Critical Care

[allendo]

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Could someone explain the Critical care aspect of Gas? Do you plan the Anesth for the critically ill or do you function like IM doc working in ICU? Anyone with any info please??????

 

[militarymd]

Could someone explain the Critical care aspect of Gas? Do you plan the Anesth for the critically ill or do you function like IM doc working in ICU? Anyone with any info please??????

Both. After doing a critical care fellowship, you become VERY comfortable taking care of dying patients. You become comfortable with death also. Invariably, if you are the Critical care guy, you will get the sickest patients coming to the OR.

Depending on what type of practice you get in, you could also attend in the ICU..either MICU or SICU and take care of ICU patients. Be forwarned, there aren't that many practices in N. America where you will get to attend in the ICU.....just not finanically feasible for most anesthesia groups.

 

[xampower]

While I was doing one of my away rotations, over and over again it was suggested to me that if I have any interest in critical care and could stomach doing a cc fellowship then do one. The one year sacrafice would pay-off b/c practices would like to have a double boarded member of the group according to them. They weren't necessarily saying this to suggest doing cc full time or even at all. Their feeling was that you would be more desirable to a group. Does anyone have a perspective on this.

 

[militarymd]

They weren't necessarily saying this to suggest doing cc full time or even at all. Their feeling was that you would be more desirable to a group.

that is correct

 

[UTSouthwestern]

While I was doing one of my away rotations, over and over again it was suggested to me that if I have any interest in critical care and could stomach doing a cc fellowship then do one. The one year sacrafice would pay-off b/c practices would like to have a double boarded member of the group according to them. They weren't necessarily saying this to suggest doing cc full time or even at all. Their feeling was that you would be more desirable to a group. Does anyone have a perspective on this.

While it is a nice feather in your cap, it is unlikely to enhance your candidacy unless you are joining a high risk group (i.e. sick, sick, sick cardiac patients).

 

[militarymd]

While it is a nice feather in your cap, it is unlikely to enhance your candidacy unless you are joining a high risk group (i.e. sick, sick, sick cardiac patients).

Must disagree. Having just went through looking for a job...in the west, midwest, southeast, northeast.

Every place I looked, the groups wanted me because I had CCM as part of my credentials....it didn't matter if it was a community hospital with only ASA 1 and 2's for 99 percent of its cases or academic centers with only sick patients.

With my CCM board Cert...I was writing my own ticket.

 

[VentdependenT]

I have a feeling that those who take a CCU month must really have an intense liking for the field, Thats a pretty tough year if I'm not mistaken with OR and Unit call thrown in. I'm sure you come out extremely confident. I've seen the anesthesiology group in action over at the Lutheran General Hospital (big private hospital) SICU out here. They manage post thoracic sx pt's and they are a truly wicked (in the laudable sense) bunch of of docs.

However if you won't be an active player in the unit then I would imagine a large percentage of high ASA class cases as a resident would be more practical. I truely enjoyed my past ICU experiences and a fellowship sounds highly intriguing but not enticing by any means. We'll see how crispy I am in 3 years.

Maybe I'll just do a fellowship in anti-aging medicine. Apple a day sort of thing. 😀

 

[painmanager]

I've also heard this is true. i'm in my ty year right now, this cc/pulm i admit under sometimes was telling me i'd be stupid to not spend the extra year and get the cc fellowship, makes u much more marketable. There's also eICUs that are popping up everywhere to try to deal with the cc shortage. My hospital uses it, it's pretty freaking cool. They pay cc docs about $300/hr to work 8 hour shifts, not too shabby.

 

[gaspimp]

eICU?

 

[militarymd]

eICU?

google it

 

[VentdependenT]

We have them in both the SI and MICU. I suppose its a nice back up. I have only seen it used once and that was during a code when there wasn't an attending around in the SICU.

I heard that the camera has visual acuity high enough to read the drug labels on the IV bags next to the pt. Freeeaakkyyy.

All of our notes are electronic and are kept on file electronically through the VICU system. So if we get a readmission all of the prior MR is basically sitting right in front of you. That is if the system isn't down.

 

[MD Dreams]

How does a critical care fellowship compare to a cardiac fellowship. Would a CC trained person be able to do heart cases? Which route is more advantageous in terms of job placement?

 

[powermd]

I hate to be the shallow *sshole in this thread, but how much of a pay cut do you take going from OR anesthesia to full time CCM?

 

[militarymd]

I hate to be the shallow *sshole in this thread, but how much of a pay cut do you take going from OR anesthesia to full time CCM?

I think that is very difficult to say. It will be regionally dependent. Some full time intensivists will make more than full time anesthesiolgists, and vice versa.

Best way to figure is look up median salaries of each specialties. In general, passing gas gets you $$$$ a lot easier than seeing ICU patients, but seeing ICU patients is much more intellectually rewarding than passing gas...even complex cases...at least for me.

And if you are wondering, I have gone over to the dark side....I pass gas exclusively...and see ICU patients only as favors to surgeons who ask..... I don't even bother billing for it.

 

[jumpin bean]

If you get a job with an academic department, you'll get paid on par with the other faculty that do OR work. You may even get more money since academic departments are hurting for CCM faculty. The ICU requirement for residents is going up from 2 months to 6 months, and it is required that the residents are trained in units covered by Anesthesia CCM attendings at least 50% of the time. The demand for anesthesia trained CCM people in academics is only going to increase.

Private practice is a different story. Most intensivist jobs (not working in OR at all) that I have seen are offering about half of what you can make as a starting Anesthesiologist in the OR. However, I have seen groups that take turns in the unit and OR in order to spread out the cost of doing ICU work. The ICU work keeps your general medicine skills sharp, helps your relationship with your surgeons, and is interesting. If you can share the call and the decrease in revenue that comes with spending time out of the OR with several partners, critical care isn't a bad choice.

 

[gaslady]

One financial aspect that no one has mentioned yet is the opportunity cost of doing the fellowship. That's another year of making around $45-50K versus anesthesia attending salary. It would take years to make up that lost revenue.

Also, I think there's some variability in the rigorousness of the fellowships. Some will work you to the bone with ICU call, while others are more of a daytime commitment.

There is a huge need to ICU attending due to the Leapfrog initiative. Most ICU trained docs aren't anesthesia trained.

The following link is to a recent ASA newsletter on critical care. There's multiple articles in it including one on private practice.
http://www.asahq.org/Newsletters/2004/02-04/TOC02_04.html

 

[MD Dreams]

What's the leapfrog initiative?

 

[KGUNNER1]

What's the leapfrog initiative?

http://www.leapfroggroup.org/about_us/leapfrog-factsheet

 

[Skip Intro]

http://www.leapfroggroup.org/about_us/leapfrog-factsheet

Most interestingly from that page (my bolding for emphasis)...

Staffing ICUs with doctors who have special training in critical care medicine, called ‘intensivists’, has been shown to reduce the risk of patients dying in the ICU by 40%.

-Skip

 

[docdaname]

what if i want to be an ICU attending as my career? I like anesthesia a lot, but i think i would rather be in the ICU than in the OR. Should i not take the anesthesia route if my goal is to be in the unit?