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M1i

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Critical Care.
I had a question (sort of a multi-part question) in regards to critical care that I wasn’t really able to find a clear cut answer on. I’m aware there are various specialties of medicine, i.e General Surgery, IM, Anesthesiology, and I’m sure a few others, that are able to obtain fellowships in critical care. My question is would all three of the above specialties with a Critical Care fellowship do the same thing in terms of a patients care, or would each one play a more specific role tailored to there base specialty? Also would any of the aforementioned doctors be the patients primary in the hospital, or would that be another physician who sort of overlooks all the various doctors interacting with the patient. Lastly, after you complete a fellowship in critical care, would you always assume that role in a hospital setting, for example, would an Anesthesiologist have a job that allowed him both time in the OR and time in an ICU, or NICU ward? Critical Care is an aspect of the hospital (like many parts of a hospital for that matter) that i know little about, so any information or a point in the right direction for more info on the subject would be greatly appreciated.

Thank you!

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Different specialties work in different ICUs. Generally, the most common pathways are internal medicine followed by a three year pulmonary critical fellowship, or anesthesiology or emergency medicine followed by a two year critical care fellowship.

Most academic hospitals will have IM trained critical care doctors in the medical ICU while anesthesia or EM will often staff the neuro ICU and surgical ICU.

NICU is usually staffed by pediatricians who have been boarded in critical care after a critical care fellowship.
 
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Disclaimer: Just a med student who has rotated in the MICU.

1) depends on the setting, hospital culture/polocy, etc. But the ICU attending's responsibility is to manage the care of patients in the ICU, whatever that entails.

2) As the ICU attending, they oversee the patient and call consults as needed.

3) Depends on many factors. In the academic center where I train, all MICU attendings are internists with critical care fellowships. In the private hospital where I used to work, multiple physicians covered the ICU, including pulm/crit, a nephrologist, and an anesthesiologist with cc fellowship who did ambulatory cases three days/week. At the academic center where I used to work, some EM attendings also covered the MICU 50/50. There are myriad practice models - up to the individual physician to find what they prefer.
 
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