Simply doing more MICU months won't make you a better or even a more well-rounded intensivist. Also, most SICU patients are there for medical reasons.
How many months of MICU have you done, as a fellow?
😛
What MICU brought to my education (besides sicker patients, no offense) was a broader exposure to medical diseases, and a
much more evidence-based approach to treatment (and generally a more modern approach to critical care - surgeons invest less time in reading). It may have been specific to my center, but I doubt it. We were primary only in the MICU though, so that also mattered a lot (but that's the setup in most ICUs).
I remember spending physically more time on call in the MICU than in the SICU, and I remember the patients being older and sicker, on average. I barely remember seeing severe ARDS/pulmonary edema in the SICU, for example. Never a bad asthma attack or a diabetic coma. Never a tumor lysis syndrome. Never a pheo crysis. Fewer electrolyte disorders. Much less AKI. Much less ID exposure; more knee-jerk antibio- and everything-therapy. Never a septic + cardiogenic shock at the same time. Never a fulminant liver failure. Never a severe COPD/chronic lung disease/PHTN. Never a high-dose peripheral pressor or an unconventional treatment. Much less POCUS for both diagnosis and treatment. Less difficult vent management. Etc, etc, etc. One third of the patients were there for nursing reasons (neuro checks, vascular checks etc.).
Spending months in the MICU as THE fellow (not just as an elective/afterthought) may not matter at a top 10-20 academic center, but, in many places, I would expect it to. Same with in-house calls and running the ICU at night with the attending on home call
and hands-off (much rarer in a SICU, where the trauma surgeon is in the house). Our responsibilities were so broad and deep, as on-call fellows, that the PD kept asking if it was not too much for us, if we felt it was safe.
Another big difference, in my view: many patients with multiple severe pre-existing medical diseases never get a surgery in the first place, because no surgeon wants bad outcomes. At the same time, the MICU is the last resort for exactly those patients who would never qualify for a non-emergent surgical intervention. During my fellowship, I forgot more (patho)physiology I had learned in the MICU than what I had ever seen in the SICU. I also think that anesthesiologists come with enough SICU experience from their residency, while having too little MICU experience (especially if they didn't do a medicine internship).
Yes, critical care is mostly the same group of frequent diseases in both SICU and MICU, but each has its own specifics, strengths and weaknesses, and cross-pollination teaches one the best of both worlds. Even in the SICU world, there are so many specialties, and one should get exposure to as many types of patients as possible. As I have said, looking back, the fellowship feels almost too short; critical care is more like another specialty than a subspecialty.
