Jun 12, 2018
39
22
Status
Attending Physician
Hey y'all,
Just want to know for any of y'all regular posters who have a part to do with hiring. I have sent out lots of feeler emails for jobs that are advertised for CCM only, not Pulmonary consult or outpatient consults. Only of course to get back "Sorry, we are looking for Pulmonary/CCM or people with an IM background".

I just want to get an idea of what you guys/gals think about anesthesiologist in the unit. Clearly many of you think we aren't up to par and/or want to hold on to your territory or there's something else. Ignorance of hospitals and recruiter I believe plays a role. Are there some disease processes/pathology that I am not as familiar with as an IM person? Yes, like some of the immunology/oncology diseases that immediately come to mind. But I can read and familiarize myself with stuff since I didn't get exposed to as much of that as the MICU intensivists.

I guess I am butt hurt for being discriminated against. Our anesthesia department ran the community hospital ICU with the usual bread and butter community admissions which is what is prevalent in the community and the type of jobs I have applied to. It also ran the Neuro ICU. But yet I am told by some of these hospitals that they are looking for someone with IM background AND a Neuro-CCM fellowship. Do these hospitals have any idea how many people, outside of neurology are actually doing a NeuroCCM fellowship?

I have had a few job offers but have gotten more rejections than offers simply because I don't have an IM background. It's quite annoying.

Would love to hear some HONEST responses please. As in, if you've had bad experiences with anesthesia CCM docs, or whatever.

Probably a coincidence, but wasn't that crazy ICU doc in Columbus who was giving massive Fentanyl doses anesthesia trained? Just wondering if that is scaring off some community hospitals.
Personally I haven't had any bad experiences w/ anesthesia-CCM docs, although at my hospital they work primarily in the cardiothoracic ICU and most are cardiac anesthesia trained also. None of them round in the MICU (and I'm pretty sure none of them want to).
 

RemyMcswain

7+ Year Member
Feb 21, 2011
64
9
Status
Resident [Any Field]
Probably a coincidence, but wasn't that crazy ICU doc in Columbus who was giving massive Fentanyl doses anesthesia trained? Just wondering if that is scaring off some community hospitals.
Personally I haven't had any bad experiences w/ anesthesia-CCM docs, although at my hospital they work primarily in the cardiothoracic ICU and most are cardiac anesthesia trained also. None of them round in the MICU (and I'm pretty sure none of them want to).
Friend, there are sociopaths in every field of medicine. This has nothing to do with him being an anesthesiologist.
 
About the Ads

jdh71

Grim Optimist.
10+ Year Member
Dec 14, 2006
68,387
49,291
Last House on the Block, USA
Status
Attending Physician
What was his point? Maybe I missed it too.
That simply because this was a anesthesia trained CC doc who got in trouble, it might put off some people. It’s not necessarily rational but you can see how someone might connect those dots.
 
OP
C

chocomorsel

Senior Member
10+ Year Member
May 24, 2006
3,223
1,756
somewhere always warm
Status
Attending Physician
That simply because this was a anesthesia trained CC doc who got in trouble, it might put off some people. It’s not necessarily rational but you can see how someone might connect those dots.
That just happened in the past couple of years. I have been eyeing CCM jobs for years and most still post for Pulmonary CCM and have for ever. Not just CCM.
I think that would be a stretch. Any sociopath could kill some patients intentionally.
 

jdh71

Grim Optimist.
10+ Year Member
Dec 14, 2006
68,387
49,291
Last House on the Block, USA
Status
Attending Physician
That just happened in the past couple of years. I have been eyeing CCM jobs for years and most still post for Pulmonary CCM and have for ever. Not just CCM.
I think that would be a stretch. Any sociopath could kill some patients intentionally.
Sure. I was simply clarifying the point.

I don’t know that I’m convinced the guy in this case was a “sociopath.”
 

jdh71

Grim Optimist.
10+ Year Member
Dec 14, 2006
68,387
49,291
Last House on the Block, USA
Status
Attending Physician
Yeah. You are probably right. He was a misguided angel of mercy. Can’t do that in this country.
“fentanyl” is also political poison right now

I think fentanyl and even fentanyl infusions aren’t euthanasia and should and could work very well for the dying. I do NOT use them for this exact reason.

Though I think in the cases related to this guy he did give some eyebrow raising bolus doses. But other than that if the patient was dying and was on comfort care, I don’t know that as a CC doc I can get too outraged. Yes, we don’t put people down. We provide “comfort” and the secondary effects of our comfort medications will hasten death. I know some think this is a distinction without meaning. I’m not convinced. I think it is an important distinction. But I still don’t think this guy should be crucified based on what I know about the case.
 
OP
C

chocomorsel

Senior Member
10+ Year Member
May 24, 2006
3,223
1,756
somewhere always warm
Status
Attending Physician
“fentanyl” is also political poison right now

I think fentanyl and even fentanyl infusions aren’t euthanasia and should and could work very well for the dying. I do NOT use them for this exact reason.

Though I think in the cases related to this guy he did give some eyebrow raising bolus doses. But other than that if the patient was dying and was on comfort care, I don’t know that as a CC doc I can get too outraged. Yes, we don’t put people down. We provide “comfort” and the secondary effects of our comfort medications will hasten death. I know some think this is a distinction without meaning. I’m not convinced. I think it is an important distinction. But I still don’t think this guy should be crucified based on what I know about the case.
He will be crucified because this is America and we always want heroics for everyone and if we hasten death without the family consent, some consider it murder. Even though there is no other alternative.
 

jdh71

Grim Optimist.
10+ Year Member
Dec 14, 2006
68,387
49,291
Last House on the Block, USA
Status
Attending Physician
He will be crucified because this is America and we always want heroics for everyone and if we hasten death without the family consent, some consider it murder. Even though there is no other alternative.
pretty much
 
  • Like
Reactions: chocomorsel

ShockIndex

Toxically Masculine
Nov 21, 2019
190
204
Status
Attending Physician
He will be crucified because this is America and we always want heroics for everyone and if we hasten death without the family consent, some consider it murder. Even though there is no other alternative.
There is still a nugget in me that thinks that we may someday find a middle ground and consensus between heroics for everyone vs. active euthanasia with a milligram of fentanyl.
 
  • Like
Reactions: chocomorsel

Hamhock

10+ Year Member
May 6, 2009
1,270
593
Status
Attending Physician
It's a lot easier to see our job as relieving suffering and promoting human flourishing.

Within this context, 1000mcg fentanyl or so much more is not ethically challenging. Who hasn't had a patient on 300 mcg/hr infusion fentanyl and then needed much much more to minimize suffering after the "terminal extubation"?

HH
 

ShockIndex

Toxically Masculine
Nov 21, 2019
190
204
Status
Attending Physician
It's a lot easier to see our job as relieving suffering and promoting human flourishing.

Within this context, 1000mcg fentanyl or so much more is not ethically challenging. Who hasn't had a patient on 300 mcg/hr infusion fentanyl and then needed much much more to minimize suffering after the "terminal extubation"?

HH
Before going off on a tangent, let me say that I don’t think that Dr. Husel’s actions have anything to do with the uphill battle that anesthesia intensivists face getting jobs outside of surgical and CVICUs. IMHO, it has a lot more to do with the fact that anesthesia-CCM fellowships have traditionally focused on those ICU populations, and (to a lesser extent) medical intensivists are financially incentivized to limit their labor pool.

Having said that, I’m not aware of any instance among the 25 counts in his indictment where Husel appropriately escalated therapeutics. Instead, he gave massive, single doses of fentanyl to patients without their consent, and in a manner that is most reasonably understood as an effort to end their life. This includes a 2 mg dose of fentanyl for a patient who was relatively opiate naive. Keep in mind that neither the family nor the patient were involved with this decision or prepared for the immediate death that resulted. Personally, I suspect this guy had a God complex and enjoyed the power that these actions afforded him.
 
Last edited:
  • Like
Reactions: Colorado outliers
Jun 12, 2018
39
22
Status
Attending Physician
Before going off on a tangent, let me say that I don’t think that Dr. Husel’s actions have anything to do with the uphill battle that anesthesia intensivists face getting jobs outside of surgical and CVICUs. IMHO, it has a lot more to do with the fact that anesthesia-CCM fellowships have traditionally focused on those ICU populations, and (to a lesser extent) medical intensivists are financially incentivized to limit their labor pool.

Having said that, I’m not aware of any instance among the 25 counts in his indictment where Husel appropriately escalated therapeutics. Instead, he gave massive, single doses of fentanyl to patients without their consent, and in a manner that is most reasonably understood as an effort to end their life. This includes a 2 mg dose of fentanyl for a patient who was relatively opiate naive. Keep in mind that neither the family nor the patient were involved with this decision or prepared for the immediate death that resulted. Personally, I suspect this guy had a God complex and enjoyed the power that these actions afforded him.

I agree, although it came to mind I don't really think Husel's stuff has anything to do with the OP's predicament in most markets (as long as you are not in Columbus)
Also agree that Husel's use of massive fentanyl doses in opioid-naive patients, without knowledge of family, is not defensible. Not sure if these were the circumstances in every case.
Personally, don't think pharmacy/nursing would ever agree to administer such large doses at our hospital. If someone (even an attending) tried to order it, I don't think it would happen.
 

leviathan

Drinking from the hydrant
Moderator Emeritus
15+ Year Member
Sep 30, 2003
2,436
69
Vancouver, BC, Canada
Status
Attending Physician
Just to offer a different perspective, my ICU is often heavily occupied by patients waiting for transfer to the wards who are well outside of their critical illness, and strictly are internal medicine patients at this point. We routinely have people waiting so long for transfer that they just get discharged home from the ICU. I would be less confident in a non IM trained intensivist managing these patients, whether it be gen surg or anesthesia or otherwise. On the other hand, I would still gladly hire an intensivist with anesthesia or other backgrounds, as long as they know their limitations and can ask for advice (or consult) as needed.

I'm not sure if that's the reason you were getting resistance from hospitals, but just one other possibility to consider.

Otherwise, I agree with the sentiment that we all enter critical care training with different strengths/weaknesses and we address those weaknesses before finishing. In my case I spent several months in my fellowship doing anesthesia and a difficult airway rotation so I was more comfortable with that aspect.
 

MoMoGesiologist

What is dead may never die
2+ Year Member
Sep 17, 2016
501
606
Status
Attending Physician
Just to offer a different perspective, my ICU is often heavily occupied by patients waiting for transfer to the wards who are well outside of their critical illness, and strictly are internal medicine patients at this point. We routinely have people waiting so long for transfer that they just get discharged home from the ICU. I would be less confident in a non IM trained intensivist managing these patients, whether it be gen surg or anesthesia or otherwise. On the other hand, I would still gladly hire an intensivist with anesthesia or other backgrounds, as long as they know their limitations and can ask for advice (or consult) as needed.

I'm not sure if that's the reason you were getting resistance from hospitals, but just one other possibility to consider.

Otherwise, I agree with the sentiment that we all enter critical care training with different strengths/weaknesses and we address those weaknesses before finishing. In my case I spent several months in my fellowship doing anesthesia and a difficult airway rotation so I was more comfortable with that aspect.
Sounds like your ICU sucks... agreed that many of us wouldn’t want to manage floor patients and their chronic illnesses.
 
  • Like
Reactions: chocomorsel
About the Ads