general rather then specific patient population like OB regional or peds.
I am not saying its only one, how comfortable will someone be with premature kids if they have not done peds in a while ? or with Cardiomyopathic pregnant pt. if they have not done high risk OB in a while ? I am not talking about general bread and butter cases its about real consultant level cases where additional training always helps. Can you go without it ? of course yes like plain old anesthesiologists. But is the population getting any healthier ? No and where do we see sickest patients ? ICU . 🙂

 

[GA8314]

My 2 cents are that if you have a good partnership opporunity then you need to consider taking the bird in the hand. Perhaps I'm biased as I went directly into PP sans fellowship, but I'm doing ALL type of cases except heads (not a big deal IMO) and indeed it's not like I'm not learning and honing my skills. I'm becoming a better anesthesiologist this first year out, no question, but shouldn't that be obvious?

A fellowship can not hurt you as an anesthesiologist, but CC and Pain will take you away from the OR of course. If you end up practicing doing little or any of each, then I'm not positive it's worth it. PP groups look for special skills to be sure. But, if you have a chance to take a partnership track job (a good one), then maybe you should given that they are becoming less prevalent. Remember, the partners make the rules. Does the group want to seek CC folks to help build the PSH at their institution? The partners will decide that. Not sure CC is that much of a leg up over a good generalist for the PSH.

Also, will you be pigeon-holed for your fellowship? In other words, whill your fellowship training put you in the position where you may lose skills in other areas of anesthesiology (OB, Peds, Cards, Neuro, Regional etc)? Some PP jobs seeking fellowships MAY result in skill attrition in other areas if they have you doing XZY specialty majorily....
So, are you really a better anesthesiologist? Depends on what you are referring to as being better....

It's a personal choice....

 

[ether123]

My 2 cents are that if you have a good partnership opporunity then you need to consider taking the bird in the hand. Perhaps I'm biased as I went directly into PP sans fellowship, but I'm doing ALL type of cases except heads (not a big deal IMO) and indeed it's not like I'm not learning and honing my skills. I'm becoming a better anesthesiologist this first year out, no question, but shouldn't that be obvious?

A fellowship can not hurt you as an anesthesiologist, but CC and Pain will take you away from the OR of course. If you end up practicing doing little or any of each, then I'm not positive it's worth it. PP groups look for special skills to be sure. But, if you have a chance to take a partnership track job (a good one), then maybe you should given that they are becoming less prevalent. Remember, the partners make the rules. Does the group want to seek CC folks to help build the PSH at their institution? The partners will decide that. Not sure CC is that much of a leg up over a good generalist for the PSH.

Also, will you be pigeon-holed for your fellowship? In other words, whill your fellowship training put you in the position where you may lose skills in other areas of anesthesiology (OB, Peds, Cards, Neuro, Regional etc)? Some PP jobs seeking fellowships MAY result in skill attrition in other areas if they have you doing XZY specialty majorily....
So, are you really a better anesthesiologist? Depends on what you are referring to as being better....

It's a personal choice....

I personally think all anesthesiologists in the next 10 years will be intensivists. Most countries do not differentiate between the two and with the proliferation of CRNAs you can be sure the only cases where we will be asked to provide cre will be the tough ones.

 

[deleted171991]

I personally think all anesthesiologists in the next 10 years will be intensivists. Most countries do not differentiate between the two and with the proliferation of CRNAs you can be sure the only cases where we will be asked to provide cre will be the tough ones.

The countries where anesthesiologists are also intensivists have 5-year combined residencies (anesthesia-CCM), not just 4 years like us. Don't expect that to change.

 

[GA8314]

I personally think all anesthesiologists in the next 10 years will be intensivists. Most countries do not differentiate between the two and with the proliferation of CRNAs you can be sure the only cases where we will be asked to provide cre will be the tough ones.

First, this is in no way remotely possible within the next 10 years. Even if all residents did a 5 year combined program to get boarded in both, it would still be limited by the actual demand for ICU docs. I don't see the Pulm/CC guys or the surgical/CC guys stepping aside. I do feel that anesthesia/CC is a great way to train an ICU doc, but sometimes things are cultural/traditional. We have not had the tradition of anesthesia/CC staffing the ICUs in this country as is seen in Europe.

 

[intensivista]

You are attempting to have complete strangers tell you what is best for your life. I am interpreting your prose to imply that at the end of the day you are not willing to go the extra mile to be in a job situation where you would be practicing CCM regularly. If that is the case don't do it. Find the area you want and the group you want to work for and then sign up.

I am biased toward CCM but doing year of fellowship in a miserable state is a miserable existence.

If i could sway you any bit toward a fellowship it would be to consider what your life goals are, what type of flexibility you may want down the road, could you see an academic appointment in the future? Would you get bored in the OR? If the practice landscape changes in 10 years would you go back and do a fellowship?

I tend to miss the ICU more than I miss the OR after being away for a time. Do you have that personality?

It's not that I'm not willing to go the extra mile to find a CCM job, I'd love to practice CCM and OR anesthesia. Unfortunately CCM jobs for anesthesiologists are exceedingly rare in the Western US which is where my S.O. is from. If I was single I would consider moving out east. If it was a viable option, I'd maybe consider doing an extra year pulmonology fellowship so I could complete on a more level playing field with the internists by doing pulm consults on the floor.

The fellowship is actually at a program in CA in a cool city, but it's an expensive place to live and I don't have much desire to live in CA after fellowship.

I actually love teaching residents, but I think I'd be happier in PP after having experienced both settings throughout my training. I don't think I would get bored in the OR, I really love the all aspects and subspecialties of OR anesthesia and I find CCM fills some of the voids I miss in traditional medicine practices.

In terms of flexibility, it seems that the CCM fellowship is making me less flexible. I could have signed contracts doing only OR anesthesia and I have yet to find a PP group that gives a s*** about a CCM fellowship. In my opinion, that seems a little short sighted in terms of long term stability and being able to offer more services to a hospital, but I can also see the logistical problems with trying to cover both services not to mention the decreased revenue in the ICU.

 

[intensivista]

Thanks for the replies everyone.

"But I'm not OK with the high possibility that I won't be practicing CCM in private practice. "

Part time anesthesia and part time critical care private practice positions are rare and likely you would be entering unchartered territory if you decide to pursue that path with a PP group. I recently did a CC fellowship and then joined a PP group and currently doing OR only. Do I feel like a wasted a year...I don't personally and would do the same thing over again.

"It seems superfluous to do a ccm year and only do private practice anesthesia."

Can you be a great anesthesiologist in any setting without doing a fellowship...without question...I currently work with many of them. Do I feel like I am personally a better physician and anesthesiologist after doing the fellowship...absolutely.
Spend a year doing the most challenging inductions and procedures in the ICU while taking care of the sickest patients without question made the transition into being a independent anesthesiologist easier. It did take me a little bit to get back into the flow of the OR setting but for the most part the transition was no issue. After the fellowship I find myself having more in depth discussion with our surgical colleagues regarding the care of the patient in regards to appropriate management going forward.
I did and still feel like I would have regretted not going forward with the fellowship. Based on what you said it seems like you would regret doing the fellowship if you don't become a practicing intensivist as soon as you graduate so based on that assessment I think I would pursue the PP jobs without the fellowship unless you have a solid lead on a job that splits both positions.

Do you miss not practicing CCM in the ICU? I have no doubt that the CCM year would help you in the OR, it just doesn't seem like something that most PP groups place much value on.

The main reason I think I'd regret doing the fellowship if I didn't practice CCM upon graduation is skill attrition as I have heard that nobody would hire you to work as an intensivist if you went straight into 100% OR. If it was possible to start picking up CCM shifts several years after graduation then it might not be as big of a deal.

 

[BLADEMDA]

A CCM Fellowship can be valuable in the O.R. Many Groups will see you as well-trained for doing hearts and big cases. If you get elective time do a month of Echo,especially TTE at the bedside, as this will enhance your perioperative skills. Why is it that a Cardiac Fellowship for doing PP hearts makes one more valuable than a solid CCM Fellowship with electives in Echo? I, for one, would be glad to hire a new Anesthesiologist to do trauma, sick adults, hearts, etc who chose a year of CCM over Cardiac in order to enhance their skill set.

Of course, the highest risk Cardiac cases should utilize Cardiac Anesthesiologists but the vast majority of hearts in PP can easily be performed by general Anesthesiologists or those with CCM fellowships. I may be the only one to say this on this thread but the CCM year is a valuable experience which makes you a better Physician. This doesn't mean that general anesthesiologists aren't good doctors but rather that same general anesthesiologist would be a better Physician after the fellowship.

I've know a few CCM trained Anesthesiologists who didn't do ICU for the first 5 years in practice but migrated back to the ICU. The shortage of CCM physicians made it fairly easy for them to find work. In addition, what if that great PP job doesn't work out or gets acquired by an AMC? How does it hurt to have a back-up plan in place?

People change and their goals change with them. By no means do you need to do an extra year of CCM but opting to do the extra year in this environment can only help you over the long run. Too bad the ASA/ABA doesn't include the Critical Care year with the Residency itself. 4 years of Categorical anesthesia is enough time to do O.R. and ICU for 1 year.

 

[BLADEMDA]

Based on the OP's initial comments my gut feeling is that she would be better off skipping the fellowship for private practice. If lifestyle and money are the primary goals for the OP she should just take one of her job offers. Is she looking for a mommy track in a few years? Does high acuity really fit into her long term goals?

CCM is about long term career enhancement for those who want extra skills for the O.R. and the ICU. CCM will give you options down the road if and when your Solo MD group loses the contract to the CRNA run AMC. Or, when the hospital decides to hire CCM trained Anesthesiologists to run the ICU and the O.R. which utilizes CRNAs. Another scenario is the ACO or single payer system of the future where sitting on the stool pays "X" amount regardless of your credentials.

One last thing is that a superstar CCM trained doc like Seinfeld can do it all: ICU, O.R. hearts, etc.

 

[seinfeld]

Thanks BLADEMDA for the compliment. Gotta say that my group does offer that rare ability to do it all including regional.

A fellowship will not limit you from doing any type of anesthesia but what "opportunity cost" are you willing to pay? Would doing a fellowship in CA help you land an OR job? I still believe that all of anesthesia should be like pulmonary in the double board arena. It doesnt make any sense to me that we/ABA dont do that.

 

[murdoc9]

Too bad the ASA/ABA doesn't include the Critical Care year with the Residency itself. 4 years of Categorical anesthesia is enough time to do O.R. and ICU for 1 year.

I still believe that all of anesthesia should be like pulmonary in the double board arena. It doesnt make any sense to me that we/ABA dont do that.

This seems like a great idea.

PGY 1 year should be 3 - 4 months ICU balanced out by 3 - 4 months anesthesia, 1 month emergency, 1 cardiology, 2-3 electives. (cut out gen med; some programs are already like this anyway.)
PGY 2 - 4 remains the same except an additional 1 - 2 rotations /year of ICU, which would ~10 months in the unit total, which seems to be the average for the anesthesia CCM fellowships. Then you automatically graduate board eligible for both. Or they just make a combined anes/ccm boards or something, though that sounds epically painful.

 

[Mman]

If it was a viable option, I'd maybe consider doing an extra year pulmonology fellowship so I could complete on a more level playing field with the internists by doing pulm consults on the floor.

I'm unaware of what "an extra year pulmonology fellowship" is. Pulmonary fellowships are 2 years minimum (3 for pulm/cc) following 3 years of IM residency. I'm fairly certain that you cannot skip the IM residency first.

 

[Random Anesthesiologist]

This seems like a great idea.

PGY 1 year should be 3 - 4 months ICU balanced out by 3 - 4 months anesthesia, 1 month emergency, 1 cardiology, 2-3 electives. (cut out gen med; some programs are already like this anyway.)
PGY 2 - 4 remains the same except an additional 1 - 2 rotations /year of ICU, which would ~10 months in the unit total, which seems to be the average for the anesthesia CCM fellowships. Then you automatically graduate board eligible for both. Or they just make a combined anes/ccm boards or something, though that sounds epically painful.

I don't like this. The decision-making capacity of a pgy1 or 2 with the same amount of workload as a fellow just isn't the same. Maybe scattered through the senior years or as some mention, a straight extra year.

 

[intensivista]

I've know a few CCM trained Anesthesiologists who didn't do ICU for the first 5 years in practice but migrated back to the ICU. The shortage of CCM physicians made it fairly easy for them to find work. In addition, what if that great PP job doesn't work out or gets acquired by an AMC? How does it hurt to have a back-up plan in place?

People change and their goals change with them. By no means do you need to do an extra year of CCM but opting to do the extra year in this environment can only help you over the long run. Too bad the ASA/ABA doesn't include the Critical Care year with the Residency itself. 4 years of Categorical anesthesia is enough time to do O.R. and ICU for 1 year.

That is encouraging, I have been told that it isn't as easy to go back if you don't practice CCM straight out of fellowship. It would be great to be double boarded after 4 years but it's only an extra year which isn't a big deal for me unless I end up having fewer options after fellowship. Timing is key and I've already let 2 great PP jobs go so I can do the fellowship. It's too early to say if there will be additional spots available within these groups when I graduate. They both have very low turnover and they both had people retire/move recently.

Based on the OP's initial comments my gut feeling is that she would be better off skipping the fellowship for private practice. If lifestyle and money are the primary goals for the OP she should just take one of her job offers. Is she looking for a mommy track in a few years? Does high acuity really fit into her long term goals?

CCM is about long term career enhancement for those who want extra skills for the O.R. and the ICU. CCM will give you options down the road if and when your Solo MD group loses the contract to the CRNA run AMC. Or, when the hospital decides to hire CCM trained Anesthesiologists to run the ICU and the O.R. which utilizes CRNAs. Another scenario is the ACO or single payer system of the future where sitting on the stool pays "X" amount regardless of your credentials.

One last thing is that a superstar CCM trained doc like Seinfeld can do it all: ICU, O.R. hearts, etc.

Lifestyle and money are not my primary goals, I'm OK taking a pay cut to do CCM as long as it's a skill I can keep up and continue to practice albeit at a lower salary than 100% OR. I don't have kids and I am not sure if I'll have any in the future. My S.O. and I have strong ties in the western US but not in CA so we would like to live somewhere close to our families. Getting a good job without the fellowship wouldn't have been an issue. Seinfeld is a superstar and his posts made me excited about choosing to enter the CCM match.

Thanks BLADEMDA for the compliment. Gotta say that my group does offer that rare ability to do it all including regional.

A fellowship will not limit you from doing any type of anesthesia but what "opportunity cost" are you willing to pay? Would doing a fellowship in CA help you land an OR job? I still believe that all of anesthesia should be like pulmonary in the double board arena. It doesnt make any sense to me that we/ABA dont do that.

I could have signed contracts with great PP groups in good locations without the fellowship, but timing might be an issue in the future. Both groups were indifferent about me doing CCM including some partners who had done CCM fellowships which wasn't encouraging. Group's like yours give me hope that there will be more opportunities like that in the future. I want to do CCM, big cases in the O.R. including PP adult cardiac, neonate+ in general O.R., TTE-TEE, OB and regional would be cool too.

I'm unaware of what "an extra year pulmonology fellowship" is. Pulmonary fellowships are 2 years minimum (3 for pulm/cc) following 3 years of IM residency. I'm fairly certain that you cannot skip the IM residency first.

That was a hypothetical situation. I know cc alone is 2 years and pulm-cc 3 years but made the incorrect assumption that pulm alone was 1 year. The point was that IF it was an option, I would consider additional training to become boarded in pulm too so I could compete better with the internists, obviously you can't without IM. There is someone that used to post here that did anesthesia+medicine+pulmcc, he had a prince avatar. CCM jobs are plentiful but a lot of them want someone to cover the floor pulm consults. I'm not looking for a mommy track lifestyle but 9 years of post-grad training is too much.

 

[seinfeld]

This seems like a great idea.

PGY 1 year should be 3 - 4 months ICU balanced out by 3 - 4 months anesthesia, 1 month emergency, 1 cardiology, 2-3 electives. (cut out gen med; some programs are already like this anyway.)
PGY 2 - 4 remains the same except an additional 1 - 2 rotations /year of ICU, which would ~10 months in the unit total, which seems to be the average for the anesthesia CCM fellowships. Then you automatically graduate board eligible for both. Or they just make a combined anes/ccm boards or something, though that sounds epically painful.

Working as an ICU doc is so much different than working in the ICU as an intern/resident; THis is the biggest single problem for recruiting into the field. I wish more ICU experiences were less about the scut of replacing electrolytes and doing incredibly long hours and more about learning how to diagnosis and treat Critical Illness. Most of the scut in the ICU is like asking the father of the baby to go boil water, its keeps you busy but doesnt affect outcomes. Live a week in my shoes doing the ICU and you will find that it is more mentally rewarding than physically exhausting.

 

[kazuma]

Working as an ICU doc is so much different than working in the ICU as an intern/resident; THis is the biggest single problem for recruiting into the field. I wish more ICU experiences were less about the scut of replacing electrolytes and doing incredibly long hours and more about learning how to diagnosis and treat Critical Illness. Most of the scut in the ICU is like asking the father of the baby to go boil water, its keeps you busy but doesnt affect outcomes. Live a week in my shoes doing the ICU and you will find that it is more mentally rewarding than physically exhausting.

When our hospital went to epic from paper charts it decreased the amount of non-educational scut work tremendously and we had more time to spend on critical thinking and diagnosis. We also have great CCM attendings so it made the rotations educational and enjoyable.

 

[nycitygas]

Do the fellowship if you want to be an intensivist. If not it is likely a waste of time. An ICU fellowship will NOT help you for most PP jobs-at best it will be neutral.

Blade might have a difference perspective but I can assure it will be difficult if not impossible to obtain a CCM position if you haven't practiced for several years. My group will not look at anybody who hasn't practiced in the last several years and we are very short staffed. You will need to find a job where you can do both to hone your skills as attending which will limit your opportunities tremendously.

Seinfeld has the ideal job but in most big cities, you will not be doing cardiac cases as a CCM attending. Only a few programs offer sufficient TEE training that will allow you to become even basic certified (Michigan, Duke). Also, the number of cardiac cases keeps going down at non-academic centers while the supply of cardiac anesthesiologists increases every year. Cardiac surgeons tend to like to work with the same people and it's tough to do that when you are in the unit 1-2 weeks of the month.

That'ld being said, I love critical care and the fellowship was the right choice for me. I currently do 50% general OR and 50% ICU which I think is the perfect mix. Straight CCM jobs are extremely plentiful and they pay more than most AMC anesthesia gigs. The locums market for anesthesia is dead in my area but plenty of CCM shifts to go around.

The trend is toward 24/7 dedicated ICU care with no pulm consults/clinics ect so I think opportunities will continue to increase. The old model of the pulmonologists seeing their ICU patients in the AM then going to do their bronchs/clinic/sleep studies/consults is dead.

I know an intensivist who is hospital employed at a BFE hospital. I'm not sure if the state is opt out, but he told me the OR is run by independent CRNAs and one MD medical director/fireman. The take home point is that the hospital is willing to subsidize the 24/7 MD Intensivist coverage (with no NPs) but will not provide that same support to have MD anethesiologists.

 

[BLADEMDA]

Do the fellowship if you want to be an intensivist. If not it is likely a waste of time. An ICU fellowship will NOT help you for most PP jobs-at best it will be neutral.

Blade might have a difference perspective but I can assure it will be difficult if not impossible to obtain a CCM position if you haven't practiced for several years. My group will not look at anybody who hasn't practiced in the last several years and we are very short staffed. You will need to find a job where you can do both to hone your skills as attending which will limit your opportunities tremendously.

Seinfeld has the ideal job but in most big cities, you will not be doing cardiac cases as a CCM attending. Only a few programs offer sufficient TEE training that will allow you to become even basic certified (Michigan, Duke). Also, the number of cardiac cases keeps going down at non-academic centers while the supply of cardiac anesthesiologists increases every year. Cardiac surgeons tend to like to work with the same people and it's tough to do that when you are in the unit 1-2 weeks of the month.

That'ld being said, I love critical care and the fellowship was the right choice for me. I currently do 50% general OR and 50% ICU which I think is the perfect mix. Straight CCM jobs are extremely plentiful and they pay more than most AMC anesthesia gigs. The locums market for anesthesia is dead in my area but plenty of CCM shifts to go around.

The trend is toward 24/7 dedicated ICU care with no pulm consults/clinics ect so I think opportunities will continue to increase. The old model of the pulmonologists seeing their ICU patients in the AM then going to do their bronchs/clinic/sleep studies/consults is dead.

I know an intensivist who is hospital employed at a BFE hospital. I'm not sure if the state is opt out, but he told me the OR is run by independent CRNAs and one MD medical director/fireman. The take home point is that the hospital is willing to subsidize the 24/7 MD Intensivist coverage (with no NPs) but will not provide that same support to have MD anethesiologists.

Let's say you do a CCM year and go into private practice doing O.R. only. After 3 years at your new gig the hospital gives the contract to an AMC. What are your options now? Do you go look for another job or join the AMC? Alternatively, you could go back to Academia and do CCM. How do you get that academic job? Just agree to do it the first year for $200K. I bet many Chairs would be glad to get a CCM attending (even a rusty one) for $200K. after 12 months (2 months if you are a superstar) catching up on the latest and greatest protocols you are up to full speed. Your salary will then go up to full time CCM pay (second year) and you have the option of joining a PP group doing CCM.

 

[nycitygas]

Let's say you do a CCM year and go into private practice doing O.R. only. After 3 years at your new gig the hospital gives the contract to an AMC. What are your options now? Do you go look for another job or join the AMC? Alternatively, you could go back to Academia and do CCM. How do you get that academic job? Just agree to do it the first year for $200K. I bet many Chairs would be glad to get a CCM attending (even a rusty one) for $200K. after 12 months (2 months if you are a superstar) catching up on the latest and greatest protocols you are up to full speed. Your salary will then go up to full time CCM pay (second year) and you have the option of joining a PP group doing CCM.

That sounds pretty logical. However, you'ld probably have to offer to work for less than 200 (the local academic centers near you in FL are starting off in the low 200's already for academic ccm). I think 3-4 years would be the cutoff. The local academic center that is actively hiring for ccm recently passed on applicant who hadn't practiced for 5 years.

 

[BLADEMDA]

That sounds pretty logical. However, you'ld probably have to offer to work for less than 200 (the local academic centers near you in FL are starting off in the low 200's already for academic ccm). I think 3-4 years would be the cutoff. The local academic center that is actively hiring for ccm recently passed on applicant who hadn't practiced for 5 years.

Perhaps you would need to move to an undesirable location in academia and work for $150K year 1 but that would get you back in the game.

 

[deleted87051]

Perhaps you would need to move to an undesirable location in academia and work for $150K year 1 but that would get you back in the game.

That's a very severe financial penalty to practice CCM.