critical care

[echod]

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During my clerkships, I have seen both Anesthesiologist and Pulmonologists doing critical care (ie. staffing ICUs). What proportion of Anesthesiologists become board certified in critical care? How much time do Anethesiologists spend in the ICU vs. the OR? Do Anesthesiologists generally enjoy the critical care aspect as compared to the OR? Thanks a lot.

 

[PMPMD]

During my clerkships, I have seen both Anesthesiologist and Pulmonologists doing critical care (ie. staffing ICUs). What proportion of Anesthesiologists become board certified in critical care? How much time do Anethesiologists spend in the ICU vs. the OR?

The first ICUs were created by anesthesiologists, but since then (1950s), anesthesiologists have made up an decreasing proportion of intensivists. Now, most intensivists are internal medicine trained. Out of about 1300 graduating anesthesia residents each year, only about 50 go into critical care. A similar number do trauma surgery/CCM. Compare that to about 500 pulm/CCM grads. Most often, anesthesia trained intensivists staff SICUs, although they can staff any adult ICU. The practice models vary, but many divide their time between OR and ICU. The exact ratio depends on the individual and the practice they're in.

Do Anesthesiologists generally enjoy the critical care aspect as compared to the OR?

A large part of anesthesiology is critical care in the OR. Even if a patient is health to begin with, with general anesthesia, we paralyze them (=respiratory failure), give them anesthetics (vasodilators and negative inotropes), and take away their protective reflexes. So if they weren't critical to begin with, they sure are under GETA. Add in multiple medical comorbidities and surgical pathology and you can see why it's a logical transition from OR to ICU.

 

[seinfeld]

i have written many threads on this topic, for your own education i would do a search as i cant possibly summarize all of them here.

Fact: there are more critical care jobs than people to fill them (i need to find 3 more guys to do CCM
Fact: Most (not all) Anesthesiologists CURRENTLY make more money doing anesthesia than critical care
Fact: Not all pulmonologists who are trained by default in CCM (was a structed part of their fellowship) will do CCM. With the advent of sleep labs more and more pulmonary guys will seek money in this realm.
Fact: I work in both a Medical and Surgical ICU. Most surgeons will not trust a medical intensivist to care for their patients.

I did the fellowship as a way to secure a future in medicine, plus i liked the icu environment. Both on a local and national scale i am so glad i did it. I have so much leverage to determine my own destiny.

 

[cfdavid]

The first ICUs were created by anesthesiologists, but since then (1950s), anesthesiologists have made up an decreasing proportion of intensivists. Now, most intensivists are internal medicine trained. Out of about 1300 graduating anesthesia residents each year, only about 50 go into critical care. A similar number do trauma surgery/CCM. Compare that to about 500 pulm/CCM grads. Most often, anesthesia trained intensivists staff SICUs, although they can staff any adult ICU. The practice models vary, but many divide their time between OR and ICU. The exact ratio depends on the individual and the practice they're in.




A large part of anesthesiology is critical care in the OR. Even if a patient is health to begin with, with general anesthesia, we paralyze them (=respiratory failure), give them anesthetics (vasodilators and negative inotropes), and take away their protective reflexes. So if they weren't critical to begin with, they sure are under GETA. Add in multiple medical comorbidities and surgical pathology and you can see why it's a logical transition from OR to ICU.

This can change. For sure. Like many things, it's all up to us. A few strong, well placed, pioneers can go a long way. Hell, it's a ONE year fellowship. This is on top of the critical care/acute care training that an anesthesiology resident learns during the normal 4 years, and on top of the ICU months.

I really think we just need to get aggressive......

cf