ICU Fellowship: Is this an asset?

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Dawkter

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New to anesthesia and loving it so far. Already starting to think about fellowship and ICU is on the top of my list! I feel like it would give me a very complete skill set, make me an extremely marketable physician, and I would get to re-gain some of the patient contact aspects and medicine knowledge that isn't always maximized in the OR setting.

Has anyone on the forum completed an ICU fellowship? Are most anesthesia ICU fellowships primarily SICU only? Also, what is the market like for anesthesia trained ICU docs in both private practice and academia? Will this give us some protection against midlevels in anesthesia?

Thanks again 🙂
 
Has anyone on the forum completed an ICU fellowship? Are most anesthesia ICU fellowships primarily SICU only? Also, what is the market like for anesthesia trained ICU docs in both private practice and academia? Will this give us some protection against midlevels in anesthesia?
AFAIK, there are multiple Anesthesia/CCM-trained people on the forum. Some of them also post in the Critical Care section. I personally got outstanding help from one of the fellows (he is an attending now).

Many, but not all, anesthesia CCM fellowships rotate only through surgical units, but there are also some where one can have a good amount of MICU exposure. The number of the latter is decreasing, as the IM RRC requires their residents/fellows to be trained only by IM intensivists, and the mixed medical-surgical CCM culture is beginning to suffer.

I cannot tell you about the market. I still have to do the fellowship myself and get a taste of the market. I think this is the kind of fellowship one does for the pleasure of becoming a better doctor, not for better marketability. Many of the most knowledgeable anesthesiologists I know are CCM-trained; just look at who does sick liver transplants in your program. Especially in an era when manual skills are becoming less important than cerebral multitasking, being able to supervise the care of multiple sick patients at a time is more and more important, and that's what you are trained to do as an intensivist. If you add basic regional and pediatric anesthesia skills, and an advanced TEE certification on top of it, even as a testamur, there isn't much you won't be able to do in the OR.

Will this give you protection against midlevels? Depends what you mean by protection. Will you always have a job until you retire? Most probably. Will it be a good lifestyle and easy job? Most probably NOT. It will be a tough job, with calls, requiring supervision of multiple midlevels and sick patients at a time, either in the OR or in the ICU, but you will be so much better at it than many others, and thus less likely to be replaced. This is the future anyway; it's your choice how you prepare for it.
 
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It had damn well better be an asset!

There are several on SDN that have done ICU fellowship after anesthesiology residency. Mine was done at University of Michigan, with a very heavy emphasis on surgical critical care, and I think many of the anesthesiology-based training programs have that bend.

I don't think I can say much more than what FFP already eloquently said; I'm biased into believing my training will be an asset as I look for jobs. I can only share my own personal experiences on the job search (I'm in a second fellowship now, so just getting started on looking): I have spoken with a great private practice group in which multiple partners not only do OR anesthesiology, but also round in their ICUs and I have spoken with multiple academic centers where they're looking for an anesthesiologist-intensivist. Curiously, I just got an interview invite to talk with a PP group that does no ICU, but felt that their patient population isn't getting any healthier, and felt my ICU background would be an asset. Obviously, my anecdotes can't be extrapolated to the overall market, but I've been pleasantly surprised with the amount of available positions now.

I don't know that ICU fellowship provides midlevel "protection". It (along with Pain and Sleep Medicine) will give you a separate board certification outside of OR anesthesiology, if you ever wanted to leave the OR entirely. The ICUs that I know of from medical school, residency, fellowship #1 and fellowship #2 (all in different places) all had at least a palpable NP or PA presence. The midlevels were not running rounds, or final decision makers, but they are there. And I'd conjecture that many of the planned post-surgical ICU admissions can be easily managed by routine protocol, so there will always be a midlevel presence.

Regarding my (perhaps "rose-colored-glasses") opinion, I'm personally very happy I did the extra year.
 
There was a big discussion few yrs ago (maybe it continues) that an ICU fellowship would allow u to be the ultimate perioperative physician that could guide Pts thru their entire hospital course. This was the way Anesthesia (and medicine) were going. Big discussion at ASA meeting few years ago...but at this point I'm not sure that is the case. 5-10 yrs from now with full implementation of obamacare maybe it will be the standard????

I do have a friend or 2 who do a mix of anesthesia and ICU in PP which was pretty non-existent 5 yrs ago...but I don't see gigs like this popping up like wild fire or becoming the norm.

If you love ICU do it. If you think it will make you a better doc do it. If you're ok (at this point) taking an academic job then do ICU...it may be only job you can find doing Some % of ICU. If you want an escape from the OR possibly 10 yrs from now do it. We have NPs and PAs too in our ICUs but just like CRNAs once things deviate off the algorithm their lack of medicine (and subsequent decision making ability) knowledge quickly evaporates. Now a days mid levels round with cardiology and most IM subspecialties, do EM, etc...they're a vital component to keeping the healthcare wheels moving, reducing cost, and caring for as many Pts as possible.
 
It's hard to say that anyone will be worse off by doing a fellowship. The only issue I've noticed with ICU is the seeming lack of PP jobs out there. I liked ICU, but when I did some research it seemed the vast majority of jobs posted were for Pulm/CC folks.

Not sure if this will change, or is changing, but that was what I did notice...
 
New to anesthesia and loving it so far. Already starting to think about fellowship and ICU is on the top of my list! I feel like it would give me a very complete skill set, make me an extremely marketable physician, and I would get to re-gain some of the patient contact aspects and medicine knowledge that isn't always maximized in the OR setting.

Has anyone on the forum completed an ICU fellowship? Are most anesthesia ICU fellowships primarily SICU only? Also, what is the market like for anesthesia trained ICU docs in both private practice and academia? Will this give us some protection against midlevels in anesthesia?

Thanks again 🙂

Just finished ICU fellowship in a medicine-heavy, SICU-light fellowship. I did it for all the reasons you've listed above. It was worth it, for all the reasons you've listed above. It directly helped me get my first job out of fellowship, which is 100% OR anesthesia in a desirable group in a desirable area. OR/ICU jobs in PP are few and far between, but if you have a wide geographical scope, shouldn't be a problem to find.
 
One thing that I forgot is that, in most countries, "anaesthetists" tend to be both OR and ICU-trained. So it's kind of expected to know CCM; it's complementary to anesthesia.
 
I'm curious to know if doing an Anes-CC fellowship prepares you well enough to work in the MICU in a community setting? Just because most smaller hospitals seem to only have one unit and wanted to know if anyone has done MICU/mixed and how well they were able to adapt? Also I understand the usual setting is the CT-SICU for Anesthesiologists but what about CCU? Or is that exclusively run by cardio? Basically for all the different types of ICU settings, which ones can Anesthesiologists work in besides CT/SICU?
 
I'm curious to know if doing an Anes-CC fellowship prepares you well enough to work in the MICU in a community setting? Just because most smaller hospitals seem to only have one unit and wanted to know if anyone has done MICU/mixed and how well they were able to adapt? Also I understand the usual setting is the CT-SICU for Anesthesiologists but what about CCU? Or is that exclusively run by cardio? Basically for all the different types of ICU settings, which ones can Anesthesiologists work in besides CT/SICU?

Being a CCM fellow, I haven't yet experienced private practice, nor do I know if I ever will. However, I feel like ICUs in the community settings tend to see more bread and butter scenarios rather than the zebra cases that you see in academic medical ICUs, and that the med-surg divide doesn't really exist as much. It's likely a combined med-surg ICU that exists out in the community. If they admit a zebra or get a case that's difficult for them to manage without access to specialists, I have a feeling that they would transfer to a major academic hospital. Also, when I was a medical intern, and on rotation at our community hospital MICU, the way that unit ran resembled most SICUs - primary care physician admitted the patient and co-managed along with the Medical Intensivist. The concept of a closed ICU still seems new, and actually doesn't really exist where I'm training.

Where I'm training, our department is involved in the trauma ICU, the SICU, and CT-SICU, and recently opened a critical care consult service to hospitalist patients that require ICU care. The medical hospitalist manages the patient, but we're on consult for CCM-related issues (e.g. vent management, lines if they're having trouble, pressors/sedation, intubation, perc trachs, chest tubes, major resuscitation, etc). As a fellow, I'm not really privy to the details behind the arrangement, but I bring it up to try and illustrate that a lot of CCM is similar regardless of which unit you're in. In addition, I think our department has been involved in the Neuro-ICU in the past, as well, where we took care of problems below the head, and left the head to the neurologists and neurosurgeons. So really, though I think your exposure in fellowship would influence it, I think most anesthesiologists who train in Critical Care would be comfortable in any type of community ICU setting. It's just that finding a community ICU that isn't dominated by pulmonology, or trying to find an anesthesiology group that actually wants involvement in the unit is difficult.
 
How competitive is ICU fellowship relative to the other fellowships? And is there anything about CCM that oneu doesn't realize as a resident until fellowship/attending?
 
CCM is one of the easier fellowships to get into. Other than the top programs, you can pretty much pick your program and go from there.

Although others have different experiences, my ccm fellowship didn't help me at all with straight OR jobs. If anything, it was a negative.

That being said, plenty of anesthesia/ccm jobs out there and everybody is looking for help.
 
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