Critical Care

[cfdavid]

Back in 2003, UTSouthWestern commented that there was a big push by the ASA to increase the number of CC trained anesthesiologists. Something like, in the past, up to 60% of anes docs were CC trained, with this number dropping precipitously over the past decade or more.

Any word on "the street" regarding this? UT, if you're out there, is this still the case?

Thanks,

cf

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[fakin' the funk]

Back in 2003, UTSouthWestern commented that there was a big push by the ASA to increase the number of CC trained anesthesiologists. Something like, in the past, up to 60% of anes docs were CC trained, with this number dropping precipitously over the past decade or more.

Any word on "the street" regarding this? UT, if you're out there, is this still the case?

When I was interviewing, I expressed a fairly strong interest in CCM. This is typically well-received by PD's and chairs, especially since a disproportionate # of chairs are CCM peeps. I was told that the CCM-heavy programs, which tend to be the bigger, more famous/prestigious, academic programs, were pushing for a integrated full-year CCM fellowship to be incorporated into the anesthesia residency, extending it to internship + 4. There was a lot of pushback from smaller or less ICU-leaning programs that simply couldn't provide the rotation/curricular experience necessary to do so. So, instead we get the compromise of 4 (or is it 6?) months of required ICU experience throughout your 4 years of residency.

My understanding of CCM fellowships in anesthesia is that less than 50% of the spots fill annually. I don't know how competitive even "top" fellowships are, since apparently some of them don't fill year-to-year.

So, to answer your questions, yes, not a whole lot of anesthesiologists are going into CCM these days.

You can always take pride that Danish anesthesiologists invented the ICU during the polio epidemic in the 50's though

 

[cchoukal]

I can't imagine the number was ever 60%. The number has always been pretty low because operative anesthesia has always billed better than critical care. There has been a push by certain factions of anesthesiology leadership into ICU as a way to define or redefine our role as perioperative physicians, as opposed to "just" OR anesthesiologists. The majority of the literature suggests patients do better when a trained intensivist is involved, and regulatory/quality agencies have said the world needs more intensivists. I cannot yet say how this will turn out in terms of job availability, as, so far, anesthesia CC is largely an academic pursuit. I'm a fellow now, so I guess we'll see soon!

 

[2win]

Back in 2003, UTSouthWestern commented that there was a big push by the ASA to increase the number of CC trained anesthesiologists. Something like, in the past, up to 60% of anes docs were CC trained, with this number dropping precipitously over the past decade or more.

Any word on "the street" regarding this? UT, if you're out there, is this still the case?

Thanks,

cf

No money in this field - interest is pretty low.

 

[Noyac]

No money in this field - interest is pretty low.

Exactly right. I was talking to one of the CC guys at my hospital just this week. He was complaining about how little money there was in CCM. They are all pulmonary guys (no anesthesiologists) so they have a pulmonary clinic as well and they make half of what we do.

On a side note, they only get and average of $40/bronch in the clinic. There's no way I'd do bronchs for only $40 especially when things like a colonoscopy gets so much more.

 

[seinfeld]

The best money in CC comes when the hospital decided it needs to staff its ICUs with Fellowship trained Intensivisits then the money is more comparable. Considering a full time CC position is 24 weeks per year, it gives you time to work per diem or part time with an anesthesia group.

Given how few people are wanting to do ICU, the laws of supply and demand take over when a hospital sets its sights on making a CC service.

 

[periopdoc]

Several of the groups that I have been talking to want CCM because their hospitals want CCM certified docs. The gigs are 1/4 CCM 3/4 OR. The hospital subsidizes the CCM time so you get paid the same as an operative FTE. Not a bad gig except you are reliant on a hospital subsidy which has its own set of issues.

-pod

 

[cfdavid]

Several of the groups that I have been talking to want CCM because their hospitals want CCM certified docs. The gigs are 1/4 CCM 3/4 OR. The hospital subsidizes the CCM time so you get paid the same as an operative FTE. Not a bad gig except you are reliant on a hospital subsidy which has its own set of issues.

-pod

I'd imagine that the surgeons find it more profitable to be operating versus staffing the SICU as well, no?

 

[fakin' the funk]

The best money in CC comes when the hospital decided it needs to staff its ICUs with Fellowship trained Intensivisits then the money is more comparable. Considering a full time CC position is 24 weeks per year, it gives you time to work per diem or part time with an anesthesia group.

Given how few people are wanting to do ICU, the laws of supply and demand take over when a hospital sets its sights on making a CC service.

I have been explicitly told by several PP anesthesiologists, some of whom did CCM fellowships, that no pulmonologist-heavy CCM group out in PP land will hire an anesthesia intenstivist -- y'know, cuz we're different -- any thoughts on this? With the supply and demand changing, might that be different in 5-10 years?

Disclaimer: I'm really really hoping someone tells me that in 5-10 years PP CCM groups will be begging for intensivists of any kind, so that I can do 1/2 OR and 1/2 ICU

 

[cfdavid]

I have been explicitly told by several PP anesthesiologists, some of whom did CCM fellowships, that no pulmonologist-heavy CCM group out in PP land will hire an anesthesia intenstivist -- y'know, cuz we're different -- any thoughts on this? With the supply and demand changing, might that be different in 5-10 years?

Disclaimer: I'm really really hoping someone tells me that in 5-10 years PP CCM groups will be begging for intensivists of any kind, so that I can do 1/2 OR and 1/2 ICU

Who's staffing the SICU's in PP?? Like I said, just as it's currently more profitable for CC trained anesthesiologists to be in the OR, so would it seem to be for the surgeons.

 

[periopdoc]

I forgot and should have added. The CCM responsibilities in those jobs were daytime only. Nights and weekends were covered by the primary services and they just wanted an intensivist for the weekdays.

- pod

 

[bigdan]

Several of the groups that I have been talking to want CCM because their hospitals want CCM certified docs. The gigs are 1/4 CCM 3/4 OR. The hospital subsidizes the CCM time so you get paid the same as an operative FTE. Not a bad gig except you are reliant on a hospital subsidy which has its own set of issues.

-pod

POD -

Were these offers in PP? Finding a 1/4 CCM 3/4 OR job is EXACTLY what I think I'd like to do with my life, and had accepted (read:"resigned myself to") academics.

I'm not asking for numbers (unless ya wanna give 'em), but was the wage competitive at these places?

dc

 

[periopdoc]

Yes PP. They were not formal offers as I am not CCM trained (yet). Wages are competitive for the market that the practices are in. That doesn't mean >75th percentile MGA income, but the wages are in line with the region in which the practices are located.

None of them were aggressively looking for just another CT doc.

- pod

 

[seinfeld]

POD -

Were these offers in PP? Finding a 1/4 CCM 3/4 OR job is EXACTLY what I think I'd like to do with my life, and had accepted (read:"resigned myself to") academics.

I'm not asking for numbers (unless ya wanna give 'em), but was the wage competitive at these places?

dc

Thats my job in a nutshell, in PP. I get paid what all the other anesthesiologists get.

 

[bigdan]

You guys made my day! NICE!

dc