Critical care

[anbuitachi]

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Did a search, didn't see recent posts.

For CC fellowships, after anesthesiology, do you only train with anesthesiology grads? Or is it a mix with other specialties as well?

And how is CC after anesthesiology these days? Is it still reallly hard to get a decent job...?

And this is probably a really dumb question... but can CC doctors open private clinics (like primary care clinics..)? [can any fellowship trained anesthesiologist other than Pain, open clinics?]

 

[lazypanda]

depends on where you get your fellowship. Stanford fellows train with with neurologists going into neuro critical care, emergency medicine folks going into CC, and medicine people in pulm/ccm. UW has mixing with pulm and EM. Job market for critical care anesthesiologists isn't in demand compared to pulm/ccm. Academic jobs are filling up quick. No critical care doctors can't/don't open clinics. No reason to, its a hospital based specialty.

 

[cchoukal]

Lots of different types of fellowships. Many (I'd say most) are separate, meaning you train with just other anesthesia fellows. Some anesthesia fellowships accept EM and surgery fellows. There are programs, however (Pitt and UCSF come to mind, but I'm sure there are others), where all the fellows are in one group. At UCSF, we have anesthesia, pulm, surgery/trauma, sometimes EM, sometimes a random nephrologist). Pros and Cons to each, I suppose, but I really valued training with and under a variety of specialists and practice styles.

I can't say too much about the job market, as it is highly regionalized. Fellowships tend to graduate more fellows than their institutions can hire (fellowship is one year, a faculty career might be 25 or 30), so as more programs fill, graduates will have to go farther afield to find work. In the Bay Area, some opportunities have opened up at one of the large HMOs in town, but many of our graduates take positions that don't include critical care.

Can you open a clinic? State licensure doesn't limit what kinds of medicine you practice, so I suppose technically, even as an anesthesiologist and intensivist, you could hang up your shingle as a primary care doc. The only thing stopping you would be the overhead, negotiating your own insurance contracts, generating referrals in an environment that is almost exclusively HMO-saturated, and, by the way, that you would likely be totally incompetent to do really good primary care. And let's not forget that you'd never be able to bill enough primary care visits to generate what you'd make as an anesthesiologist.

 

[epidural man]

As cchoukal said - yes you can open a clinic. Your medical license doesn't dictate scope of practice. You can open an ENT clinic if you want. You can practice gynecology if you want. You can even build a surgery center and perform surgeries. In fact, in Idaho, a medical license allows you to practice dentistry. But as mentioned, there are lots of problems with this.

However, if you really want to practice front line medicine - your best bet is to get a job as an anesthesiologist and ICU, and moonlight at an ER or urgent care. I have known several anesthesiologists that do that.

 

[G-Man82]

In my area of the country, a lot of straight CCM jobs exist that take Anesthesiologists. But I didn't go into this field to do 100% CCM. So finding a straight up CCM job isn't that hard. It's the mix that's tough to find. It does exist though, and I have interviewed with them. Actually there are some recent postings on GasWork looking for CCM guys.

But I agree with most people that the jobs for anesthesia CCM tend to be in academics.

My fellowship, by the way, is essentially with other anesthesia fellows. The only time we cross train is in the Trauma ICU, which has an anesthesiologist one week per month who does mostly trauma anesthesia, too, but trauma surgeons the rest of the time. Fellows in that unit are mostly trauma, with us rotating through every now and then.