EM vs CCM

[Pix87]

Hello EM forum! I'm a med student interested in CCM and EM. Someone asked the CCM vs EM question in the CCM forum, I wanted to post it here and get the EM side of the story.

What are the pros/cons of going EM vs CCM? Is there a lot of overlap between skill sets used to manage patients in EM and CCM? Anyone on the EM side double boarded or crossed over from CCM? I would appreciate your thoughts!

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[deleted109597]

There is overlap in the critical care patients. The rest, not so much.
The pros/cons are the same for each individual field.
Plenty of people are double boarded EM/CCM through the European boards.

 

[jbar]

I think the real question is how do you want to get to CCM? I couldn't do IM, so that route was out. I was thinking of doing anesthesia and then CCM through that, but decided on EM. There are some EM docs who do fellowships in critical care, and work in both the units and the ED. So since you have to do either EM, IM, or anesthesia to even get to CCM, the question is which would you rather do? And which do you like enough that if you decide not to do CCM or don't get into fellowship, you will still like your career.

 

[Saladin MD]

I was considering CCM as a back-up should I have not gotten into EM. I decided against it after actually rotating in it, which made me realize some major differences with it and EM.

The majority of your patients in the ICU will be on the ventilator. Even those who aren't are so sick that you can't talk with them much. One of the best things about EM for me is that you get to talk to patients, meet new people every day, etc.

I'm a social person and I like talking to patients. During my IM rotations in my Transitional Year, I spent like 30+ minutes going through the patients charts, labs, filling out crap, etc., and only like 5 minutes in the patient's room. In the ICU, it was like 3 minutes with the patient and 45+ minutes doing other stuff, like filling crap out, looking through the charts, labs etc. (I'm talking about pre-rounding on patients.) I feel like in EM you spend a greater percentage of your time with patients, and less time writing crap, going through charts, etc. This I speak from the perspective of an intern. (Maybe EM attendings have to deal with a lot of paperwork, I don't know.)

Of course, you'll get your share of ICU-like patients in the ED, but it's not the ONLY patients you meet. It's a healthy mix of patients, from super acute to why the heck are you here in the ED. I like that mix, instead of having all on-the-brink-of-death patients who can't talk, communicate, etc.

Also, all that buzzing and beeping in the ICU would drive me nuts.

I may have misunderstood your question. If you are asking what route to take to do CCM, I think doing IM would be the best route to take, not EM. Whatever you do, I think you would want to not always have to defend your training. For example, I would never advise a person to go through FP and then do an ER fellowship. You'll always be second rate that way. If you do EM and then CCM, you'll be looked down upon by your colleagues. For some, this wouldn't be an issue, and all the more reason to excel...but for me, I'd hate that situation.

Also, if you do end up doing the CCM route, do a Pulmo/CCM fellowship (it's just one year longer). I know of at least a couple people who did that and ended up focusing on the pulmo part, since they hated doing CCM in their later years of life. So it's good to have that option available. Although I think CCM will eventually shift to hospitalist type of schedule--or even like EM--but right now, most CCM jobs seem pretty hectic and unrewarding...that's what I hear from very trusted people in the field. Lifestyle wise, CCM sucks. On the other hand, both EM and Pulmo are not as unfulfilling in that aspect.

Anyways, for me, EM >>>>> ICU.

 

[Pix87]

Thanks for the input! I did not fully consider the ramifications of failing to secure a CCM fellowship, so good looking out on that one!

I'm definitely interested in EM on its own, but I don't know all that much about the work done in critical care and was interested in the job description (as far as paper descriptions go). Your thoughts go a long way, so I appreciate your posts!

 

[GreenShirt]

I also enjoy both EM and CCM. Here are my thoughts on the two:

1) High Acuity Patients-Both are alluring fields if you are interested in treating severely ill patients. However the amount of critical cases you see differs amongst the 2 fields. 100% of patients in the ICU are very sick and would not be alive if it wasn't for the medical care you are providing. It's humbling and awe-inspiring that we have such technology/medicine available. In the ED, only about 30% of your patients will be severely ill. The reminder will be minimal to medium acuity (cold, asthma exacerbation, cholecystitis, laceration etc.).

2) Work Environment Stress: Dealing with very sick people is stressful but here's my impression of the workplace environment. In the ED, you are constantly running around trying to move people through. Your patients are at times angry, combative, non-cooperative or sick of waiting. In the ICU, on the other hand, things are more relaxed day to day IMHO. You have a set amount of patients to round on. Most your patients are sedated and incubated and therefore not thwarting your attempts at treatment. However, the really stressful part of ICU is that on a daily basis you will have meetings with families to discuss withdrawal of care of their loved one. You're not just giving families bad news, you're actually asking them to let their loved one die.

Training route: As one of the above posters mentioned, the training route is important b/c you have to be satisfied with your career if end up not going into CCM fellowship. I think IM is the best training for CCM. CCM is, afterall, a medicine sub-specialty. The way you think/train in Medicine vs. EM is very different.

 

[Arcan57]

I also enjoy both EM and CCM. Here are my thoughts on the two:

1) High Acuity Patients-Both are alluring fields if you are interested in treating severely ill patients. However the amount of critical cases you see differs amongst the 2 fields. 100% of patients in the ICU are very sick and would not be alive if it wasn't for the medical care you are providing. It's humbling and awe-inspiring that we have such technology/medicine available. In the ED, only about 30% of your patients will be severely ill. The reminder will be minimal to medium acuity (cold, asthma exacerbation, cholecystitis, laceration etc.).
.

30% is an unrealistic number, only found in residencies that purposefully group all critically patients in the same pod/area for training reasons. 5-10% crit care time in a tertiary care hospital would be more the norm. For a community hospital, 10% admission rate would be about standard.