Critical Care Anesthesiology Match

Started by gasman2014
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More anesthesiologists should do it. I'm a totally different physician in the ORs as a result of my CC practice.

Plus it's kinda gratifying to be able to take care of a sick patient during high-risk surgery and then also assume their care later in the ICU.

I hope the Match went well. I was in the last class before the Match.


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People should do it if they really like it (it makes one a better doctor like few other things do). It's gratifying (one can truly save lives), but doesn't translate in better income, better lifestyle, or better anything (more like the opposite). I still have to see one critical care anesthesiologist who gets true respect and gratefulness from most surgeons, or true appreciation from his department chair. Most (available) jobs have a component of cardiac SICU, resulting in even less satisfaction. MICU is a different story, but few MICUs accept non-internists.

It's also a waste of $200-300K in lost wages, much more if compounded for 30 years.
 
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Ezekiel2517 said:
I know plenty of people who were able to secure prime jobs and positions as a result of the fellowship. Have a plan for what you want in your career post-fellowship. Know and learn how to use your fellowship training to attain leverage.
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Can you expand on that ? How so ? Exclusively in groups that cover the unit as well ? Locums ?

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Seems to me like the best defined role for anesthesia CCM fellows is to remain in academics to train more anesthesia CCM fellows and to provide the mandatory ICU experience for anesthesia residents. Beyond that it's very hit or miss but more often a miss.
 
Just a med student... but is research a huge component of your CV for critical care? What does it take to get CC from anesthesia residency? Appreciate it!
 
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DetectiveAlonzo said:
Just a med student... but is research a huge component of your CV for critical care? What does it take to get CC from anesthesia residency? Appreciate it!
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Since the field switched to the SF match system and started making the data widely available, anyone can look up and see that there are a lot more spots than people who choose to go into CCM from anesthesiology. Research is not necessary to get a spot. It may be necessary for a borderline applicant trying for a big name program like Michigan or UPMC, but not for a good applicant trying for nearly any other program (seriously, look up which programs have vacancies after this year's match, and which still have vacancies for the class that starts in a week).

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Good lord, I didn't know it was that bad. There are some huge programs on there that appear to have filled only 1 or 2 of their spots. Lots of great training places like UCSF, Johns Hopkins, University of Washington, Cleveland Clinic, and Mayo that have multiple offerings.
Guess that makes me appreciate that our program fills pretty much every year. We had 90+ applicants for 4 positions and interviewed around 40 or so. Matched very well. I was very impressed with the quality of applicants this year, and our fellows over the last 3-4 years have been superstars (myself excluded).
The number of positions around the country have gone up every year, as have the number of accepted applicants. Looks like the match rate is about the same (high 90's).
I still think it's one of the best kept secrets in the field of Anesthesiology, and am very glad that I did it. Hopefully more residents catch on and the field continues to expand in popularity.
 
KaoticMessiah said:
Good lord, I didn't know it was that bad. There are some huge programs on there that appear to have filled only 1 or 2 of their spots. Lots of great training places like UCSF, Johns Hopkins, University of Washington, Cleveland Clinic, and Mayo that have multiple offerings.
Guess that makes me appreciate that our program fills pretty much every year. We had 90+ applicants for 4 positions and interviewed around 40 or so. Matched very well. I was very impressed with the quality of applicants this year, and our fellows over the last 3-4 years have been superstars (myself excluded).
The number of positions around the country have gone up every year, as have the number of accepted applicants. Looks like the match rate is about the same (high 90's).
I still think it's one of the best kept secrets in the field of Anesthesiology, and am very glad that I did it. Hopefully more residents catch on and the field continues to expand in popularity.
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Must be one of the few combinations of big name + great training. Many times one or the other are lacking.
 
FFP said:
It's also a waste of $200-300K in lost wages, much more if compounded for 30 years.
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How much less do intensivists get paid in the states?

Sometimes I think anaesthesics is a walk in the park.compared to ICU and sometimes vice versa. But I do believe I am infintely better anaesthetist after 3 years of icu..
 
KaoticMessiah said:
Good lord, I didn't know it was that bad. There are some huge programs on there that appear to have filled only 1 or 2 of their spots. Lots of great training places like UCSF, Johns Hopkins, University of Washington, Cleveland Clinic, and Mayo that have multiple offerings.
Guess that makes me appreciate that our program fills pretty much every year. We had 90+ applicants for 4 positions and interviewed around 40 or so. Matched very well. I was very impressed with the quality of applicants this year, and our fellows over the last 3-4 years have been superstars (myself excluded).
The number of positions around the country have gone up every year, as have the number of accepted applicants. Looks like the match rate is about the same (high 90's).
I still think it's one of the best kept secrets in the field of Anesthesiology, and am very glad that I did it. Hopefully more residents catch on and the field continues to expand in popularity.
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UPMC?

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FFP said:
Must be one of the few combinations of big name + great training. Many times one or the other are lacking.
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Of the big name programs which didn't fill - UCSF, Johns Hopkins, University of Washington, Mayo...

Which ones would you say are lacking in great training?
 
26B said:
Of the big name programs which didn't fill - UCSF, Johns Hopkins, University of Washington, Mayo...

Which ones would you say are lacking in great training?
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Well, that depends on what you want to get out of your additional year of training, and what price you are willing to pay for it. I know several people who interviewed at Mayo who were turned off by how medicine-heavy it was. Similarly, I know some who thought that Cleveland Clinic had too much SICU. For others, these would be benefits, not drawbacks. I didn't interview at Hopkins, but I know a few that did, and said that the training there could be acquired at any other training program, and was not worth the heavy call burden.

When interviewing programs, don't just become enamored by the name and reputation. You must think of how the program will serve your needs (impart knowledge, provide job connections, allow for specific areas of research, etc), and what you will need to give up to go there (crappy location, long hours, lots of call, high cost of living, little exposure to a secondary area of interest, less research time/funding etc).

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FFP said:
People should do it if they really like it (it makes one a better doctor like few other things do). It's gratifying (one can truly save lives), but doesn't translate in better income, better lifestyle, or better anything (more like the opposite). I still have to see one critical care anesthesiologist who gets true respect and gratefulness from most surgeons, or true appreciation from his department chair. Most (available) jobs have a component of cardiac SICU, resulting in even less satisfaction. MICU is a different story, but few MICUs accept non-internists.

It's also a waste of $200-300K in lost wages, much more if compounded for 30 years.
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Would you still pick CCM if you were to choose again? If not, which fellowship would you have done?
 
Turtlez said:
Would you still pick CCM if you were to choose again? If not, which fellowship would you have done?
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No.

I did CCM because I love the internal medicine aspect of it and I don't especially like cardiac surgeons, but, for the so inclined, cardiac is a much better choice. Also, if doing CCM, make sure you get into a very well-balanced (MICU, SICU, NeuroICU, Cardiac ICU) big name program with proven alumni placement in good jobs (not just slaving away in some academic department), and with OR electives or moonlighting (that's the first thing PP groups will ask you about). Not many of these AFAIK.

I don't think one should do only a CCM fellowship after anesthesiology (couple it with a cardiac one afterwards), unless one wants to practice it (almost) full-time in PP (like pain, not easy to find a job like that for anesthesia CCM in certain markets) or one is OK with just being the surgeon's monkey in a surgical (especially cardiac) ICU (again not many SICU jobs for anesthesia CCM in certain markets, and definitely very few MICU).

The neuroICUs are being closed down to most non-neuro people, the same way MICUs have been. (I know neurocritical care boarded anesthesiologists who lost their neuroICU positions after decades.) The SICUs are dominated by trauma surgeons in most places, with a lot of the usual OR knee jerk-type medicine, much less interesting or enjoyable than a MICU. It's mostly cardiac ICUs that matter for the academic anesthesiology departments, but you're mostly like an APRN there.

I don't have a strong enough PP CCM market where I am, but my feeling is that it's dominated by either IM/Pulm-CCM (in MICUs) or trauma surgeons (in SICUs). Many bean counters have no idea of the advantages an anesthesiologist intensivist brings to either setting. Anesthesiologists have been extremely bad at marketing themselves as one of the most multidisciplinary specialties in the hospital, and that applies to our intensivists, too. Plus there is this idiotic dynamic (as in the OR) where the surgeon rarely thinks about you as a valuable consultant, but mostly as his monkey (you're there to take care of his patients, with his blessing, as he sees fit).

People's personal experiences will differ, so take everything you read or hear with a grain of salt. Markets vary, people vary, expectations vary.

P.S. I don't want to derail the thread, so congratulations to all the smart residents who matched in CCM. Find yourself a good job in the first few months of fellowship and enjoy every minute of the latter. It will be the best year of your training.
 
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FFP said:
No.

I did CCM because I love the internal medicine aspect of it and I don't especially like cardiac surgeons, but, for the so inclined, cardiac is a much better choice. Also, if doing CCM, make sure you get into a very well-balanced (MICU, SICU, NeuroICU, Cardiac ICU) big name program with proven alumni placement in good jobs (not just slaving away in some academic department), and with OR electives or moonlighting (that's the first thing PP groups will ask you about). Not many of these AFAIK.

I don't think one should do only a CCM fellowship after anesthesiology (couple it with a cardiac one afterwards), unless one wants to practice it (almost) full-time in PP (like pain, not easy to find a job like that for anesthesia CCM in certain markets) or one is OK with just being the surgeon's monkey in a surgical (especially cardiac) ICU (again not many SICU jobs for anesthesia CCM in certain markets, and definitely very few MICU).

The neuroICUs are being closed down to most non-neuro people, the same way MICUs have been. (I know neurocritical care boarded anesthesiologists who lost their neuroICU positions after decades.) The SICUs are dominated by trauma surgeons in most places, with a lot of the usual OR knee jerk-type medicine, much less interesting or enjoyable than a MICU. It's mostly cardiac ICUs that matter for the academic anesthesiology departments, but you're mostly like an APRN there.

I don't have a strong enough PP CCM market where I am, but my feeling is that it's dominated by either IM/Pulm-CCM (in MICUs) or trauma surgeons (in SICUs). Many bean counters have no idea of the advantages an anesthesiologist intensivist brings to either setting. Anesthesiologists have been extremely bad at marketing themselves as one of the most multidisciplinary specialties in the hospital, and that applies to our intensivists, too. Plus there is this idiotic dynamic (as in the OR) where the surgeon rarely thinks about you as a valuable consultant, but mostly as his monkey (you're there to take care of his patients, with his blessing, as he sees fit).

People's personal experiences will differ, so take everything you read or hear with a grain of salt. Markets vary, people vary, expectations vary.

P.S. I don't want to derail the thread, so congratulations to all the smart residents who matched in CCM. Find yourself a good job in the first few months of fellowship and enjoy every minute of the latter. It will be the best year of your training.
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I appreciate reading your thoughts, I was torn between IM and anesthesia and had hoped anesthesia + CCM would be the answer to that dilemma. Here's hoping that in ~6 years, anesthesia will have asserted themselves a bit more in the critical care space!
 
sunealoneal said:
I appreciate reading your thoughts, I was torn between IM and anesthesia and had hoped anesthesia + CCM would be the answer to that dilemma. Here's hoping that in ~6 years, anesthesia will have asserted themselves a bit more in the critical care space!
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Definitely don't do anesthesia just because of CCM. IM/Pulm + CCM will open many more doors, and you can get great multidisciplinary CCM training even if coming from IM (just find the right program, with lots of non-medical ICU experience).

In my subjective view, an anesthesiologist has much better chances of becoming a good intensivist (much better airway, vent, resus, physiology, pharmacology, pain management, sedation, invasive monitoring etc. knowledge/skills after residency), but again that would be a very bad reason for choosing anesthesiology over IM. You would have 3 very long years of anesthesiology residency and much fewer career alternatives if you change your mind about CCM. If you hate IM, consider EM + CCM.
 
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FFP said:
Definitely don't do anesthesia just because of CCM. IM + CCM will open many more doors, and you can get great multidisciplinary CCM training even if coming from IM (just find the right program, with lots of non-medical ICU experience).
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If I have to choose between scratching my IM itch and anesthesia I will end up picking the latter.
 
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sunealoneal said:
If I have to choose between scratching my IM itch and anesthesia I will end up picking the latter.
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IMO, if you have an IM itch, you don't belong in anesthesia (as in you will be less happy in it). Anesthesiologists are mostly surgical-type of people. 😉

We can ask @GravelRider and other dual-trained members if I am wrong.

There is an easy question to separate IM residency applicants from anesthesiology ones: do you feel better in the OR or outside?
 
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sunealoneal said:
I wonder what IM physicians would say about people with an anesthesia itch!
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There is no true anesthesia itch for most medical students, unless they have spent a lot of time with anesthesiologists in the OR, for some reason, which is extremely rare. There is just wishful thinking. 😉

Many students who choose anesthesia are running away from something else they had the opportunity to truly experience during medical school. Very few students get to experience real life OR anesthesiology beyond the theatricals.
 
FFP said:
IMO, if you have an IM itch, you don't belong in anesthesia (as in you will be less happy in it). Anesthesiologists are mostly surgical-type of people. 😉

We can ask @GravelRider and other dual-trained members if I am wrong.

There is an easy question to separate IM residency applicants from anesthesiology ones: do you feel better in the OR or outside?
Click to expand...

I don't think it's that simple lol
 
anbuitachi said:
I don't think it's that simple lol
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I think it is, at least as negative predictive value. One has to click and work with the surgical types in the OR, from surgeons to staff. It's like mixing oil and water; they just think differently than medical people (a lot of black and white, very little gray, a lot of not recognizing their own limits and cowboy attitudes). Many anesthesiology residents who fail to graduate are people who would have been really happy in a non-surgical residency.
 
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FFP said:
There is no true anesthesia itch for most medical students, unless they have spent a lot of time with anesthesiologists in the OR, for some reason, which is extremely rare. There is just wishful thinking. 😉

Many students who choose anesthesia are running away from something else they had the opportunity to truly experience during medical school. Very few students get to experience real life OR anesthesiology beyond the theatricals.
Click to expand...

A happy accident of attending a DO school is that my anesthesia rotation was at a private practice with what seems to be a 4:1 model... I still liked it!
 
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McPoyle said:
He will even put his cigarettes out on you like your real dad.


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Click to expand...

I prefer Consigliere when he drinks and hurls nasty insults at me and makes me feel like the bottom of the totem pole med student I am.

It's making me tough. I know he loves me!
 
Congrats to all CCM matches, yall will be great!

On the subject of anes sub-I: plenty of academic institutions have anes sub-I. In fact i did 2 months of it as a med student practically...

I also agree with FFP in that anes are REALLY well placed to be a good intensivist. Every other route to intensivists require a step up in acuity. For anes, most ICU pts are actually much less acute than a lot of OR situations (e.g. Trauma, CT, etc).

However, I will be applying to CT rather than CCM for fellowship because of a lot of similar reasons that FFP explained, as interns we do 4 months of ICU in all the types he mentioned. I totally agree with his sentiment that the market saturation/competition and the job dynamics makes it a lot less attractive to me. My hope is that i'm able to become board eligible for CCM after my CT fellowship.
 
dchz said:
Congrats to all CCM matches, yall will be great!

On the subject of anes sub-I: plenty of academic institutions have anes sub-I. In fact i did 2 months of it as a med student practically...

I also agree with FFP in that anes are REALLY well placed to be a good intensivist. Every other route to intensivists require a step up in acuity. For anes, most ICU pts are actually much less acute than a lot of OR situations (e.g. Trauma, CT, etc).

However, I will be applying to CT rather than CCM for fellowship because of a lot of similar reasons that FFP explained, as interns we do 4 months of ICU in all the types he mentioned. I totally agree with his sentiment that the market saturation/competition and the job dynamics makes it a lot less attractive to me. My hope is that i'm able to become board eligible for CCM after my CT fellowship.
Click to expand...

So you want to do CCM without doing a fellowship? There is no way you'll be adequately prepared after ACTA to sit for the CCM boards. I'm doing both (CCM and then ACTA) and couldn't imagine one year preparing you to be well versed in both....


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