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.
