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

[Doctor Bob]

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.

Yep. SICU doesn't count. PICU doesn't count.
CCU probably would count.

It's an ABIM requirement which is why they only care about IM and IM subspecialty rotations.

All in all a program isn't going to care much about how many months you need in order to make up the required 6 months, unless they are dependent on fellows to staff a resident-supervising rotation.
I took an EM-trained applicant this past year who still needed two months. But it wouldn't have mattered because the first time he supervised IM residents was 6 months into training. We have enough other ICUs here that I had a lot of flexibility in the schedule. I suppose at smaller places that only have one or two ICUs it could be more of a problem.

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[partypantss]

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.

Got it, yeah if CCU counts by some places that will get me up to 4 months total after using my 2 elective months. Thank you for the info. My 3 year program is very ED-heavy.

 

[partypantss]

Yep. SICU doesn't count. PICU doesn't count.
CCU probably would count.

It's an ABIM requirement which is why they only care about IM and IM subspecialty rotations.

All in all a program isn't going to care much about how many months you need in order to make up the required 6 months, unless they are dependent on fellows to staff a resident-supervising rotation.
I took an EM-trained applicant this past year who still needed two months. But it wouldn't have mattered because the first time he supervised IM residents was 6 months into training. We have enough other ICUs here that I had a lot of flexibility in the schedule. I suppose at smaller places that only have one or two ICUs it could be more of a problem.

Okay, thank you this is good insight. I just have to focus on the things that I CAN control and not worry too much about not having enough IM months I guess.

 

[lolaluver]

For what it's worth, there are never more than 10 applicants to the surgical CC programs. I think most EM people are (understandably) turned off by the "advanced preliminary surgical year." However, after talking with fellows at one SCC program, it sounds like you're functioning more as a PGY-3 surgery resident ie trauma team leader, and you also only see ICU level patients on the other surgical rotations. So in practice it's a better deal than how it sounds on paper. I will say that this program is very EM friendly with lots of EM-CC faculty, although there are other similar SCC programs I've heard of.

From my research (which is unfortunately mostly through word of mouth), if you have your boards under surgery you will forever be locked out of academic MICUs. I hear anesthesia boarded folks have better luck elbowing their way into MICU's, but I assume it depends on how much MICU exposure they get during fellowship.

As I understand, this is all for political reasons as I've heard from EM-CC docs who did surgery/anesthesia/medicine that you get adequate exposure through any route to handle "medical" ICU patients as "medical" critical care is the one common thread through all ICU environments. As said before, if you go community it doesn't matter what you have your boards under.

I'm applying to fellowship this cycle and am having a really tough time deciding between the three routes as I'm unsure exactly what I want my future career to look like. It's complicated by the fact that they all have different application cycles and processes, so I'm limited in being able to interview and evaluate the different types of programs. Plus, many places have very scant information online as to how they are structured.

"Start with where you want to end up and work back from there" is the advice I consistently get. Unfortunately for me, I'm still trying to figure that out 🤷‍♀️

 

[SpacemanSpifff]

... As I understand, this is all for political reasons as I've heard from EM-CC docs who did surgery/anesthesia/medicine that you get adequate exposure through any route to handle "medical" ICU patients as "medical" critical care is the one common thread through all ICU environments. As said before, if you go community it doesn't matter what you have your boards under.

I don't think we have enough data to substantiate the bolded. There are still relatively few EMCC folks out there. The majority of CCM docs in the community are pulmonary trained, leading me to guess that they would have limited interest in hiring anesthesia and virtually none in hiring surgically trained applicants.

 

[lolaluver]

I don't think we have enough data to substantiate the bolded. There are still relatively few EMCC folks out there. The majority of CCM docs in the community are pulmonary trained, leading me to guess that they would have limited interest in hiring anesthesia and virtually none in hiring surgically trained applicants.

I agree, I don't have data, just hearsay. I've also heard that pulm-crit groups are less likely to hire any non-pulmonary trained intensivist, but it would make sense that anyone from an IM-CCM background will prefer medicine>anesthesia>surgery, even in the community. I suppose the common theme is which boards you have matters "less" in the community.

Like I said, all hearsay. Appreciate the thoughts of anyone more experienced and wiser than I am.

 

[chocomorsel]

I agree, I don't have data, just hearsay. I've also heard that pulm-crit groups are less likely to hire any non-pulmonary trained intensivist, but it would make sense that anyone from an IM-CCM background will prefer medicine>anesthesia>surgery, even in the community. I suppose the common theme is which boards you have matters "less" in the community.

Like I said, all hearsay. Appreciate the thoughts of anyone more experienced and wiser than I am.

I just joined a group that is mostly IM where I am the only anesthesiologist. There is an EM guy who’s part time but everyone else is IM trained.
My friend that recruited me is IM trained and heard good things about me and asked me to join the group.

 

[EM-CCfellow]

Current 2nd year EM-CCM fellow in an anesthesia based program. Happen to come by this thread and thought I would add some thoughts.

-anesthesia-CCM having multiple open/unfilled spots has nothing to do with EM-CCM. As one person mentioned, there are a finite amount of programs that accept EM (now 29, Training Options). Of those, maybe 2/3 actually want EM, and most of those have only 1, maybe 2 EM-CCM spots per year....you're looking at maybe 40-50 spots-ish. So yes, it is competitive. That being said, a good EM resident with interest in critical care demonstrated through their CV (committees, publications, education, etc.) will be able to get a spot.
-Of those 29, there are certain programs that actively recruit EM, others clearly do not want EM-CCM (based off my interview process 2 years ago). Others wanted EM-CCM but had no experience with it, was unsure if they had funding for it, etc. This means that the amount of spots that will give you a good EM-CCM training is even smaller.

-Not sure about stats for IM-CCM as I didn't pursue it, but from what I've seen programs frequently let you finish out the 6 months at the start of fellowship if you didn't finish during residency, so no big deal.
-I am biased so grain of salt, but surg-CCM seemed like a waste of one of your two years of fellowship and I never considered it. The first year is required to be preliminary surgical for 9 months of the year.

-I am currently starting the job hunt so hard to say how well it's going (and also COVID is making things worse) but the market is tight for EM and slightly less so for CCM but it's out there. No one seems to care too much if I am ABIM or ABA so far. There are some places who won't let non-IM intensivists train their IM residents, but that old school style thinking is just as likely to refuse you for being EM irrespective of being ABIM or ABA.

 

[YCAGA]

Current 2nd year EM-CCM fellow in an anesthesia based program. Happen to come by this thread and thought I would add some thoughts.

-anesthesia-CCM having multiple open/unfilled spots has nothing to do with EM-CCM. As one person mentioned, there are a finite amount of programs that accept EM (now 29, Training Options). Of those, maybe 2/3 actually want EM, and most of those have only 1, maybe 2 EM-CCM spots per year....you're looking at maybe 40-50 spots-ish. So yes, it is competitive. That being said, a good EM resident with interest in critical care demonstrated through their CV (committees, publications, education, etc.) will be able to get a spot.
-Of those 29, there are certain programs that actively recruit EM, others clearly do not want EM-CCM (based off my interview process 2 years ago). Others wanted EM-CCM but had no experience with it, was unsure if they had funding for it, etc. This means that the amount of spots that will give you a good EM-CCM training is even smaller.

-Not sure about stats for IM-CCM as I didn't pursue it, but from what I've seen programs frequently let you finish out the 6 months at the start of fellowship if you didn't finish during residency, so no big deal.
-I am biased so grain of salt, but surg-CCM seemed like a waste of one of your two years of fellowship and I never considered it. The first year is required to be preliminary surgical for 9 months of the year.

-I am currently starting the job hunt so hard to say how well it's going (and also COVID is making things worse) but the market is tight for EM and slightly less so for CCM but it's out there. No one seems to care too much if I am ABIM or ABA so far. There are some places who won't let non-IM intensivists train their IM residents, but that old school style thinking is just as likely to refuse you for being EM irrespective of being ABIM or ABA.

Really good info. I wish this could be disseminated to more medical students. I have heard from countless med students online and at my school that plan on “applying EM and I can always do a critical care fellowship if EM jobs are in short supply.” Which is insane given that there seem to be around 50 CC spots a year for 2,500+ (and growing) EM graduates per year. Obviously not everyone wants to do CC, but it definitely won’t get less competitive as general EM jobs dry up.