While on the interview trail for EM, I interviewed at a few Prelim Medicine places since I applied to several 2,3,4 programs. At one of those Prelim Med programs, I mentioned that I was interested in Critical Care following my EM residency. The doctor that was interviewing me is a dinosaur and prominent figure in the Pulm/CC world. His response to my statement was quite discouraging. While laughing he said, ER docs and CC docs only have 2 things in common:
1) They work shifts
2) They "see" really sick patients, then went on to say that ER docs literally only "see" the sick but haven't a clue when it comes to properly managing them.
That gave me the sense that the dinosaurs won't be letting any of the EM trained folks to sit for the boards anytime soon. 👎
Safe to say I won't be ranking that prelim med program....
This is an area of frustration we face in light of increasing numbers of ICU beds (and LTAC beds) without a significant increase in manpower. EM folks represent a possible resource for providing critical care services which some of the old guard may not fully embrace, despite the growing gap between increasing number of ICU beds without a substantial increase in providers.
Agreeing with KGUNN here, critical care is not a domain ruled by one group or another... Multidisciplinary critical care is the wave of the future, where there is consistency among training programs from different specialty backbones and where guidelines composed of expert opinions from the different disciplines can be employed with some consistency.
As I have said before, the backbone the EM provides would be entirely adequate to support a *complete* training program for delivery of critical care beyond the ER. I can't predict that this potential worker pool will make a dramatic dent in the forthcoming shortages in CCM but perhaps may be at least a finger in the crack within the dam.
Now I can say all these things and it sounds nice, but to get the Sharks and the Jets to agree on combining critical care training programs nationally and establishing a multidisciplinary training model is a daunting if not impossible task....and hence we have just a handful of such programs where the "Division" of critical care exists.
If ER is your passion then follow it...but be careful if you decide critical care is your grand amour as the road for acceptance for ER/CCM may still be bumpy as the old guard changes, although the movement needs its leaders. At this time, there are more expeditious, guaranteed ways to reach that goal.
One final statement/opinion/rant ---> ICU care is not necessarily "shift work" and we should be more aware of how we think of critical care delivery. 12 hour shift models exist but at current, most ICUs employ physicians that cover daytime work hours for at least a week or > 1 week periods with call or *shifts* being shared, much as it is with other inpatient practices. "Shift work" implies washing one's hands of the care of critically ill patients at the end of the day when the reality is if the the patient is fortunate to be alive in the morning, they are still your responsibility and the longer term knowledge of their condition is generally more enriched than a covering call physician. The ICU stay of a critically ill patient may range from 3 hours to 3 months and provision of continuous care does have an impact on our success in the ICU and this should be reflected in the future goal of 24 hour MD ICU coverage. Additionally, many of these patient's care following their ICU stay and/or hospitalization will be continued by the ICU physician (as occurs with, for example, the pulmonary/CCM, trauma/CCM models). This may be distinctly different than the shift model of staffing found in emergency departments.
