Hospitals where PICU attendings care for congenital heart disease?

[dynamicsingleventricle]

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Does anyone have examples of academic hospitals where PICU attendings [who did not undergo further training in CVICU or cardiology] care for at least a moderate volume of kids with congenital heart disease (from just overnight coverage, to actually rounding and being the ICU attending for them), including single ventricles, cardiac ECMO, or heart transplants?

Is this structure more common in mixed units, or in places where the pediatric cardiac ICU is more under the umbrella of pediatric critical care?

I'm aware that it is becoming more common for pediatric CVICUs to be dedicated and separate from PICUs. But as a PICU fellow, I would love to know if there's an option to care for critically ill children/babies with congenital heart disease (as I'm deciding whether to pursue further cardiac training or not).

 

[SurfingDoctor]

Does anyone have examples of academic hospitals where PICU attendings [who did not undergo further training in CVICU or cardiology] care for at least a moderate volume of kids with congenital heart disease (from just overnight coverage, to actually rounding and being the ICU attending for them), including single ventricles, cardiac ECMO, or heart transplants?

Is this structure more common in mixed units, or in places where the pediatric cardiac ICU is more under the umbrella of pediatric critical care?

I'm aware that it is becoming more common for pediatric CVICUs to be dedicated and separate from PICUs. But as a PICU fellow, I would love to know if there's an option to care for critically ill children/babies with congenital heart disease (as I'm deciding whether to pursue further cardiac training or not).

Almost no place that is serious about taking care of complex CHD patients would have less trained individuals doing that.

That being said, I've occasionally taken shifts in the CVICU during the day time. But there are more experienced attendings that I can bounce things off and NPs that pretty much run the show anyway and know all the protocols. They just need a warm body to sign the notes. None of this is because they want this system though, its strictly a monetary/personnel issue. And of course, one could question how serious we are about taking care of CHD for doing so and it would be a valid question.

 

[BigRedBeta]

Yes, there are units out there. Will they be there in 10 years? Probably not, but if you get in now, probably will be grandfathered in and get to keep doing it if you want. But at some point there's going to reach a critical mass of people with additional training able to meet the necessary staffing to make it completely siloed off.

You're going to be putting yourself into smaller units though with lower volumes and less complex cases. Those units are not going to be in major centers, so you're probably not going to have transplants and only occasional single ventricles. And more than likely are going to be in constant threat of losing your surgeons.

At this stage, I think the decision point is akin to 3rd year med students deciding on a specialty, where I always told them that their first decision point was "do you *need* the OR to be happy?" if yes, then focus on only surgical fields/anesthesia. If you *need* hearts to be satisfied professionally, then you need to do the extra training.