DOs in Critical/Intensive Care

[CTrainSJU]

Anybody know or are familiar with DOs currently practicing in Critical/Intensive Care? Care to share how they went about doing this? I am incredibly interested in this field of medicine after extensive shadowing. My research hasn't really provided me with much info such as if there are specific residencies for this. The two doctors I have talked to about this did their residencies in internal medicine. Any info any one could provide me with on this would be awesome and greatly appreciated.

---

Members don't see this ad.

 

[Dr JPH]

IMED residency with a fellowship in critical care medicine/pulmonary medicine. That seems to be the most common way for people to do it. I know many DOs who are in this field. Pulmonary can be tough to get into, but its not the most competitive IM subspecialty.

Some surgeons do critical care fellowships as well, but thats more for surgical ICU patients and has a totally different pathway.

 

[CTrainSJU]

IMED residency with a fellowship in critical care medicine/pulmonary medicine. That seems to be the most common way for people to do it. I know many DOs who are in this field. Pulmonary can be tough to get into, but its not the most competitive IM subspecialty.

Some surgeons do critical care fellowships as well, but thats more for surgical ICU patients and has a totally different pathway.

Thanks JP, that helps a lot. Looks like I was 50% right. One of the docs I shadowed did a fellowship in nephrology along with IMED residency.

 

[Dr JPH]

Thanks JP, that helps a lot. Looks like I was 50% right. One of the docs I shadowed did a fellowship in nephrology along with IMED residency.

Yeah.

You can really work in "critical care" without actually doing a critical care fellowship. I know a few ICU docs who are just IM without the critical care training.

I think most of the jobs for younger physicians and many ICUs, especially at academic centers, will want the additional education as opposed to just an IM residency.

As I said above, look into Pulmonary medicine. Some procedures, lots of thinking and not as competitive as some other spots.

 

[CTrainSJU]

Did you consider doing ICU? You seem to know a lot about getting into it.

 

[Hernandez]

Anybody know or are familiar with DOs currently practicing in Critical/Intensive Care? Care to share how they went about doing this? I am incredibly interested in this field of medicine after extensive shadowing. My research hasn't really provided me with much info such as if there are specific residencies for this. The two doctors I have talked to about this did their residencies in internal medicine. Any info any one could provide me with on this would be awesome and greatly appreciated.

I'm not, but I know several who are and if I do a fellowship, it'll be pulm/cc. 2 in particular did their IM residencies in an Osteopathic residency then went on to allo pulm/cc fellowships. There are also several dually accredited programs who have excellent reputations for fellowship placement.

 

[Hernandez]

Did you consider doing ICU? You seem to know a lot about getting into it.

As JP stated, you really don't have to be CC certified to work in a MICU setting. The Intensivist movement will never be large enough to force non-cc trained physicians out of the ICU, just as the Hospitalists will not replace traditional docs out of the hospital setting.

 

[SexPanther]

Anybody know or are familiar with DOs currently practicing in Critical/Intensive Care? Care to share how they went about doing this? I am incredibly interested in this field of medicine after extensive shadowing. My research hasn't really provided me with much info such as if there are specific residencies for this. The two doctors I have talked to about this did their residencies in internal medicine. Any info any one could provide me with on this would be awesome and greatly appreciated.

I have met several including 3 trauma surgeon/surgical CC docs at a level 1 trauma center in Wichita, KS. As stated previously, IM followed by pulm/cc is the most common way to become an intensivist (this isn't the way in Europe). You can also go GS followed by a trauma/surgical cc fellowship.

The way I plan on going is via Anesthesiology followed by a CC fellowship (this is the predominant type of intensivist in Europe).

Emergency medicine is also making a big push to be able to become board certified in CCM. Good luck.

 

[CTrainSJU]

I'm not, but I know several who are and if I do a fellowship, it'll be pulm/cc. 2 in particular did their IM residencies in an Osteopathic residency then went on to allo pulm/cc fellowships. There are also several dually accredited programs who have excellent reputations for fellowship placement.

Nice! Gives me hope. I'm only going to be a first year at DMU so I know how the residency ang all that good stuff works but how do fellowships work? I would assume that, like residency, you apply and interview, etc. Is this correct?

 

[Dr JPH]

As JP stated, you really don't have to be CC certified to work in a MICU setting. The Intensivist movement will never be large enough to force non-cc trained physicians out of the ICU, just as the Hospitalists will not replace traditional docs out of the hospital setting.

While that may be true the current trend towards subspecialization will take over IMO.

I think future ICU directors and the bulk of intensivists will be CC trained or at least have some additional post grad training beyond a 3 year IM residency.

 

[Dr JPH]

Did you consider doing ICU? You seem to know a lot about getting into it.

Nope

 

[CTrainSJU]

While that may be true the current trend towards subspecialization will take over IMO.

I think future ICU directors and the bulk of intensivists will be CC trained or at least have some additional post grad training beyond a 3 year IM residency.

Makes sense to me

 

[jhug]

I think future ICU directors and the bulk of intensivists will be CC trained

i feel (mostly from what i've heard) that the pulmonary component of the training will become more and more important as well. Intensivists are great but (as i understand it) a pulmonologist is still required to be in house so why pay for both when you can get both in a pulmo/cc trained physician.
i've LOVED pulmo/cc!!! There also is a trend to take the ICU's more toward shift work much like a hospitalist now! It's an exciting field...

 

[Hernandez]

Nice! Gives me hope. I'm only going to be a first year at DMU so I know how the residency ang all that good stuff works but how do fellowships work? I would assume that, like residency, you apply and interview, etc. Is this correct?

It's just like applying for residency, you apply, interview and hope you get accepted to the fellowship you apply for.

While that may be true the current trend towards subspecialization will take over IMO.

I think future ICU directors and the bulk of intensivists will be CC trained or at least have some additional post grad training beyond a 3 year IM residency.

I don't see this happening for a very long time. I'm sure it's possible, but with the impending shortage of docs especially in the more rural areas, this Can't happen for the foreseeable future, expect for academic medicine areas.

 

[The Eye Guy]

There is a residency at POH Medical Center, in Pulmonary/Critical care 3 years. You need to do IM to do critical care as sub-specialty. Your question was answered probably, but didn't feel like reading entire forum. You can do CC via cardiology (the cardiologist I rotated with was Cardio and Critical Care, surgery, and anesthesiology as well I believe since they have those in the hospitals, I think some places may allow certain ER residencies to do it, but that's just what I heard via mouth.

 

[SexPanther]

There is a residency at POH Medical Center, in Pulmonary/Critical care 3 years. You need to do IM to do critical care as sub-specialty. Your question was answered probably, but didn't feel like reading entire forum. You can do CC via cardiology (the cardiologist I rotated with was Cardio and Critical Care, surgery, and anesthesiology as well I believe since they have those in the hospitals, I think some places may allow certain ER residencies to do it, but that's just what I heard via mouth.

I see you've changed your name Eye Guy. Drop a line sometime and let me know how you are.

Hijack over.

 

[Taty]

Nope

JP what kind of surgeon you want to be ? I am dead set on surgery I guess medical school will help me to deside between transplant and trauma.

 

[Dr JPH]

I don't see this happening for a very long time. I'm sure it's possible, but with the impending shortage of docs especially in the more rural areas, this Can't happen for the foreseeable future, expect for academic medicine areas.

But where are you really going to use your ICU/CC skills?

Most of the places where there are a shortage of docs and thus they have IMED people covering the units dont have very busy ICUs. Or, the ICUs arent truly ICU type patients as we would know it.

A small rural hospital who has trouble attracting a CC/Pulm person for their unit will be sending their most critical patients to a larger tertiary or academic center anyway.

So yes, in some places you wont need CC training but if you really want to get into CC medicine and see the sick patients and deal with the true essence of critical care, you will be in that big academic hospital where you will indeed need to be CC trained.

The ICU of some of the smaller hospitals have patients that would hardly qualify for step-down units at some bigger places. Many of these places grind to a halt when a patient is put on pressors. Try an ICU where every other bed the patient had a neo drip.

 

[Dr JPH]

JP what kind of surgeon you want to be ? I am dead set on surgery I guess medical school will help me to deside between transplant and trauma.

Not sure yet. I have tossed around a few ideas from Plastics/Reconstructive to Oncology.

 

[nvshelat]

I know of some DO gas guys that did a fellowship in CC; ive read that some select ICUs in the country are run by gas attendings.

 

[Kuba]

I thought there were multiple routes to CC fellowships... can't surgeons, Anes., ED docs, and internists all pursue it?

 

[group_theory]

I thought there were multiple routes to CC fellowships... can't surgeons, Anes., ED docs, and internists all pursue it?

There are multiple routes for critical care ... the most common is IM followed by either a combine Pulm/CC or just CC alone (board certification by the ABIM in CC subspecialty)

You can go the route of surgery follow by surgical critical care (board certification by ABS in surgical critical care)

You can do EM and then try to do a critical care fellowship, but as of right now, there are no board certification in critical care for EM-trained physicians. While the exam administered by the Society of Critical Care Medicine is commonly viewed as just as tough as the ABIM critical care medicine boards (EM residents are eligible to take the SCCM exam), it is not a formal board certification recognized by the American Board of Medical Specialties (ABMS). Another option is to take the European Diploma in Critical Care exam, the official standard of critical care competence for the European Union

You can always do a IM/EM/CC route ... there are currently only two programs that offer this (Henry Ford and Long Island Jewish Hospital). University of Pittsburgh is in the process of starting one soon.

Another popular option is to do Anesthesiology followed by Critical Care, and be board certified by ABA (american board of anesthesiology in critical care)


For pediatric critical care, it's a pediatric residency followed by a pediatric critical care fellowship (board certification by the american board of pediatrics in pediatrics critical care medicne)

Or pediatric residency followed by a neonatal-perinatal medicine fellowship (board certification by the American board of pediatrics in neonatal-perinatal medicine)

 

[Hernandez]

But where are you really going to use your ICU/CC skills?

Most of the places where there are a shortage of docs and thus they have IMED people covering the units dont have very busy ICUs. Or, the ICUs arent truly ICU type patients as we would know it.

I really have no clue why people like you get it in your brain that academic medicine is the peak of medicine and that there is no way sick people can't be handled outside of it. I can personally tell you that I have been in hospitals which are at best level 3 centers, but still have ICUs which handle everything that they can appropriately handle. And that is they ship out major trauma and those who need neurosurgery. I have seen 20+ bed ICUs run solely by hospitalists who routinely handle S/P CABG, MI, severe sepsis, etc, etc and with ICU staff who can handle pressors, vents, balloon pumps, etc, etc, etc.

I respect your opinion, but don't sit there and expect me to listen to another 4th year's word as gospel when I know for a fact that there are large hospitals with modern ICUs who get by just fine and provide standard of care without CC trained docs.

The ICU of some of the smaller hospitals have patients that would hardly qualify for step-down units

I better call the last hospital I was in and let them know that they had no right to keep 9/10ths of the pts they managed in their MICU/SICU and should promptly ship them to an academic center.

 

[Dr JPH]

Hernandez, why are you taking this so personal?

Im giving my opinion based on my experiences and you are giving yours.

Dont turn it into a pissing contest.

 

[Hernandez]

Hernandez, why are you taking this so personal?

Im giving my opinion based on my experiences and you are giving yours.

Dont turn it into a pissing contest.

fine, would you like my in-depth analysis of the situation? There are ~350 grads from CC/PCC programs per year and ~22,000 IM grads per year, there are 300,000,000 million Americans with 5,810 hospitals with 984,000 beds with approximately 10% of these beds being ICU beds, and you're going to sit here and tell me with a straight face that a paltry 350 grads per year are going to be able to take care of close to 100,000 ICU beds in close to 6,000 hospitals? I don't think so. Even if you dismiss the small hospitals, you won't be decreasing the number of ICU beds by that much since those hospitals don't have that many ICU beds anyways.

I've looked into this, because this is what I want to do, and I've put a hell of a lot of thought into whether it makes sense to spend an additional 2-3 years when I can end up in a modern facility and still take care of critically ill pts without a fellowship. I have no desire to end up in a Center of excellence, nor do I care to end up in an academic center and it's well within the realm of reasoning to do primarily ICU based work as an internist with a reasonable expectation of handling high acuity pts.

 

[Dr JPH]

fine, would you like my in-depth analysis of the situation?

Not really.

Good luck with your IM residency.

 

[NRAI2001]

I thought getting an IM residency and then a sub specialty wasnt too difficult for a DO?

 

[CTrainSJU]

bump