Critical care

[Nestle]

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Hi -

I wanted to get some more info on the critical care route in anesthesiology. how many yrs is the fellowship? and what kind of lifestyle do critical care anesthesiologist have? i've heard from internal med folks that pulm/critical care is one of the worst subspecialties in terms of lifestyle. is that true from the anesthesiology route as well? do people ever have mixed practices - ie OR anesthesiology plus some critical care stuff thrown in for fun??
Critical care is so interesting, but i need to have a decent lifestyle.

 

[KGUNNER1]

Critical care is going to shift work now, especially in the SICU. It is not uncommon to find jobs where you work 10 or 12 hr shifts and go home, to be replaced by another Intensivist over night.

A couple of my partners are Anesthesiologists. They round for a week and then go back to the OR for the rest of the month. We have fellows that take in house call at night. We still are on call 24/7, but only get the occasional call at night if the fellow can't handle it. It is a great mix.

You will probably have to sacrifice a little lifestyle compared to straight general Anesthesiology, but if you really love the unit, it's worth it in the long run.

Kyle

 

[2ndyear]

Nestle,
There is a good critical care thread going in the General Residency forum right now, check that out too. Critical care is a one year fellowship and not really competitive right now to get into. As KGunner described, shift work is becoming the norm, it's here at my institution. Basically in terms of lifestyle I would say that if you are on shifts, it's comparable to ER. It's interesting that you heard it's one of the worst in terms of lifestyle from an IM point of view. Many people consider the shift work a bonus of ER medicine, ie no office, set schedule, etc. As far as what group you can work in, it's my understanding that it doesn't matter what route you got to critical care, once you are there you can work in any ICU. Some places have combined Med/Surg ICU's and many have separate. It seems that at least where I am, the SICU and MICU staff have different mindsets though.

 

[sean wilson]

" it doesn't matter what route you got to critical care, once you are there you can work in any ICU."

People have told me that on the West Coast, anesthesia has a stong presence in the ICU, especially SICU. According to these people, MICU is the providence of the pulmonary care/CC doc on the East Coast, though.

 

[Adcadet]

I'm also wondering where in the US anesthesiology dominates the (m/s)ICU. Here in Minnesota from what (little) I've seen the MICU is definitely pulm/CC attendings + pulm/CC fellows + IM residents.

 

[KGUNNER1]

I'm also wondering where in the US anesthesiology dominates the (m/s)ICU. Here in Minnesota from what (little) I've seen the MICU is definitely pulm/CC attendings + pulm/CC fellows + IM residents.

Anesthesiologists aren't practicing CCM much any more. General Anesthesiology has become very lucrative. Critical Care doesn't pay nearly as well. The last few years only about 50 fellows went into Critical Care through the Anesthesiology route.

KG

 

[DireWolf]

Are anesthesiologists required to complete a critical care fellowship in order to work in ICUs?

I ask because I know that many anesthesia docs do not opt for Cardiac, OB, Neuro, etc. fellowships because they are trained to do these cases anyway. It is mostly docs intereseted in academics that pursue these fellowships.

 

[Adcadet]

Are anesthesiologists required to complete a critical care fellowship in order to work in ICUs?

I ask because I know that many anesthesia docs do not opt for Cardiac, OB, Neuro, etc. fellowships because they are trained to do these cases anyway. It is mostly docs intereseted in academics that pursue these fellowships.

and they're already doing peri-operative critical care. I'm confused as well.

 

[KGUNNER1]

Are anesthesiologists required to complete a critical care fellowship in order to work in ICUs?

I ask because I know that many anesthesia docs do not opt for Cardiac, OB, Neuro, etc. fellowships because they are trained to do these cases anyway. It is mostly docs intereseted in academics that pursue these fellowships.

Nobody is "required" to have any special training to work in an ICU. The Top speciality for billing Critical Care time according the the Medicare Database are general internists and Family practice. If the hospital is willing to give you privilages, you can do anything without special training. However, after the leapfrog report http://www.leapfroggroup.org/safety1.htm hospitals are now looking for board certified intensivists to staff their units.

All base specialities that have good resuscitation skills (ER, Anesth, Surg) are well prepared for a CCM fellowship. The unit is quite a bit different than the OR or ER. You have multiple (sometimes up to 30) patients, most very sick. You have to have very strong multi-tasking skills. This is different for Anesthesiologists or surgeons who are trained to intensly focus on 1 or 2 patients at a time. ER is well trained for multi-tasking, however, the depth of knowledge is usually too superficial for critical care without further training.

KG

 

[2ndyear]

Yeah, I have seen only a few places where anesthesiolgists have a really strong presence in the ICU. URochester, UMass and Baystate come to mind. As an aside, what is the general interest in critical care among anesthesiolgy applicants/residents on this board?
I matched anesthesia and am interested in a fellowship, but not totally committed yet as I've only had 3 months unit experience as a med student. Others?

 

[Tenesma]

MGH SICU is anesthesia run... no ifs, ands or buts...