How Competitive is it for EM Residents to get into a Critical Care Fellowship?

[partypantss]

I'm an M4 matching into EM this year trying to get a better idea of how challenging it is to go into CC from EM. Will having high step 1/2 scores help me out? Does going to a strong academic residency matter much? There aren't really any published stats that I know of on chances/ stats of EM residents matching into CC fellowship so it's hard for me to guage just what my chances would be if I do decide to go the cc route. I've heard that it's competitive but I have no way of quantifying just what the odds are. Appreciate any insight!

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[chocomorsel]

I'm an M4 matching into EM this year trying to get a better idea of how challenging it is to go into CC from EM. Will having high step 1/2 scores help me out? Does going to a strong academic residency matter much? There aren't really any published stats that I know of on chances/ stats of EM residents matching into CC fellowship so it's hard for me to guage just what my chances would be if I do decide to go the cc route. I've heard that it's competitive but I have no way of quantifying just what the odds are. Appreciate any insight!

Easy. Plenty of anesthesia CCM spots go infilled each year. Many take EM folks.

 

[partypantss]

Easy. Plenty of anesthesia CCM spots go infilled each year. Many take EM folks.

Awesome, that's good to hear then since I was under the impression that it was difficult, thanks!

 

[Doc Doc Doc Goose]

Easy. Plenty of anesthesia CCM spots go infilled each year. Many take EM folks.

How about for the IM-CCM fellowships???

 

[partypantss]

How about for the IM-CCM fellowships???

True, I didn't realize before that it's more specifically IM-Crit that you need if you want to get hired to work specifically in the MICU correct?

 

[chocomorsel]

How about for the IM-CCM fellowships???

I know nothing about that. I am an anesthesiologist.

 

[Doc Doc Doc Goose]

True, I didn't realize before that it's more specifically IM-Crit that you need if you want to get hired to work specifically in the MICU correct?

Just an MS-3 here, but from my own research /forum reading: MICUs are going to prefer IM-based CCM trainees. This is especially true in bigger hospitals.

Now when you go out into the community/smaller hospitals where ICUs are often combined (like a Med-Surg ICU) and there are less CCM-trained physicians around, anything is fair game.

 

[deleted547339]

I'm an M4 matching into EM this year trying to get a better idea of how challenging it is to go into CC from EM. Will having high step 1/2 scores help me out? Does going to a strong academic residency matter much? There aren't really any published stats that I know of on chances/ stats of EM residents matching into CC fellowship so it's hard for me to guage just what my chances would be if I do decide to go the cc route. I've heard that it's competitive but I have no way of quantifying just what the odds are. Appreciate any insight!

Hard to say. Also, it’s a small field with few spots so can vary greatly year to year. I did EM->CCM. Also, you can’t just do any infilled anesthesia spot - they have to have applied for an aba/abem track - only 19 programs have done so last I checked.

Are you going to a program with a CCM fellowship? If so, that seems to be the best thing for you. Step 1/2, aoa, etc all help, but are only a small part. Rec letters matter a lot as do interviews.

 

[SpacemanSpifff]

I'm an M4 matching into EM this year trying to get a better idea of how challenging it is to go into CC from EM. Will having high step 1/2 scores help me out? Does going to a strong academic residency matter much? There aren't really any published stats that I know of on chances/ stats of EM residents matching into CC fellowship so it's hard for me to guage just what my chances would be if I do decide to go the cc route. I've heard that it's competitive but I have no way of quantifying just what the odds are. Appreciate any insight!

Anesthesia consistently has spots that go unfilled and the surgical pathway is also not particularly competitive.

The most recent IM/CCM cycle was quite competitive for a number of reasons, primarily growing interest and an expanding applicant pool. The terrible job market during COVID also probably led many to apply for continued training. As an EM applicant you will be competing against EM trainees, IM trainees only interested in CCM, and fellowship-trained IM people (nephrology, infectious disease, etc.). Many programs with 1-2 spots received >200 applications. Several programs reached out to make sure that I would complete my 6 months of IM/ICU time prior to sending interview invites. In my n=1 experience, my letters and faculty connections were very important.

If you want more information about EM/CCM check out the EMRA page, which includes programs that are currently accepting EM applicants.

 

[Tipsy McStagger]

Some things to consider:

1) IM -CCM is getting more competitive, but it's nowhere near cards/GI. We had a significantly larger applicant pool this year, depending on your program leadership and their philosophy, EM may be an uphill battle to get in or may not be.

2) There is an antiquated rule that EM applicants need I think 6 months inpatient medicine rotations, and technically consult services do not count (neither do your ICU rotations in SICU/Neuro ICU/Peds ICU/Neonatal ICU). Now most places don't really care about this, or they'll accept consult services, or will be ok if you get close (say 4-5 months). But there are a few sticklers out there who will not consider you unless you have all 6 months. This rule doesn't apply for anesthesia or surgical fellowships.

3) In light of #2, if you're in a 3-year program you will need to tailor all of your electives to critical care or inpatient medicine services (bleh). If you're in a 4-year program then you will be more able to accomodate this requirement.

Personally I really prefer IM-CCM. I'm graduating this year and will be working in SICU/CVICU/MICU so going to a medicine program doesn't impair your ability to work in a SICU if that's what you want to do - I don't know if the reverse is true or not (it may be for all I know).

Will having high step 1/2 scores help me out?

Yes but it's probably not worth worrying about. There are more important things to consider, such as your LORs. You'll need good letters from intensivists as well as your program director. Much like residency, great step scores will not necessarily get you in, but terrible step scores might keep you out.

Does going to a strong academic residency matter much

This may be controversial, but I'm going to say yes. Fellowships are going to be in academic centers, and academia tends to prefer academia to community. You will also be more likely to be at a program with a CCM fellowship which will help your electives and getting the needed LORs.

 

[CCM-MD]

IM CCM is very competitive. We don’t have actual match data for IM-CCM but if it’s any indication, Pulm/CCM was the most competitive match this year based on number of applicants to positions (more than GI and cards I believe). The key is not whether it’s an IM or anesthesia based program... the best programs are multidisciplinary where one has rotations with a diverse faculty and a wide range of medical, surgical CV, neuro critically ill patients.

 

[partypantss]

Hard to say. Also, it’s a small field with few spots so can vary greatly year to year. I did EM->CCM. Also, you can’t just do any infilled anesthesia spot - they have to have applied for an aba/abem track - only 19 programs have done so last I checked.

Are you going to a program with a CCM fellowship? If so, that seems to be the best thing for you. Step 1/2, aoa, etc all help, but are only a small part. Rec letters matter a lot as do interviews.

Thanks for the info! Currently my top 2 ranked programs are Detroit receiving hospital (Wayne state University) and University of Pittsburgh. UPMC I believe does have an IM-CCM fellowship, while Wayne State I think just has a pulm-crit and surgery-crit. I think I'll reach out to some programs to get a better idea of their track record for graduates going into IM-crit care fellowships, since for example a random program like John peter smith in Dallas mentioned they had 3 people last year go into crit care, at least one of which went the IM route.

 

[partypantss]

Some things to consider:

1) IM -CCM is getting more competitive, but it's nowhere near cards/GI. We had a significantly larger applicant pool this year, depending on your program leadership and their philosophy, EM may be an uphill battle to get in or may not be.

2) There is an antiquated rule that EM applicants need I think 6 months inpatient medicine rotations, and technically consult services do not count (neither do your ICU rotations in SICU/Neuro ICU/Peds ICU/Neonatal ICU). Now most places don't really care about this, or they'll accept consult services, or will be ok if you get close (say 4-5 months). But there are a few sticklers out there who will not consider you unless you have all 6 months. This rule doesn't apply for anesthesia or surgical fellowships.

3) In light of #2, if you're in a 3-year program you will need to tailor all of your electives to critical care or inpatient medicine services (bleh). If you're in a 4-year program then you will be more able to accomodate this requirement.

Personally I really prefer IM-CCM. I'm graduating this year and will be working in SICU/CVICU/MICU so going to a medicine program doesn't impair your ability to work in a SICU if that's what you want to do - I don't know if the reverse is true or not (it may be for all I know).


Yes but it's probably not worth worrying about. There are more important things to consider, such as your LORs. You'll need good letters from intensivists as well as your program director. Much like residency, great step scores will not necessarily get you in, but terrible step scores might keep you out.



This may be controversial, but I'm going to say yes. Fellowships are going to be in academic centers, and academia tends to prefer academia to community. You will also be more likely to be at a program with a CCM fellowship which will help your electives and getting the needed LORs.

Thanks this is all helpful info. Yeah I'm personally right now thinking I would rather go the IM-CCM route, since it sounds like MICUs in large cities preferentially want IM-CCM rather than anesthesia/ surgery folks. My list is all 3 year programs so I will have that issue with inadequate floor months. Hopefully with a bit of planning ahead I can at least partially mitigate that disadvantage.

 

[partypantss]

IM CCM is very competitive. We don’t have actual match data for IM-CCM but if it’s any indication, Pulm/CCM was the most competitive match this year based on number of applicants to positions (more than GI and cards I believe). The key is not whether it’s an IM or anesthesia based program... the best programs are multidisciplinary where one has rotations with a diverse faculty and a wide range of medical, surgical CV, neuro critically ill patients.

I see, but I guess my understanding was depending on where you want to work, different places prefer different types of CCM training correct? Like for MICUs I was told they prefer IM-CCM grads.

 

[CCM-MD]

I see, but I guess my understanding was depending on where you want to work, different places prefer different types of CCM training correct? Like for MICUs I was told they prefer IM-CCM grads.

I would say that’s probably true for academia.

 

[chocomorsel]

I see, but I guess my understanding was depending on where you want to work, different places prefer different types of CCM training correct? Like for MICUs I was told they prefer IM-CCM grads.

If pulmonary docs have the contract they do favor their own kind. They want someone to do pulmonary consults and clinic. Meaning other pulmonary docs or IM folks if pure intensive care. Otherwise if it’s the hospital hiring, they often don’t care. If they do it’s because they don’t know any better as pulmonologists have always run their ICUs.

That being said, I have been offered work by a pulmonary doc who has a contract in a couple of hospitals in town. And another hospital pulmonologist told me she would be more confident in me as an anesthesiologist working in the ICU due to my managing ventilators daily instead of an IM-CCM person.
I have also literally asked a hospital looking for pure intensivists why they want only pulmonologists and they straight up said it’s because that’s what they are used to and aren’t planning on changing anytime soon. I suspect it comes from the pulmonologists not being comfortable with non pulmonary intensivists.
It can be very confusing. But yeah it’s best to try to get into a multidisciplinary fellowship and if not get into the “other side’s” ICU for lots of electives. We could all teach and learn from each other.

 

[sylvanthus]

Keep in mind there are going to be more and more EM docs doing fellowships in the coming years due to the powersthatbe flooding the market with grads. I wouldnt be surprised if ccm became pretty competitive.

 

[CCM-MD]

Maybe it will be competitive, maybe not. I think CCM is going to be saturated like EM in the next 5 years. There are more and more fellowships and combined with the ongoing midlevel explosion, I wouldn’t be surprised if things become similar to EM. I’m already planning my “out”.

Keep in mind there are going to be more and more EM docs doing fellowships in the coming years due to the powersthatbe flooding the market with grads. I wouldnt be surprised if ccm became pretty competitive.

 

[Doc Doc Doc Goose]

Maybe it will be competitive, maybe not. I think CCM is going to be saturated like EM in the next 5 years. There are more and more fellowships and combined with the ongoing midlevel explosion, I wouldn’t be surprised if things become similar to EM. I’m already planning my “out”.

What is your “out” if I may ask?

 

[CCM-MD]

What is your “out” if I may ask?

Nothing very special. Working hard now in a less desired area with higher compensation, limit expenses. Save up and invest now, compound interest is a real thing. Build some other passive income streams.

Having a non hospital based specialty like pulmonary as an “out” is definitely an advantage in many ways. Hence its popularity. Wish I could tolerate clinic, I would have done it.

 

[partypantss]

Maybe it will be competitive, maybe not. I think CCM is going to be saturated like EM in the next 5 years. There are more and more fellowships and combined with the ongoing midlevel explosion, I wouldn’t be surprised if things become similar to EM. I’m already planning my “out”.

Dang, in that case you don't think CCM is at all a good "out" from EM if the market collapses? That's partially why I'm considering it, I'm trying to diversify my employment options (with things I'd still enjoy doing.)

 

[CCM-MD]

Dang, in that case you don't think CCM is at all a good "out" from EM if the market collapses? That's partially why I'm considering it, I'm trying to diversify my employment options (with things I'd still enjoy doing.)

Going into CCM to get away from the problems of EM is like jumping from one sinking ship to another sinking ship. CCM has many of the same problems of EM: midlevels, hospital admin, corporate medical groups. Don’t get me wrong, CCM is great, and there is tremendous amounts of opportunity even pre-pandemic... but the future is uncertain.

 

[Tipsy McStagger]

Dang, in that case you don't think CCM is at all a good "out" from EM if the market collapses? That's partially why I'm considering it, I'm trying to diversify my employment options (with things I'd still enjoy doing.)

Choose critical care because you enjoy it. Managing complex medical patients past the first resuscitation comes with its own challenges and rewards. Make no mistake, the work is hard and burnout is high. It's not an out, it's just another path. Choosing it out of fear for the future of EM is the path to the dark side. "Fear leads to anger. Anger leads to hate. Hate leads to suffering" - Yoda

 

[partypantss]

Choose critical care because you enjoy it. Managing complex medical patients past the first resuscitation comes with its own challenges and rewards. Make no mistake, the work is hard and burnout is high. It's not an out, it's just another path. Choosing it out of fear for the future of EM is the path to the dark side. "Fear leads to anger. Anger leads to hate. Hate leads to suffering" - Yoda

Oh yeah for sure, don't get me wrong, I am considering it since I'm looking for something more "cerebral" and that + managing complex, very sick patients just sounds awesome. The diversity of employment options is just a bonus, although I am spooked by what EM people have been saying about EM.

 

[spacegun]

Oh yeah for sure, don't get me wrong, I am considering it since I'm looking for something more "cerebral" and that + managing complex, very sick patients just sounds awesome. The diversity of employment options is just a bonus, although I am spooked by what EM people have been saying about EM.

Have you thought about anesthesia? I know they have their own challenges (e.g., CRNA's, AMG's), but anesthesia sounds better than EM right now, and you can have a more "regular" kind of a schedule unlike EM or CCM (except for when you're on call but a lot of anesthesiologists seem to get the next day off or come in later, I think?). Also you can do CCM from anesthesia too. And at least right now anesthesiology still seems to have a higher salary than either EM or CCM, but then again money could change in the future.

I guess though one big problem with anesthesiology, EM, and CCM is that they're all predominantly hospital-based. As far as I know, there's no way to escape that from these specialties except pain medicine or palliative care, but these are such different specialties.

 

[partypantss]

Have you thought about anesthesia? I know they have their own challenges (e.g., CRNA's, AMG's), but anesthesia sounds better than EM right now, and you can have a more "regular" kind of a schedule unlike EM or CCM (except for when you're on call but a lot of anesthesiologists seem to get the next day off or come in later, I think?). Also you can do CCM from anesthesia too. And at least right now anesthesiology still seems to have a higher salary than either EM or CCM, but then again money could change in the future.

I guess though one big problem with anesthesiology, EM, and CCM is that they're all predominantly hospital-based. As far as I know, there's no way to escape that from these specialties except pain medicine or palliative care, but these are such different specialties.

I appreciate the advice, but that ship has sorta sailed at this point considering I just wrapped up interviewing my full list of EM programs. Pretty locked into EM at this point. Talk to me a year ago!

 

[CCM-MD]

I appreciate the advice, but that ship has sorta sailed at this point considering I just wrapped up interviewing my full list of EM programs. Pretty locked into EM at this point. Talk to me a year ago!

Pain is a better option for what you are looking for than CCM to be honest. It can be non-hospital based, has procedures and pays well. But you would have to do pain... 🤢

 

[Doc Doc Doc Goose]

Nothing very special. Working hard now in a less desired area with higher compensation, limit expenses. Save up and invest now, compound interest is a real thing. Build some other passive income streams.

Having a non hospital based specialty like pulmonary as an “out” is definitely an advantage in many ways. Hence its popularity. Wish I could tolerate clinic, I would have done it.

What exactly are you referring to when you say “tolerate clinic”: is it the fact of going to a clinic and interacting with patients for 15-20 minutes at a time that bugs you? The long-term management of chronic medical problems? The lack of immediate (positive or negative) feedback? As opposed to relatively immediate feedback when managing the acute exacerbations of those chronic pathologies, like you see in the ED and the ICU?

I ask you this 1) because I wasn’t able to direct message you 2) because im a student who is figuring out (or trying to) what he dislikes, likes, loves, and the reasons why. And because I’m considering 2 potential paths that incorporate the ICU:

On the one hand, EM/CCM, where I would look to work in both. One of the unique instances where a fellowship actually broadens your scope of practice and fund of knowledge. And this seems much more appealing/exciting/enjoyable/interesting to me (vs path 2). And the fall-back being going to part-time work with other streams of revenue

2) pulm/crit: maybe I like clinic not sure? for a day or two here and there on rotations to mix it up. But .... the “fall-back” plan in this option (aka consults and clinic) is more sustainable, in addition to other streams of revenue. BUT, at least in clinic, I’m managing chronic issues with little immediate feedback. (Not to mention IM residency vs EM residency sheeeeesh)

It’s tough to predict who I will be things in 10 months let alone 10, 20 years........

 

[spacegun]

I appreciate the advice, but that ship has sorta sailed at this point considering I just wrapped up interviewing my full list of EM programs. Pretty locked into EM at this point. Talk to me a year ago!

If you are sure you want to do EM, that's cool and all the best to you. But in case you are still uncertain, please don't feel like you can't change specialties anymore because you're "locked in". You're definitely not "locked in" even at this point. It might even be a kind of "sunk cost fallacy" to think you are. Worst case scenario, you can still try to SOAP or even change a specialty after a year in another specialty. You could change from EM to IM or anesthesiology or something else (okay maybe not derm lol). And maybe this would be miserable for you in the short-term (for a few years during residency), but it could be worth it in the long-term for you, just think about what's best for you over a 30+ year career. Just trying to give you some hope that you're not necessarily "locked in" in case you ever do change your mind about what you want to do.

Outpatient based specialties are looking really good right now. Independence, being your own boss, not having to deal with hospital admins or huge corporate sized groups except on your own terms, being regarded as someone who "brings in patients and thus money" rather than as someone who is a "necessary evil" or cost or burden to deal with because the specialty doesn't bring in any patients, etc. Also think about sustainability. It's better to be content over 30+ years in a specialty like FM than to burn out after 10 years in a specialty like EM (as a lot of the guys in the EM forum seem to be saying). I've seen several attendings at the White Coat Investor say all this too.

 

[Doctor Bob]

2) There is an antiquated rule that EM applicants need I think 6 months inpatient medicine rotations, and technically consult services do not count (neither do your ICU rotations in SICU/Neuro ICU/Peds ICU/Neonatal ICU). Now most places don't really care about this, or they'll accept consult services, or will be ok if you get close (say 4-5 months). But there are a few sticklers out there who will not consider you unless you have all 6 months. This rule doesn't apply for anesthesia or surgical fellowships.

3) In light of #2, if you're in a 3-year program you will need to tailor all of your electives to critical care or inpatient medicine services (bleh). If you're in a 4-year program then you will be more able to accomodate this requirement.

Clarification... EM residents need 6 months of IM-based rotations (between residency and fellowship) before they can supervise IM residents.
So when I accept an EM trained person into my IM-CC fellowship I look at their residency transcript and determine how many more months they need to meet that requirement. Then I make sure their first few months of fellowship are on MICU services which are just them and the attending. Once they've met the 6 month total I can assign them to the teaching services.

Thanks this is all helpful info. Yeah I'm personally right now thinking I would rather go the IM-CCM route, since it sounds like MICUs in large cities preferentially want IM-CCM rather than anesthesia/ surgery folks. My list is all 3 year programs so I will have that issue with inadequate floor months. Hopefully with a bit of planning ahead I can at least partially mitigate that disadvantage.

If you want to work in a MICU, then yes you should do an IM-CC fellowship. If you want to work in a SICU then do an anesthesia-CC or surgery-CC fellowship. If you aren't sure which kind you want, then look for a multidisciplinary program (one of them will be your home, but in a good multidisciplinary program your time will be fairly evenly split between medical and surgical ICUs)

I see, but I guess my understanding was depending on where you want to work, different places prefer different types of CCM training correct? Like for MICUs I was told they prefer IM-CCM grads.

See above

 

[Tipsy McStagger]

Clarification... EM residents need 6 months of IM-based rotations (between residency and fellowship) before they can supervise IM residents.
So when I accept an EM trained person into my IM-CC fellowship I look at their residency transcript and determine how many more months they need to meet that requirement. Then I make sure their first few months of fellowship are on MICU services which are just them and the attending. Once they've met the 6 month total I can assign them to the teaching services.

Thank you for catching that. I had forgotten that it was to supervise residents not get accepted. I will say that I was turned down from 2 programs (why they wanted to interview me in the first place I'll never know) because I only had 5 months. Most other places either didn't even ask/care, or they said they'd put me on an APP team for the first month.

 

[YCAGA]

If you are sure you want to do EM, that's cool and all the best to you. But in case you are still uncertain, please don't feel like you can't change specialties anymore because you're "locked in". You're definitely not "locked in" even at this point. It might even be a kind of "sunk cost fallacy" to think you are. Worst case scenario, you can still try to SOAP or even change a specialty after a year in another specialty. You could change from EM to IM or anesthesiology or something else (okay maybe not derm lol). And maybe this would be miserable for you in the short-term (for a few years during residency), but it could be worth it in the long-term for you, just think about what's best for you over a 30+ year career. Just trying to give you some hope that you're not necessarily "locked in" in case you ever do change your mind about what you want to do.

Outpatient based specialties are looking really good right now. Independence, being your own boss, not having to deal with hospital admins or huge corporate sized groups except on your own terms, being regarded as someone who "brings in patients and thus money" rather than as someone who is a "necessary evil" or cost or burden to deal with because the specialty doesn't bring in any patients, etc. Also think about sustainability. It's better to be content over 30+ years in a specialty like FM than to burn out after 10 years in a specialty like EM (as a lot of the guys in the EM forum seem to be saying). I've seen several attendings at the White Coat Investor say all this too.

Aren’t a ton of PCP and outpatient specialist groups getting bought up by big corporations? I’m pretty sure the number of physicians that are “their own boss” continues to decline every year. Sure you could be the exception, but it makes me nervous to plan on that.

 

[CCM-MD]

Aren’t a ton of PCP and outpatient specialist groups getting bought up by big corporations? I’m pretty sure the number of physicians that are “their own boss” continues to decline every year. Sure you could be the exception, but it makes me nervous to plan on that.

There is definitely truth to this, but if admin is a POS, you do have the option to go out on your own as an outpatient focused specialist. As an inpatient specialist you don't have this option... just have to suck it up and take it.

 

[YCAGA]

There is definitely truth to this, but if admin is a POS, you do have the option to go out on your own as an outpatient focused specialist. As an inpatient specialist you don't have this option... just have to suck it up and take it.

Gotcha, makes sense. I am most interested in rural/small city practice so hopefully those locations will be the last to be gobbled up by corporate medicine. Who knows though

 

[spacegun]

Aren’t a ton of PCP and outpatient specialist groups getting bought up by big corporations? I’m pretty sure the number of physicians that are “their own boss” continues to decline every year. Sure you could be the exception, but it makes me nervous to plan on that.

Just to add to what CCM-MD said, some specialists are regarded as having their own patients or being able to bring in their own patients and thus money, while other specialists are regarded as not owning any patients or not being able to bring in patients/money but being more of a cost or necessary evil to practicing. So even if the specialists who are regarded as bringing in money are being bought up by big corporations (e.g. pulm, gi, cards, hem-onc, surgeons), they still have more bargaining power than specialists who are regarded as necessary evils or costs to practice (e.g. anesthesiologists, radiologists, pathologists, EM, hospitalists) because they could always leave for another big corporation or group and possibly bring a lot of their patients with them. Just think of how many patients would follow their oncologists for example. So even if they’re bought out, admins still have a certain amount of respect for them or at least fear that they’ll be able to take their patients with them and thus treat them a little better. At least in areas that aren’t oversaturated.

Currently there seems to be a huge demand for hospitalists, critical care, etc., but if that changes in the future, like it is changing with emergency medicine now due to how many new residencies residents or new attendings are flooding the market, then these specialties won’t have as much to fall back on like specialties that have their own patients. Thats what it seems like to me at least.

 

[MelMcT2009]

I can only speak from my own experience as I haven’t seen any data, but I applied IM-CCM this year from a 3 year academic EM program and did well in the cycle.

I ended up with interviews at 11 of the 13 places I applied,
interviewed at 5, and had 3 offers before accepting at my top choice.

I think step scores did help. I had a few pretty meaningless pub Med publication but no real research. Did have strong LORs.


Happy to answer any other questions.

anesthesia-CCM usually has unfilled spots. No idea about the surgery route, but that’s another option as well.

 

[CCM-MD]

What exactly are you referring to when you say “tolerate clinic”: is it the fact of going to a clinic and interacting with patients for 15-20 minutes at a time that bugs you? The long-term management of chronic medical problems? The lack of immediate (positive or negative) feedback? As opposed to relatively immediate feedback when managing the acute exacerbations of those chronic pathologies, like you see in the ED and the ICU?

I ask you this 1) because I wasn’t able to direct message you 2) because im a student who is figuring out (or trying to) what he dislikes, likes, loves, and the reasons why. And because I’m considering 2 potential paths that incorporate the ICU:

On the one hand, EM/CCM, where I would look to work in both. One of the unique instances where a fellowship actually broadens your scope of practice and fund of knowledge. And this seems much more appealing/exciting/enjoyable/interesting to me (vs path 2). And the fall-back being going to part-time work with other streams of revenue

2) pulm/crit: maybe I like clinic not sure? for a day or two here and there on rotations to mix it up. But .... the “fall-back” plan in this option (aka consults and clinic) is more sustainable, in addition to other streams of revenue. BUT, at least in clinic, I’m managing chronic issues with little immediate feedback. (Not to mention IM residency vs EM residency sheeeeesh)

It’s tough to predict who I will be things in 10 months let alone 10, 20 years........

Just realized I never responded to this. Hard to put into words what I dislike about clinic but I can tell you that it probably stems from my poor exposures to outpatient medicine in both medical school and residency. My residency clinic experiences were horrific. My wife is the total opposite and loves clinic.

 

[partypantss]

I can only speak from my own experience as I haven’t seen any data, but I applied IM-CCM this year from a 3 year academic EM program and did well in the cycle.

I ended up with interviews at 11 of the 13 places I applied,
interviewed at 5, and had 3 offers before accepting at my top choice.

I think step scores did help. I had a few pretty meaningless pub Med publication but no real research. Did have strong LORs.


Happy to answer any other questions.

anesthesia-CCM usually has unfilled spots. No idea about the surgery route, but that’s another option as well.

So, I found out I matched at a place that is largely community-focused. It is in fact at a university, tertiary care center with a medical school, but they tend to only have about 10% of grads go into fellowship, and looking back the past few years, none have done CCM. They only have a US and EMS fellowship at this program. So with this in mind, do you have any advice for how I can maximize my chances? I luckily have decent step 1/2 scores going for me (>245/ ~250.) Should I reach out to the PD at some point to hopefully hook me up with a crit care doc at the hospital that could provide some potential mentorship, as there are no crit care faculty in my residency? Any advice you have is greatly appreciated! Clearly you had a lot of success getting into IM-CCM so I'm curious what factors you think played the biggest role.

 

[chocomorsel]

So, I found out I matched at a place that is largely community-focused. It is in fact at a university, tertiary care center with a medical school, but they tend to only have about 10% of grads go into fellowship, and looking back the past few years, none have done CCM. They only have a US and EMS fellowship at this program. So with this in mind, do you have any advice for how I can maximize my chances? I luckily have decent step 1/2 scores going for me (>245/ ~250.) Should I reach out to the PD at some point to hopefully hook me up with a crit care doc at the hospital that could provide some potential mentorship, as there are no crit care faculty in my residency? Any advice you have is greatly appreciated! Clearly you had a lot of success getting into IM-CCM so I'm curious what factors you think played the biggest role.

How do you not have CCM faculty at a tertiary care center? Who runs the ICUs?

 

[SpacemanSpifff]

How do you not have CCM faculty at a tertiary care center? Who runs the ICUs?

Assuming this poster is going to an EM residency. Not all EM programs have EMCCM faculty.

 

[CCM-MD]

Assuming this poster is going to an EM residency. Not all EM programs have EMCCM faculty.

True... but they should have CCM faculty if they are doing ICU rotations.

 

[partypantss]

How do you not have CCM faculty at a tertiary care center? Who runs the ICUs?

What do you mean? Looking at the EM faculty listed, none of them are in critical care. Just some Ultrasound/ EMS and a couple of other random things. There are going to be crit care physicians at the hospital, just none of them are within the EM program is what I meant.

 

[chocomorsel]

What do you mean? Looking at the EM faculty listed, none of them are in critical care. Just some Ultrasound/ EMS and a couple of other random things. There are going to be crit care physicians at the hospital, just none of them are within the EM program is what I meant.

Ok. Thanks for clarifying.
Why must you have an EM doc be your mentor? Why not use an IM or Anesthesia or Surgical one? Whichever ones that are there and are running the ICU. It’s not like you are doing an EM ICU fellowship so I don’t see how their primary specialty that matters.

 

[Doc Doc Doc Goose]

What do you mean? Looking at the EM faculty listed, none of them are in critical care. Just some Ultrasound/ EMS and a couple of other random things. There are going to be crit care physicians at the hospital, just none of them are within the EM program is what I meant.

Have you looked at all the critical care faculty and seen if any of THEM are EM-trained. For example, at my school, we have two CCM-faculty that are EM-trained; they show up on the CCM faculty page, but NOT amongst the EM faculty since they are not dual-appointed / they only practice CCM.

And in defense of Choco’s confusion, I too, was confused by your post and interpreted that as you not having any ICU docs/faculty.

 

[MelMcT2009]

So, I found out I matched at a place that is largely community-focused. It is in fact at a university, tertiary care center with a medical school, but they tend to only have about 10% of grads go into fellowship, and looking back the past few years, none have done CCM. They only have a US and EMS fellowship at this program. So with this in mind, do you have any advice for how I can maximize my chances? I luckily have decent step 1/2 scores going for me (>245/ ~250.) Should I reach out to the PD at some point to hopefully hook me up with a crit care doc at the hospital that could provide some potential mentorship, as there are no crit care faculty in my residency? Any advice you have is greatly appreciated! Clearly you had a lot of success getting into IM-CCM so I'm curious what factors you think played the biggest role.

Hey! Congrats on matching.

if you know you want to do IM-CCM, a good step to take early on is to look at the requirements for starting an IM-CCM fellowship. I think it’s 6 “internal medicine months”, 3 of which have to be ICU. So I talked to my PD early and had to make some adjustments to my schedule to meet this requirement. Do that early.

Find a mentor. I had an EM/IM/CC trained faculty member as my main mentor, but it’s ok if you don’t have EM/CC docs there. Find someone in the ICU willing to be your mentor. Good letters definitely help, and the better these CC docs know you, the better the letter is going to be (as long as you’re not a jerk I guess)

Just work on that for now, as well as being the best EM resident you can be. If you’re in to research, find someone to do some with, but it wasn’t necessary for me. I had other interests that I latched on to and got involved in though.

 

[partypantss]

Ok. Thanks for clarifying.
Why must you have an EM doc be your mentor? Why not use an IM or Anesthesia or Surgical one? Whichever ones that are there and are running the ICU. It’s not like you are doing an EM ICU fellowship so I don’t see how their primary specialty that matters.

No problem, sorry for the miscommunication. I don't feel any need for them to be EM specific, I just thought it would be easier if one of my residencyy program's faculty were CCM. So should I just reach out to my program director who can hopefully connect me with a current ICU doc working there? Or just try to look up ICU docs working there and email them? I just don't know how any of this works I guess.

 

[partypantss]

Have you looked at all the critical care faculty and seen if any of THEM are EM-trained. For example, at my school, we have two CCM-faculty that are EM-trained; they show up on the CCM faculty page, but NOT amongst the EM faculty since they are not dual-appointed / they only practice CCM.

And in defense of Choco’s confusion, I too, was confused by your post and interpreted that as you not having any ICU docs/faculty.

I managed to find that they do in fact have a pulm crit fellowship that showed three faculty, but none are EM trained and they are all FMGs if that makes a difference. I guess reaching out to one of them would be my next step?

 

[partypantss]

Hey! Congrats on matching.

if you know you want to do IM-CCM, a good step to take early on is to look at the requirements for starting an IM-CCM fellowship. I think it’s 6 “internal medicine months”, 3 of which have to be ICU. So I talked to my PD early and had to make some adjustments to my schedule to meet this requirement. Do that early.

Find a mentor. I had an EM/IM/CC trained faculty member as my main mentor, but it’s ok if you don’t have EM/CC docs there. Find someone in the ICU willing to be your mentor. Good letters definitely help, and the better these CC docs know you, the better the letter is going to be (as long as you’re not an dingus I guess)

Just work on that for now, as well as being the best EM resident you can be. If you’re in to research, find someone to do some with, but it wasn’t necessary for me. I had other interests that I latched on to and got involved in though.

Got it, yeah I think I will email my new program director and let her know that I have CCM in mind and go from there. Thanks!

 

[partypantss]

Clarification... EM residents need 6 months of IM-based rotations (between residency and fellowship) before they can supervise IM residents.
So when I accept an EM trained person into my IM-CC fellowship I look at their residency transcript and determine how many more months they need to meet that requirement. Then I make sure their first few months of fellowship are on MICU services which are just them and the attending. Once they've met the 6 month total I can assign them to the teaching services.



If you want to work in a MICU, then yes you should do an IM-CC fellowship. If you want to work in a SICU then do an anesthesia-CC or surgery-CC fellowship. If you aren't sure which kind you want, then look for a multidisciplinary program (one of them will be your home, but in a good multidisciplinary program your time will be fairly evenly split between medical and surgical ICUs)



See above

Just for clarification, is it literally only IM floor months and MICU that count toward this 6 month requirement? Between SICU, PICU and CCU none of these count, correct? If so I only have a single MICU month on my residency schedule and 2 elective months my third year I can use which would only get me to 3 months total towards the requirement. I think I have an uphill battle ahead of me!

 

[Tipsy McStagger]

Just for clarification, is it literally only IM floor months and MICU that count toward this 6 month requirement? Between SICU, PICU and CCU none of these count, correct? If so I only have a single MICU month on my residency schedule and 2 elective months my third year I can use which would only get me to 3 months total towards the requirement. I think I have an uphill battle ahead of me!

Technically it is inpatient medicine services that count. So medicine floor, cardiology floor (not consult service), MICU, (+/- CCU). More often than not you will find that programs will accept consult services as well, so if you spend time on cards consult, nephrology, GI whatever they'll often count that towards the 6 months. Many programs don't care about this rule at all, but some still do (or at least did when I was interviewing a few years ago).

All programs told me they won't count other ICUs (PICU, CVICU, Neonatal ICU, SICU etc) towards the 6 months even though I would argue those make you a great candidate and are higher yield than simply rotating on a medicine floor.

All-in-all you will be ok I think. Tailor your electives towards critical care if you're in a 3 year program and you'll get to ~5 months including consult services. If you're in a 4 year program you have nothing to worry about because you'll have plenty of elective time, though I interviewed with a number of 4 year graduates who hadn't met the requirement because they didn't decide on CCM until late.