critical care + another specialty (other than pulm)

[Roadrunner]

I'm interested in combining critical care with infectious diseases. I've known of two fellows who have done this (at academic centers other than my own). Do you know how this works? Is it usually a position that is created independently by coordinating with the two divisions? Or are there established critical care fellowships that by intention don't combine it with pulmonary?

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[JayneCobb]

I'm interested in combining critical care with infectious diseases. I've known of two fellows who have done this (at academic centers other than my own). Do you know how this works? Is it usually a position that is created independently by coordinating with the two divisions? Or are there established critical care fellowships that by intention don't combine it with pulmonary?

Yes you can combine Critical care medicine with other subspecialties. i can not remember off the top of my head if it is an additional 1 year of 2 after a sub-specialty, but you can do it. I do not have any of the links saved on this computer to point you in the right direction for more information at the moment.

 

[souljah1]

You can do this. If you do a CC fellowship after IM residency it is 2 yrs. If you have already completed a fellowship, it's just an additional year. There a decent number of CC only fellowships offered - but not as many as combined pulm/cc.

 

[RTrain]

You can do this. If you do a CC fellowship after IM residency it is 2 yrs. If you have already completed a fellowship, it's just an additional year. There a decent number of CC only fellowships offered - but not as many as combined pulm/cc.

Yes. If you complete a subspecialty fellowship, CC is one additional year after that.

If you are planning an academic career, it's a viable option - I've known ID/CCM and nephrology/CCM folks. If you're planning a career in private practice, however, doing something outside "the norm" might not be to your advantage. Private groups generally like their intensivists to bronch, and don't need their ID docs to manage vents - you might have to choose one hat to wear, and not really get rewarded for your extra time and work.

 

[MedStudent2007]

you can do a 2 year crit. care fellowship before or after ID...depends on how you want to combine it. i personally know of a guy who did IM/ER and now is doing his critical care fellowship. he is basically going to act as the liason between the ER and ICU. i'm sure you can find something similar for your ID/CC idea.

fyi - univ. of pittsburgh was the first freestanding critical care department (not affiliated with pulmonary) in the country. you may want to check them out.

 

[Roadrunner]

Yes, I realize that one can do CC with another specialty for a total 3 years of fellowship. My question is more pragmatic of whether these combined ID/CC, Renal/CC, etc. fellowships are already in existence or if one has to apply to both programs and combine them in an "outside the box" approach. For example, you won't find an ID/CC fellowship listed on the FREIDA site so I assume that these positions are created for individuals who want this kind of training.

 

[gutonc]

Yes, I realize that one can do CC with another specialty for a total 3 years of fellowship. My question is more pragmatic of whether these combined ID/CC, Renal/CC, etc. fellowships are already in existence or if one has to apply to both programs and combine them in an "outside the box" approach. For example, you won't find an ID/CC fellowship listed on the FREIDA site so I assume that these positions are created for individuals who want this kind of training.

Correct, the only currently combined program is Pulm/CC so the others tend to be "outside the box" things but are relatively common and becoming more so. In general, once you land a fellowship (ID, Renal, Cards, whatever) it will be relatively easy to tack on that extra CCM year at your "home" program since CCM programs are always looking for warm bodies to cover shifts.

 

[BMW19]

I believe they should allow Hospitalists to do a 1 yr CC fellowship after 1 or 2 years in practice. They know most of the procedures and have probably already been rounding in the ICU (if the hospital has an open ICU). Anyone agree with this?

B-

Correct, the only currently combined program is Pulm/CC so the others tend to be "outside the box" things but are relatively common and becoming more so. In general, once you land a fellowship (ID, Renal, Cards, whatever) it will be relatively easy to tack on that extra CCM year at your "home" program since CCM programs are always looking for warm bodies to cover shifts.

 

[RTrain]

I believe they should allow Hospitalists to do a 1 yr CC fellowship after 1 or 2 years in practice. They know most of the procedures and have probably already been rounding in the ICU (if the hospital has an open ICU). Anyone agree with this?

B-

I disagree. I think there is a reason why it has been determined that CCM fellowship should be 2 years for those who are BC/BE in IM only versus those who have dedicated subspecialty training - your knowledge and ability grows with the amount of training you receive, and you are not receiving training or necessarily actively growing your expertise while practicing as a hospitalist in an open ICU. Just rounding on critically ill patients doesn't mean you are doing the right thing for them, and IMHO should not substitute for formal training in the field.

Not even to mention the fact that it has been shown again and again that outcomes are significantly better in closed ICU's staffed by trained intensivists - open ICU's should be phased out anyway. 👍

 

[souljah1]

I disagree. I think there is a reason why it has been determined that CCM fellowship should be 2 years for those who are BC/BE in IM only versus those who have dedicated subspecialty training - your knowledge and ability grows with the amount of training you receive, and you are not receiving training or necessarily actively growing your expertise while practicing as a hospitalist in an open ICU. Just rounding on critically ill patients doesn't mean you are doing the right thing for them, and IMHO should not substitute for formal training in the field.

Not even to mention the fact that it has been shown again and again that outcomes are significantly better in closed ICU's staffed by trained intensivists - open ICU's should be phased out anyway. 👍

I very much agree. The Leapfrog initiative is largely motivated by data that suggest closed units staffed by intensivists are associated with better outcomes. I am all for increasing the number of programs offering critical care fellowships to IM residency grads without the need for additional subspecialty training in pulmonary care if that is something someone is interested in. However, in order for this field to maintain an academic focus the fellowship must provide time to receive formal training in translational or clinical epidemiological research. That is impossible in a one year fellowship.

 

[BMW19]

In a perfect world I think the studies that closed ICU's have better outcomes are great. However, how many people do you know that want to go into CC as a specialty when for a few more years or the same they could do Cardio, GI, outpatient pulm (sleep studies=$$) etc. etc. Correct me if I'm wrong but I think there is a shortage of CC docs in this country. I know Hospitalists take a lot of flak but who is on the front lines everyday all day besides ER docs? If they would allow the additional training segway it could make a smooth transition to Hospitalists on the floors and Hospitalists/Intensivists doing both. Anyone agree? anyone at all....

B-

I very much agree. The Leapfrog initiative is largely motivated by data that suggest closed units staffed by intensivists are associated with better outcomes. I am all for increasing the number of programs offering critical care fellowships to IM residency grads without the need for additional subspecialty training in pulmonary care if that is something someone is interested in. However, in order for this field to maintain an academic focus the fellowship must provide time to receive formal training in translational or clinical epidemiological research. That is impossible in a one year fellowship.

 

[RTrain]

In a perfect world I think the studies that closed ICU's have better outcomes are great. However, how many people do you know that want to go into CC as a specialty when for a few more years or the same they could do Cardio, GI, outpatient pulm (sleep studies=$$) etc. etc. Correct me if I'm wrong but I think there is a shortage of CC docs in this country. I know Hospitalists take a lot of flak but who is on the front lines everyday all day besides ER docs? If they would allow the additional training segway it could make a smooth transition to Hospitalists on the floors and Hospitalists/Intensivists doing both. Anyone agree? anyone at all....

B-

Many more people do P/CCM fellowships than CCM alone, and very few of them practice outpatient pulmonary exclusively, or go on to sleep fellowships. Most have a combined practice of ICU and pulmonary medicine.

I understand where you are coming from with this opinion, but I think it results from a flawed understanding of critical care medicine - you are looking at it as an extension of general medicine (as opposed to a specialty). If that were the case, then there wouldn't be that difference between closed and open ICU's. But there is. I doubt you would argue that a hospitalist should get a year knocked off an endocrinology fellowship because they take care of DKA, or a year off a cardiology fellowship because they admit chest painers or CHF exacerbations. The same holds true for CCM, which is a specialty unto itself requiring specific training, not just "experience."

 

[EMCC]

I agree with much of what has been posted here so far. CCM is NOT an extension of floor medicine. They are very different beasts, and require different ways of thinking.

A sick patient on the floor is usually quite different than a sick patient in the ICU. Granted, many sick floor patients should be in the unit, but long story short, a sick floor patient is not as likely to die as a sick ICU patient.

Also, facility with procedures is not exactly a strong suit of many hospitalists. So, simply adding a year is not the ideal setup. I am not talking about intubations and central lines. More procedures in the way of PA catheters, broncs, trachs, PEGs, etc.

I think it is okay for EM, Surgery, and anesthesia do have to do only one year critical care fellowships--especially since all 3 are very procedure heavy. For most IM docs, however, procedures are few and far in between, even during residency.

 

[gutonc]

One thing being ignored by those arguing against BMW19's thesis (practicing hospitalists should be able to do a 1yr CCM fellowship if they have X # of years in practice) is that the CCM (no pulm) fellowships I know of are essentially 1 clinical year and a year of "research." The program at our hospital has 10 mos of units (MICU, SICU, Neuro ICU) the first year and then a 1 month selective (another month in one of those places, the Trauma ICU or the ED) in the 2nd year. So the clinical portion can be completed in 1 year. How truly useful the 2nd year of research is for people planning to be out in the community is up for debate but one could certainly get the meat of the training done in 1 year.

Now...I happen to disagree w/ BMW19's thesis (and am planning an academic research career) but I thought I should point out that "only 1 year of training isn't enough" is somewhat disingenuous since basically everyone gets 1 year of training, even in a 2 year program.

To BMW19: If you want to do CCM after being a hospitalist, go nuts and just moonlight back at your old hospitalist gig (or elseewhere) during your 2nd "research" year to make up your lost income.

 

[zeloc]

Is there a list of programs that offer one year critical care fellowships after an IM subspecialty? Just searching on the Internet I came across Baylor, Stanford, and the University of Washington, but it seems that there are not many or maybe only known to the local people. Do individuals in general just try to add on a year where they are already doing fellowship?

 

[gutonc]

Is there a list of programs that offer one year critical care fellowships after an IM subspecialty? Just searching on the Internet I came across Baylor, Stanford, and the University of Washington, but it seems that there are not many or maybe only known to the local people. Do individuals in general just try to add on a year where they are already doing fellowship?

I think most people just stay put but pretty much any program that has a CCM only track would be happy to have another warm body, assuming they have the funding.