Graduating IM Resident, thinking about Anesthesia

[void88]

Hello, everyone! Currently, I'm PGY-3 IM Resident hoping to graduate this summer. Throughout my training, I have had an interest in Critical Care and enjoyed Managing airways during my Anesthesia rotation at the end of my PGY-2 year. I really enjoyed Anesthesia. Now I am having trouble deciding to what route should I go for.

I can either apply for Pulmonary/CC or just CC fellowship this year and work as a Hospitalist for one year. Or, I can just apply for Anesthesia and do one year of Critical Care after that. Ideally, I would want to have either Pulmonary or Anesthesia with Critical Care just to avoid burnout 10 years down the road.

Given that I have finished residency in Internal Medicine, will I have a better chance matching to Anesthesia? I feel like I've got more chance of matching in Anesthesia vs. Pulmonary Critical Care Medicine.

I am really stressing out and I realize that I should have made decision earlier (like last year) about these things. Please any kind of guidance would be greatly appreciated. I have average scores but no RED flag.

Thanks

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[kidthor]

Do Pulm/CC.

Done.

 

[vector2]

100% do pulm/CC. If you don't match, do a year of hospital work and apply again.

 

[void88]

Thank you so much for your quick response. Currently, I am trying to find Hospitalist job at an academic center so that, I can make connections or work on some projects with faculty. It is really hard to find a job at an academic center as there are no job ads. I am just emailining recruiters regardless of opening. I don't know what else should I do to find job sooner.

 

[vector2]

Thank you so much for your quick response. Currently, I am trying to find Hospitalist job at an academic center so that, I can make connections or work on some projects with faculty. It is really hard to find a job at an academic center as there are no job ads. I am just emailining recruiters regardless of opening. I don't know what else should I do to find job sooner.

Every academic department in the country has a staff directory listing the chairman of the medicine dept's phone number and email address. Start there.

Also check nejm and acp career websites.

Also also, you may already know this but lemme reiterate that you need to get your sht together cause you seem really behind the curve for a pgy3 about to graduate.

 

[deleted697127]

Hello, everyone! Currently, I'm PGY-3 IM Resident hoping to graduate this summer. Throughout my training, I have had an interest in Critical Care and enjoyed Managing airways during my Anesthesia rotation at the end of my PGY-2 year. I really enjoyed Anesthesia. Now I am having trouble deciding to what route should I go for.

I can either apply for Pulmonary/CC or just CC fellowship this year and work as a Hospitalist for one year. Or, I can just apply for Anesthesia and do one year of Critical Care after that. Ideally, I would want to have either Pulmonary or Anesthesia with Critical Care just to avoid burnout 10 years down the road.

Given that I have finished residency in Internal Medicine, will I have a better chance matching to Anesthesia? I feel like I've got more chance of matching in Anesthesia vs. Pulmonary Critical Care Medicine.

I am really stressing out and I realize that I should have made decision earlier (like last year) about these things. Please any kind of guidance would be greatly appreciated. I have average scores but no RED flag.

Thanks

I’ve never understood why more IM people don’t consider doing anesthesia after IM considering the length of additional training is the same as doing GI and shorter than some cardiology paths. Sure there are issues and who knows what healthcare will look like post covid, but I think our specialty can be legitimately fun. I don’t think that is true of many specialties.

I think there are character traits that people have in anesthesia that are more similar to surgery than medicine. For instance, some IM people i know couldn’t wait to never have to place a line again after training. Anesthesiologists generally love procedures and would rather act than debate differentials or right notes.

 

[nimbus]

One of the faculty when I was a resident did IM/pulm/CC/anesthesia. Best of all worlds.

 

[CopaceticOne]

One of the faculty when I was a resident did IM/pulm/CC/anesthesia. Best of all worlds.

Might this have been in the upper mid-west?

 

[Mman]

One of the faculty when I was a resident did IM/pulm/CC/anesthesia. Best of all worlds.

except the world that requires money

 

[GravelRider]

I’ve never understood why more IM people don’t consider doing anesthesia after IM considering the length of additional training is the same as doing GI and shorter than some cardiology paths. Sure there are issues and who knows what healthcare will look like post covid, but I think our specialty can be legitimately fun. I don’t think that is true of many specialties.

I think there are character traits that people have in anesthesia that are more similar to surgery than medicine. For instance, some IM people i know couldn’t wait to never have to place a line again after training. Anesthesiologists generally love procedures and would rather act than debate differentials or right notes.

Because 3 years of fellowship training after IM gets you to be a doctor that people travel to see. Unless you truly love anesthesia, my recommendation for most IM folks is to do the fellowship.

For the OP, I recommend you do Pulm/CC. From your post, it seems like you are thinking about anesthesia because you think you’ll have a better chance at an anesthesia residency vs a pulm/cc fellowship. That’s a recipe for unhappiness.

 

[Test Boy]

Just apply broadly to pulm/cc and see what happens. I don’t think it’s super competitive.

 

[jthedestroyr]

Pulm/ccm

I'm anesthesia - ccm and I wish i was pulm ccm. Having a closed unit without surgeons is a great place to be, plus you dont deal with crna. The most militant NP/PAs still arent anywhere near the crna hubris.

I have a few spread across my unit of this type of PA/NP, but they at least respect your opinion, unlike the CRNA when you try to "direct," them.

 

[nimbus]

Might this have been in the upper mid-west?

No lower West Coast.

 

[vector2]

Just apply broadly to pulm/cc and see what happens. I don’t think it’s super competitive.

Match rate is 65-70% which is def not a chipshot for an average applicant.

 

[deleted171991]

If I had a one-year accelerated pathway to IM-CCM, I would give up my anesthesiology-CCM attending career right now. I hate knee-jerk stupidity, and that includes many OR people, unfortunately. Those also tend to suffer of the Dunning-Kruger effect.

If you feel happy among internists, do NOT even consider anesthesiology, @void88. One of my biggest mistakes in life. I used to think exactly like you. One doesn't realize how different surgical and medical personalities are, until one "lives" with them. It's the difference between visiting a country and living in it.

 

[anbuitachi]

I’ve never understood why more IM people don’t consider doing anesthesia after IM considering the length of additional training is the same as doing GI and shorter than some cardiology paths. Sure there are issues and who knows what healthcare will look like post covid, but I think our specialty can be legitimately fun. I don’t think that is true of many specialties.

I think there are character traits that people have in anesthesia that are more similar to surgery than medicine. For instance, some IM people i know couldn’t wait to never have to place a line again after training. Anesthesiologists generally love procedures and would rather act than debate differentials or right notes.

i think because 1) not everyone think our field is fun. ive met ppl who think its the worst 2) people think card/GI etc are fun 3) GI/cards make more money.. can be FAR more. get more respect, and doesnt depend on surgeon for a job.

 

[anbuitachi]

Match rate is 65-70% which is def not a chipshot for an average applicant.

yes. but really have to know how good you are as an applicant. a lot of people didnt match into IM, but tend to be international. everyone i know matched into the field of their choice post IM. but yes if you come from a bottom malignant IM program, its def going to be harder

 

[Mman]

If I had a one-year accelerated pathway to IM-CCM, I would give up my anesthesiology-CCM attending career right now. I hate knee-jerk stupidity, and that includes many OR people, unfortunately. Those also tend to suffer of the Dunning-Kruger effect.

If you feel happy among internists, do NOT even consider anesthesiology, @void88. One of my biggest mistakes in life. I used to think exactly like you.

don't worry, our MICU does some knee jerk stupid things too

 

[deleted171991]

don't worry, our MICU does some knee jerk stupid things too

You bet! Internal medicine can be as full of dogma as surgery, except it's way easier to convince an internist.

I have saved at least 3 patients I took over in the last year, who had a pulmonary-CC guy on the case, consulting for the surgeon. In each case, I did the opposite of what they recommended. Lucky me!

Anesthesiology training fits critical care like the missing glove at the North Pole. The right programs can make one into a superb intensivist (that's why most intensivists in other countries are anesthesiologists). However, it's not worth it in the US. To quote Mr. Wonderful: "I forbid it!"

 

[anbuitachi]

that applies to everyone. anesthesiologists, surgeons, IM, intensivists.

 

[Mman]

You bet! Internal medicine can be as full of dogma as surgery, except it's way easier to convince an internist.

I have saved at least 3 patients I took over in the last year, who had a pulmonary-CC guy on the case, consulting for the surgeon. In each case, I did the opposite of what they recommended. Lucky me!

Anesthesiology training fits critical care like the missing glove at the North Pole. The right programs can make one into a superb intensivist (that's why most intensivists in other countries are anesthesiologists). However, it's not worth it in the US. To quote Mr. Wonderful: "I forbid it!"

everybody is good in their little area of the world. We most commonly have problems with MICU patients that were admitted with a medicine type problem (think stroke or whatever) but then develop a surgical problem (maybe dead gut or incarcerated hernia) and will sit there with their little 22 g IV and no IV fluids and a BP cuff cycling like hourly and it's a death spiral.

Medicine is not the good old days when a doc could know almost everything about everything. It's very specialized and care is compartmentalized and we need to rely on colleagues in other fields when it isn't up our alley.

 

[deleted171991]

everybody is good in their little area of the world. We most commonly have problems with MICU patients that were admitted with a medicine type problem (think stroke or whatever) but then develop a surgical problem (maybe dead gut or incarcerated hernia) and will sit there with their little 22 g IV and no IV fluids and a BP cuff cycling like hourly and it's a death spiral.

Medicine is not the good old days when a doc could know almost everything about everything. It's very specialized and care is compartmentalized and we need to rely on colleagues in other fields when it isn't up our alley.

This is all very nice and politically correct, but, still, the best specialists are also decent generalists, as in they keep a good perspective of the forest, and not everything looks like a nail to them.

Part of First Do No Harm is also knowing what one doesn't know, and ADMITTING it.

 

[Mman]

This is all very nice and politically correct, but, still, the best specialist are also decent generalists, as in they keep a good perspective of the forest, and not everything looks like a nail to them.

that doesn't disagree with anything I have said

 

[deleted171991]

that doesn't disagree with anything I have said

Because I probably don't. I tend to agree with most of your posts, in general.

That doesn't change my opinion that many surgical people have no f-ing idea how little they know about intensive care, and that includes anesthesiologists. For example, one favorite subject: maintenance IV fluids.

I am the first to admit that I don't know something, and ask for specialized help. I am also the first to never consult one again, if one spews useless "specialized" delirium and dogma. If only I could kick out surgeons from the SICU, for anything but wound care...

 

[nimbus]

i think because 1) not everyone think our field is fun. ive met ppl who think its the worst 2) people think card/GI etc are fun 3) GI/cards make more money.. can be FAR more. get more respect, and doesnt depend on surgeon for a job.

Indeed if you are GI or cards, the surgeons depend on you for a job.

 

[jthedestroyr]

You bet! Internal medicine can be as full of dogma as surgery, except it's way easier to convince an internist.

I have saved at least 3 patients I took over in the last year, who had a pulmonary-CC guy on the case, consulting for the surgeon. In each case, I did the opposite of what they recommended. Lucky me!

Anesthesiology training fits critical care like the missing glove at the North Pole. The right programs can make one into a superb intensivist (that's why most intensivists in other countries are anesthesiologists). However, it's not worth it in the US. To quote Mr. Wonderful: "I forbid it!"

My favorite quote from a "famous surgeon," at my fellowship was, "I don't care what the literature shows, I'd done this successfully like this for past 20-30 years, and I will continue doing it the same."

 

[deleted171991]

My favorite quote from a "famous surgeon," at my fellowship was, "I don't care what the literature shows, I'd done this successfully like this for past 20-30 years, and I will continue doing it the same."

To give credit where credit is due: the person who taught me to first do no harm was an old surgeon. He used to say "Don't just do something. Stand there!", right in the middle of a crisis. And he would just stand there and watch.

I have only been truly appreciating his wisdom since I became an attending, and learned to think for myself.

 

[Gill23]

If I could go back and do it over, I would do pulm/cc.

 

[chocomorsel]

Psychiatry for me.

 

[ProwlerturnGas]

I wouldn’t go into medicine

 

[void88]

Every academic department in the country has a staff directory listing the chairman of the medicine dept's phone number and email address. Start there.

Also check nejm and acp career websites.

Also also, you may already know this but lemme reiterate that you need to get your sht together cause you seem really behind the curve for a pgy3 about to graduate.

You are right about being "behind the curve for a PGY-3". Looking at things retrospectively, there were a lot of things I should've done differently. For some reason, I had a strong belief that I would be able to find an empty spot in a SOAP match. I applied at a few Pulmonary/Critical Care programs at the very end of the match season. I was all over the place. Even by the end of December, after the match result, I was still looking out for an unfilled spot. After that, I tried to follow a pathway of least resistance, i.e., to pick up a hospitalist job at my home institution. My program does not have any in-house fellowship. However, it is a great place for me to transition from a resident to an attending role as I know pretty much everyone. However, knowing myself, I decided not to go for it as I know that I will get comfortable and not seek fellowship in the future. This put me back to square one. After this, I decided to find a spot at an academic center where I can have an opportunity to work with Faculty and/or probably find a mentor.

I'm pretty sure my reasoning might be lame and I could've done better.

 

[void88]

I’ve never understood why more IM people don’t consider doing anesthesia after IM considering the length of additional training is the same as doing GI and shorter than some cardiology paths. Sure there are issues and who knows what healthcare will look like post covid, but I think our specialty can be legitimately fun. I don’t think that is true of many specialties.

I think there are character traits that people have in anesthesia that are more similar to surgery than medicine. For instance, some IM people i know couldn’t wait to never have to place a line again after training. Anesthesiologists generally love procedures and would rather act than debate differentials or right notes.

This is what I thought. I did my anesthesia rotation in the second year and enjoyed it so much. One of our anesthesiologists told me why don't I do a residency in anesthesia and consider it as a fellowship as it would be 3 years for me. However, by that time, it was already past the interview season.

Overall, I have a good relationship with my anesthesia attendings, they know that I am interested. Also, all the TY residents at our program going into anesthesia, we get along really well. All critical care attending like me as well, and they know that I will always chip in to place a central line. Sometimes, I would place a line before them even telling me to do one.

I never really knew, in the past, that I would enjoy these small procedures so much. This is something I developed as I gained more confidence during my critical care rotations by the end of PGY-2. I used to be so nervous and anxious about my ICU rotations during my intern year. I guess, due to that fear, I worked hard to get better in an ICU setting.

 

[void88]

Because 3 years of fellowship training after IM gets you to be a doctor that people travel to see. Unless you truly love anesthesia, my recommendation for most IM folks is to do the fellowship.

For the OP, I recommend you do Pulm/CC. From your post, it seems like you are thinking about anesthesia because you think you’ll have a better chance at an anesthesia residency vs a pulm/cc fellowship. That’s a recipe for unhappiness.

You're probably right. Even though I enjoyed anesthesia and I think I'll love it, deep down, I feel like I should try to get in Pulmonary Critical Care. Being an introvert and a quiet person, I always get drawn to. Not that all anesthesiologists are like that. It is the very nature of the job which attracts me. Also, the physiology, acuity, and hands-on approach of anesthesia are what draws me towards it. But I know, it would make more sense to do Pulmonary Critical Care, which has anesthesia aspect to it from the Critical care side and Pulmonology is also physiology heavy. There is so much conflict in me.

I really appreciate that you took your valuable time to write a post.

 

[void88]

Just apply broadly to pulm/cc and see what happens. I don’t think it’s super competitive.

Thank you

 

[void88]

Pulm/ccm

I'm anesthesia - ccm and I wish i was pulm ccm. Having a closed unit without surgeons is a great place to be, plus you dont deal with crna. The most militant NP/PAs still arent anywhere near the crna hubris.

I have a few spread across my unit of this type of PA/NP, but they at least respect your opinion, unlike the CRNA when you try to "direct," them.

That side of anesthesia I don't know of, obviously. Even though I believe that anesthesia is way too complex for CRNAs to practice unsupervised but it is an unfortunate reality that health care organizations like them due to profit/loss ratio philosophy.

But I really appreciate your honest opinion.

 

[void88]

Match rate is 65-70% which is def not a chipshot for an average applicant.

Pulmonary Critical Care is getting more competitive every year. This really worries me. I have been an average resident but with no red flag. I know that it is not enough but I will definitely apply on time this year and try my luck. At the same time, I will try to work as a hospitalist with an open mind and really know whether I like working as a hospitalist or not.

Money is not an issue for me in the sense that every doctor makes good enough for living. I just want to do something which I enjoy and fit in well.

 

[void88]

If I had a one-year accelerated pathway to IM-CCM, I would give up my anesthesiology-CCM attending career right now. I hate knee-jerk stupidity, and that includes many OR people, unfortunately. Those also tend to suffer of the Dunning-Kruger effect.

If you feel happy among internists, do NOT even consider anesthesiology, @void88. One of my biggest mistakes in life. I used to think exactly like you. One doesn't realize how different surgical and medical personalities are, until one "lives" with them. It's the difference between visiting a country and living in it.

If you were my attending, I could've had a long interesting conversation with you. I am always fascinated with the experiences of my attendings and their reason to pick a certain specialty. My only fear of doing IM-CCM is that I won't have anything to lean back on after 9-10 years after getting burnt out practicing CCM. The good thing about Anesthesia-CCM or Pulm/CC is that at least you have the Pulm part or Anesthesia part to lean on if you get burnt out from CCM.

However, I feel like after IM and Anesthesia, if you do CCM, you really merge Anesthesia and IM together. It is like the best of both worlds. The ability to manage chronic conditions/systems, as an internist, with skills of anesthesiologists can make you a great CCM physician.

 

[void88]

You bet! Internal medicine can be as full of dogma as surgery, except it's way easier to convince an internist.

I have saved at least 3 patients I took over in the last year, who had a pulmonary-CC guy on the case, consulting for the surgeon. In each case, I did the opposite of what they recommended. Lucky me!

Anesthesiology training fits critical care like the missing glove at the North Pole. The right programs can make one into a superb intensivist (that's why most intensivists in other countries are anesthesiologists). However, it's not worth it in the US. To quote Mr. Wonderful: "I forbid it!"

In my experience, both Anesthesiology-CCM and Pulm/CC bring something unique to the table. I have worked with great Pulm/CC docs and some really awesome Anesthesia-CCM people. They just have a different style of practicing CCM, coming from different backgrounds. Honestly, you can have a difference of opinion among two Pulm/CC or two Anesthesia/CC as well. Most of the time it is a fight of fluids that nobody wins.

 

[void88]

If I could go back and do it over, I would do pulm/cc.

What did you end up doing instead?

 

[Twiggidy]

Hello, everyone! Currently, I'm PGY-3 IM Resident hoping to graduate this summer. Throughout my training, I have had an interest in Critical Care and enjoyed Managing airways during my Anesthesia rotation at the end of my PGY-2 year. I really enjoyed Anesthesia. Now I am having trouble deciding to what route should I go for.

I can either apply for Pulmonary/CC or just CC fellowship this year and work as a Hospitalist for one year. Or, I can just apply for Anesthesia and do one year of Critical Care after that. Ideally, I would want to have either Pulmonary or Anesthesia with Critical Care just to avoid burnout 10 years down the road.

Given that I have finished residency in Internal Medicine, will I have a better chance matching to Anesthesia? I feel like I've got more chance of matching in Anesthesia vs. Pulmonary Critical Care Medicine.

I am really stressing out and I realize that I should have made decision earlier (like last year) about these things. Please any kind of guidance would be greatly appreciated. I have average scores but no RED flag.

Thanks

Consider this in your decision.....

When a pandemic hits and the OR shuts down, guess who’s sitting on the sideline trying to figure out how to make an income. Hint: it’s not the Pul/CC docs who still have patients coming to clinic, especially in our current situation.

When you see people on here using the cliche of anesthesiology being a “service industry”.....well, you’re witnessing it first hand right now.

 

[46Long]

Because 3 years of fellowship training after IM gets you to be a doctor that people travel to see. Unless you truly love anesthesia, my recommendation for most IM folks is to do the fellowship.

For the OP, I recommend you do Pulm/CC. From your post, it seems like you are thinking about anesthesia because you think you’ll have a better chance at an anesthesia residency vs a pulm/cc fellowship. That’s a recipe for unhappiness.

Yea, Anesthesia residency can be torture if you don't like it.. If you like it it can be fun... or anesthesia residency used to be fun. Now the program directors have put so much pressure on the residents it probably isn't fun anymore. BUt uniformly, the attending job as anesthesia is definitely not as fun as the residency.. BUt if you want to do an anesthesia residency to get to ICU medicine seems like a waste since you can do a 1 year icu fellowship right now and there you have it. Anesthesia's future is not clear.

 

[deleted171991]

In my experience, both Anesthesiology-CCM and Pulm/CC bring something unique to the table. I have worked with great Pulm/CC docs and some really awesome Anesthesia-CCM people. They just have a different style of practicing CCM, coming from different backgrounds. Honestly, you can have a difference of opinion among two Pulm/CC or two Anesthesia/CC as well. Most of the time it is a fight of fluids that nobody wins.

There are great people in every category of humans. My best CCM education comes from American internists and EM docs, and from European and Australian anesthesiologists. I just don't see that level of critical care from many intensivists, because many just aren't that passionate (burn out vs poor specialty fit vs treating it like just a job). For example, one who doesn't live and breathe (patho)physiology doesn't belong in this specialty.

All I wish for myself and my dear ones is to be treated by a passionate (and knowledgeable/experienced) doctor. There is no excellence without passion, regardless of specialty. Just food for thought.

 

[deleted171991]

Can't you just practice outpatient IM?

Or hospital IM.

 

[deleted162650]

There is no excellence without passion

Excellent quote. Applies to everything, not just medicine.

 

[46Long]

Excellent quote. Applies to everything, not just medicine.

I agree however in our current system excellence and passion are not rewarded and sometimes the pursuit of excellence can get you in trouble.

 

[deleted697535]

Do anesthesia if you want to do it.
Its fun.
Its great being able to keep a Big Mac alive overnight and stop surgeons killing people. The skills are fantastic.

But there are downsides. No one respects you. No one knows what you do. everyone thinks they can do it better, until something like covid comes around and suddenly our ****'s golden. But they will soon forget again.

Re this whole CRNA vs Anesthesiologist fight. Dont worry about that. That will go soon. CRNAs signed their own obituary once they got independence. In a few years the real numbers will come out without the Anesthesiologist to bail them out. Plus very few good Anesthesiologists will continue to train the new crna's so they will inevitably be lethal, once the older crnas retire.

Its a long road for you. Your accountant would advise against it. But it is fun. I look at my colleagues who only had a 3 or 4 year residency and they're so stressed all the time. They missed out or rushed through learning the basics of medicine, physiology, pharmacology and their results when the chips are down are as you'd imagine. You will be much more rounded

 

[Mman]

Yea, Anesthesia residency can be torture if you don't like it.. If you like it it can be fun... or anesthesia residency used to be fun. Now the program directors have put so much pressure on the residents it probably isn't fun anymore. BUt uniformly, the attending job as anesthesia is definitely not as fun as the residency..

I had lots of fun as an anesthesia resident. I have even more fun as an anesthesia attending. There is literally nothing in medicine that would be nearly as enjoyable to me.

 

[jcakes]

Hello, everyone! Currently, I'm PGY-3 IM Resident hoping to graduate this summer. Throughout my training, I have had an interest in Critical Care and enjoyed Managing airways during my Anesthesia rotation at the end of my PGY-2 year. I really enjoyed Anesthesia. Now I am having trouble deciding to what route should I go for.

I can either apply for Pulmonary/CC or just CC fellowship this year and work as a Hospitalist for one year. Or, I can just apply for Anesthesia and do one year of Critical Care after that. Ideally, I would want to have either Pulmonary or Anesthesia with Critical Care just to avoid burnout 10 years down the road.

Given that I have finished residency in Internal Medicine, will I have a better chance matching to Anesthesia? I feel like I've got more chance of matching in Anesthesia vs. Pulmonary Critical Care Medicine.

I am really stressing out and I realize that I should have made decision earlier (like last year) about these things. Please any kind of guidance would be greatly appreciated. I have average scores but no RED flag.

Thanks

Void88 - This is exactly what I am doing. I graduated IM residency 2019 and am currently a hospitalist who matched and will start Anesthesia training in July with plans to do Anes-CC for a total for four more years post-grad training. The extra years of training never bothered me. First, four more years isn't much different from Cards or GI (both at least 3, usually 4 if you want interventional Cards or some extra GI procedures) and some of the Pulm-CC docs I know did a fourth year of interventional Pulm as well. Secondly, I am not worried about the extra years and losing attending-level pay because I honestly just don't care. I struggled a lot during my PGY2-3 years thinking about which path to take (Pulm-CC v CC v Anes-CC vs Hospitalist with open ICU). I have never been interested in doing pulmonology as a career so the Pulm-CC fellowship was never attractive to me. I asked a few of the CC-only docs I was close with during residency which path they would choose if they did it over again and nearly all of them said Anes-CC. Their reasoning was usually "I can do both, some OR and some ICU". In the hospital where I did my residency (large, Midwest community hospital) this is an option but from talking to the few Anes-CC docs at my hospital, this is a rare find in the community world but less rare in the academic world. I am interested in academics, so finding an OR + ICU job is more realistic for me.

I applied at the beginning of my PGY-III year for R-spots where you start as a CA-1 right away in July as well as advanced CA-1 spots where I would take a gap year. I matched into an advanced spot and am working as hospitalist now. I will admit I have second thoughts now that I am working. I found an amazing hospitalist job with an open ICU and I am very happy. It is true that once you start working it is very difficult to go back to training. But when I am in the ICU seeing patients I know I am happiest there, which keeps me motivated. As a hospitalist, remember your 7am-7pm shift isn't actually 12 hours as you can leave the hospital early on many days but just need to carry your pager . Also the hospitalist v intensivist pay gap (at least where I live) is around $100K which isn't all that large once you factor in the lifestyle benefits of a hospitalist. I work 14 days a month but if I pick up an extra 6 days/month my income will match that of the ICU docs with similar levels of experience (fresh out of training).

The most important thing for you to find out is why would Anesthesia be helpful to your Critical Care career. I was asked this a lot on the interview trail and if I hadn't thought this out I probably would not have matched. A good answer for you is different than a good answer for me, but I can tell you a universally bad answer is "I don't like IM" or "I think Anesthesia-CC is less competitive than Pulm-CC". I emailed a lot of programs and asked about their interest in a candidate such as myself. This helped narrow down where I applied. I didn't go on a ton of interviews (4) but I ranked both R and Advanced so my match list had 8 spots. If you do this, tell the PD so she/he knows to rank you in both lists too. I wasn't spectacular on paper with USMLE in the high 230s, a community IM residency, ZERO research and I am a DO. But after completing a residency you will have a different perspective on what is important to your career than a medical student. I cannot tell you if being IM trained gave me a bump or not in terms of competitiveness with medical students, but don't let the names of programs with R spots intimidate you. An R spot is only as competitive as the number of people who apply. And those that do are either the same as you (completed residency in different specialty) or are military folks who haven't done a fully residency yet. One option I thought of but didn't end up choosing was applying for Pulm-CC and CC fellowship plus Anesthesia since they are on different cycles. Fellowship match day is usually a week or so after thanksgiving and if you matched you could just stop interviewing for Anesthesia. This of course is a lot of time, money and travel and for me it wasn't worth it since I was confident anesthesia-cc was the correct choice for me.

Not sure if my experience will be helpful, but I just wanted to let you know there are people like you out there. The best advice I can give you is talk to as many people as possible before applying. This will force you to explain yourself to each person and thus help you realize for yourself if this path is actually what you want to do. Try your best to find an IM-Anesthesia-CC doc and ask their experience too.

Good luck. And if you decide to apply you can DM me with more specific questions.

 

[kidthor]

I will admit I have second thoughts now that I am working.

You can still back out... just saying.

 

[NITRAS]

If you want an in to a CC/PCCM place, ask your ICU attendings to see if they have hospitalist spots where they trained. I essentially did that. Calling the hospitalist directors will probably help you more than anything.

My plans for PCCM went away for a couple reasons.
1. I really like my job. My boss (who unfortunately just got promoted) was fantastic. The money is good, I like 90% of my co-workers.
2. I don't like doing nights. I don't have too right now. Every one of my anesthesiologist friends takes frequent overnight calls. I have about 4 in my small group. Granted a couple are pedi-anesthesia.
3. Am I willing to give up about a million bucks in compensation to become an ICU doc? I'd probably make it up. . . . eventually. Both Anesthesia and critical care docs make more than me.

At the end of the day, I like critical care, but I love general medicine. I love being able to see anyone. The way that certain specialists are dismissive of parts of medicine that they should know, but isn't part of their specialized area kinda pisses me off. I love the lifestyle of my current job. If I was willing to give up some of my lifestyle, I could make more. Several in my colleagues make $400k. At least a couple that make $500k. And I don't have to go back to being a resident/fellow again.