Emergency Medicine into a Critical Care Fellowship

[deleted547339]

someone fill me in lol, what makes going surgical crit care so much worse?

It’s not “worse” - it’s just the acgme requirements make it a little silly.

I forget the exact wording, but the ABS requires ER docs do “an advanced non operative surgical internship” or something very close to that prior to doing a 1 year SCC fellowship. I’ve heard commentary on that saying it was intentionally vague to allow programs to tailor it to the needs of the applicant, but I’m not jumping into that after already completing residency.

I believe SCC was the first program to accept EM and I think that shock trauma historically was a SCC fellowship so several of the SCC EM docs trained there and are likely phenomenal. Now, the ABA and ABIM programs outnumber the ABS.

Hopefully we can figure out this nonsense and just make an intensivist be an intensivist.

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[K31]

someone fill me in lol, what makes going surgical crit care so much worse?

The agreement between ABEM and ABS is that ABEM grads have to complete an “advanced preliminary year in surgery” prior to their fellow year to be eligible to sit for the SCC boards. So I’m living the life of a PGY-2 surgery resident this year.

 

[AthleteDoc7]

The agreement between ABEM and ABS is that ABEM grads have to complete an “advanced preliminary year in surgery” prior to their fellow year to be eligible to sit for the SCC boards. So I’m living the life of a PGY-2 surgery resident this year.

wow that sounds horrible, I'm sorry to hear it. some of the surgery programs sounded so appealing to me, but this would just about take them off my radar lol

 

[arandazzo88]

Okay. My intention for doing a fellowship would be to work in both the ER and an ICU. I'd be worried about ER skills atrophy during those two years but anyways...

I wouldn't worry too much about that. ICU will keep your critical thinking skills up. It's hard to tell an ER doc from an ICU doc in my classes.

 

[emergiQ]

I did a critical care fellowship in 2009, and was in the first cohort to get board certified in 2014. I did an anesthesia critical care fellowship. I've worked primarily in SICU and CTICU ever since, though I transitioned to a community take-all-comers ICU role about a year ago.

@Me with any questions, happy to help.

 

[slurpy15]

I did a critical care fellowship in 2009, and was in the first cohort to get board certified in 2014. I did an anesthesia critical care fellowship. I've worked primarily in SICU and CTICU ever since, though I transitioned to a community take-all-comers ICU role about a year ago.

@Me with any questions, happy to help.

Prefer it to ER?

 

[Apollyon]

I did a critical care fellowship in 2009, and was in the first cohort to get board certified in 2014. I did an anesthesia critical care fellowship. I've worked primarily in SICU and CTICU ever since, though I transitioned to a community take-all-comers ICU role about a year ago.

@Me with any questions, happy to help.

Haha - yer tag iz ded!

(Since you've been away, the @ function was enabled, such that @emergiQ gets you tagged, so you are aware when someone mentions you. @Me gets someone that has, apparently, had 228 messages, but you can't see any of them.)

 

[Dr.CCM]

The agreement between ABEM and ABS is that ABEM grads have to complete an “advanced preliminary year in surgery” prior to their fellow year to be eligible to sit for the SCC boards. So I’m living the life of a PGY-2 surgery resident this year.

The big advantage of these SCC programs over some of the others ones is you get your numbers to feel confident and competent with procedures like perc trachs and pegs which is nice if you plan to do them in the community.

However you can find Anesthesia CC and Medicine Cc programs where you can get the same exposures without that intern year.

 

[deleted547339]

The big advantage of these SCC programs over some of the others ones is you get your numbers to feel confident and competent with procedures like perc trachs and pegs which is nice if you plan to do them in the community.

However you can find Anesthesia CC and Medicine Cc programs where you can get the same exposures without that intern year.

I think it would be foolish to let number of trachs and PEGs have any influence the decision on where you did fellowship. At my program, you can get them if you want them, but I don’t care to so I don’t. I know one of my colleagues will be doing them when they graduate and the program where they’re going has offered to teach that skill then get that person credentialed.

Contrary to what many people may think, what defines an intensivist is his or her ability to think.

 

[Dr.CCM]

I think it would be foolish to let number of trachs and PEGs have any influence the decision on where you did fellowship. At my program, you can get them if you want them, but I don’t care to so I don’t. I know one of my colleagues will be doing them when they graduate and the program where they’re going has offered to teach that skill then get that person credentialed.

Contrary to what many people may think, what defines an intensivist is his or her ability to think.

Not completely disagreeing with you but for some programs it’s not even an option to really get your numbers and you need at least 30 or so of each to feel confident imo. I was able to do with mine (non surgery cc) but I plan to do them in the community.

Also if you want more of Trauma/SICU experience that would be another reason for surgery over medicine/anesthesia.

I don’t think many people would disagree with you that the ability to think is what makes a good intensivist. It’s like all we do.

 

[deleted547339]

Not completely disagreeing with you but for some programs it’s not even an option to really get your numbers and you need at least 30 or so of each to feel confident imo. I was able to do with mine (non surgery cc) but I plan to do them in the community.

Also if you want more of Trauma/SICU experience that would be another reason for surgery over medicine/anesthesia.

I don’t think many people would disagree with you that the ability to think is what makes a good intensivist. It’s like all we do.

My last comment was meant to relay that I think many people OUTSIDE of critical care (I.e. residents) think CCM is more doing than thinking.

 

[emergiQ]

I think it would be foolish to let number of trachs and PEGs have any influence the decision on where you did fellowship. At my program, you can get them if you want them, but I don’t care to so I don’t. I know one of my colleagues will be doing them when they graduate and the program where they’re going has offered to teach that skill then get that person credentialed.

Contrary to what many people may think, what defines an intensivist is his or her ability to think.

Prefer it to ER?

Prefer 'em both, and by design. When I get demoralized by Press Gainey and admin whining, I'm delighted to go the ICU for a few days. When a few pulmonary rocks get me down with no movement over a couple of days, it's nice to go back to the ED.

I will say that having both board certifications has given me leverage and more career and job options thoughout my working life.

 

[em_dream21]

I am a recent ED grad, currently applying for CCM spots with anesthesia. Feel free to DM - maybe I can answer some questions. I think it's a great idea, and am all for more of us choosing this path.

Can you tell me more about pursuing a critical care fellowship in anesthesia; specifically, after graduating from your anesthesia CC fellowship, how will you allocate your time between the emergency department and the critical care unit? Is your plan to primarily work in the surgical ICU after your anesthesia CC fellowship?

 

[em_dream21]

I did a critical care fellowship in 2009, and was in the first cohort to get board certified in 2014. I did an anesthesia critical care fellowship. I've worked primarily in SICU and CTICU ever since, though I transitioned to a community take-all-comers ICU role about a year ago.

@Me with any questions, happy to help.

Do you feel that the anesthesia critical care fellowship has adequately prepared you enough to work in a MICU?

 

[em_dream21]

I would argue that my customer service skills are much better after a CCM fellowship. I can now say that my understanding of medicine and physiology is immensely improved and I think I will be a much more efficient EP. I’ve had the opportunity to see much more concentrated pathology.

Some programs require EM time, some encourage ED moonlighting, some allow moonlighting but keep the fellows too busy to do it. At first, I liked the idea of going to a program that requires EM time because of the worry of losing skills. The problem is this: they are getting attending work out of you without paying you for it. In the mean time, you are taking on all the responsibility and liability of an attending without any of the benefits, plus you’re giving up time to potentially learn more CCM.

Happy to answer any questions.

Can you provide some EM friendly Medical CC Fellowship programs that are specifically in the midwest? Thank you!

 

[em_dream21]

I wouldn't worry too much about that. ICU will keep your critical thinking skills up. It's hard to tell an ER doc from an ICU doc in my classes.

Can you please provide a list of some EM friendly medical critical care fellowship programs that are specifically in the midwest? Thank you!

 

[deleted547339]

Can you provide some EM friendly Medical CC Fellowship programs that are specifically in the midwest? Thank you!

WashU and Michigan come to mind.

 

[K31]

Can you provide some EM friendly Medical CC Fellowship programs that are specifically in the midwest? Thank you!

In addition to what TimesNewRoman said, add Henry Ford to the list. And while it may be stretching the definition of “Midwest” a bit, Pittsburgh is a lot closer to Cleveland than to Philadelphia.

 

[deleted547339]

In addition to what TimesNewRoman said, add Henry Ford to the list. And while it may be stretching the definition of “Midwest” a bit, Pittsburgh is a lot closer to Cleveland than to Philadelphia.

Haha. Yea, I googled Midwest states because I originally thought Pittsburgh (it seems Midwest to me, lol) but Penn didn’t seem to be in the Midwest. Didn’t look I’m detroit for fellowship, so I can’t comment on the quality of Henry Ford - but I can say that you would be extremely well trained and highly recruited from Pitt, WashU or Michigan.

There certainly may be other em/CCM programs through IM in the Midwest, but WashU and Michigan are the big names in the region. Pitt if you include Penn in the Midwest.

 

[DubbiDoctor]

This is a really interesting article on the jobs ED physicians can find after completing a CC fellowship: Life After Fellowship, Part I: Types of Critical Care Jobs // ACEP Basically, it's either mostly/only EM, an EM-CC split or mostly/only CC. Critical care is fascinating, but why would you want to give up 36 hr/week EM shift work for the 7-on intensivist schedule for around the same pay? The prospect of ED-ICUs is intriguing (and sounds like the perfect fit for an EM physician with specialized training in CC), but it's too soon to tell whether they will become mainstream at academic medical center, as they only exist at around at around 5-6 sites, it seems. I think for a select group of CC-interested EM physicians something like this (U-M opens one of nation's most advanced centers for critically ill and injured emergency patients | Michigan Medicine) may be the perfect job: treating the highest acuity patients while staying in the ED!

 

[DubbiDoctor]

I am a recent ED grad, currently applying for CCM spots with anesthesia. Feel free to DM - maybe I can answer some questions. I think it's a great idea, and am all for more of us choosing this path.

What kind of job are you looking for post-fellowship? Are you looking to integrate CC with EM or simply become an intensivist?

 

[deleted547339]

This is a really interesting article on the jobs ED physicians can find after completing a CC fellowship: Life After Fellowship, Part I: Types of Critical Care Jobs // ACEP Basically, it's either mostly/only EM, an EM-CC split or mostly/only CC. Critical care is fascinating, but why would you want to give up 36 hr/week EM shift work for the 7-on intensivist schedule for around the same pay? The prospect of ED-ICUs is intriguing (and sounds like the perfect fit for an EM physician with specialized training in CC), but it's too soon to tell whether they will become mainstream at academic medical center, as they only exist at around at around 5-6 sites, it seems. I think for a select group of CC-interested EM physicians something like this (U-M opens one of nation's most advanced centers for critically ill and injured emergency patients | Michigan Medicine) may be the perfect job: treating the highest acuity patients while staying in the ED!

The same reason you pick any other specialty over EM, you like it more.

 

[DO class of 2018]

Any fellow DOs planning on doing this fellowship taking step 3? Or does anyone in the know feel it should be taken?

 

[engineeredout]

Any fellow DOs planning on doing this fellowship taking step 3? Or does anyone in the know feel it should be taken?

You mean USMLE step 3? Totally unnecessary.

 

[K31]

Taking Step 3 is completely unnecessary. EM inservice scores matter a little but most program directors likely don’t know how to interpret them (since most aren’t emergency physicians). Most important by far is references from EM and ICU faculty.

 

[Dr.CCM]

Do you feel that the anesthesia critical care fellowship has adequately prepared you enough to work in a MICU?

You’ll be fine in the community MICU. EM gives you an excellent background in general medical knowledge and we know what to do when stuff goes bad quickly.

It’ll be hard to get a job where you can do both for the same group outside of academics (anesthesia guys have the same issue). You almost always will have to choose between the two specialities for full time work. But it wouldn’t be too hard to find a place that needs 1week/month icu doc and then however many ER shifts at another hospital.

Taking Step 3 is completely unnecessary. EM inservice scores matter a little but most program directors likely don’t know how to interpret them (since most aren’t emergency physicians). Most important by far is references from EM and ICU faculty.

Yup references, research and your contacts.

 

[DO class of 2018]

Thanks for the input folks. I did mean USMLE step 3. I have two questions if anyone can spare a minute:

1) Research: I didn't do much research in med school outside of published case reports. So I'm pretty uninformed on the process. I'm keen on doing something to increase my competitiveness for a cc fellowship. I don't have any great ideas at this point. Anyone have any ideas on perhaps finding projects that need help, or resources to look into? I'll inquire with attendings in the ICU, etc., once I'm in residency, but I certainly have more time now than I will have after I start residency. I've searched around on the web and didn't really come across anything

2) Doing a rotation at a program. The residency where I'm going doesn't have a fellowship. But there is a program not too far away in the same state that does. Thoughts on doing a rotation? It might be too logistically annoying (getting privileges, etc.,), but it seems like something that could really help.

Thanks in advance.