ICU vs Interventional Radiology

Started by jonsnowtaxguy
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jonsnowtaxguy

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Hello, I am sorry for bombarding this board with yet another "versus" question. This dilemma is driving me crazy. I have spoken with a few seniors in my field who have given me different answers.

Background: I am an Intensive Care Trainee in Australia. The system here is slightly different to most countries. It is considered a primary speciality training program i.e when I finish my training program, I will have no other qualification other than being an intensivist.

I have loved intensive care since I was a medical student, I have come pretty far into the training program as a trainee and I have cleared my primary ICU board exams.

I don't mind the family discussions, breaking bad news, palliating patients who need to be palliated, long ward rounds, shift work etc etc.

My issues:
a) I only got exposed to interventional radiology as an ICU trainee. I am always in awe how technically challenging the procedures are, and how quickly incredibly unwell patients become stable.

b) I'm a work horse. I'm happy to change specialties and do all the studying/work required.

c) I am becoming a bit disenchanted of my ICU aspirations:
i) Our training is disorganised.
ii) We have a surplus of trainees relative to attending/consultant vacancies. Fully trained fellows continue to gain extra skills and negotiate one year contracts in their late 30s early 40s
iii) ICU private work is a soul crusher. I have picked up shifts in a few private ICUs now, and I feel like the consultants are the ward surgical registrar for the surgical attending/consultant.
iv) Older ICU consultants look exhausted all the time. Older radiology bosses seem to love what they do.

With this context in mind I have a few questions:

a) For those who were in a similar predicament as me i.e intensive care vs. another procedural speciality -- which field did you choose and why?

b) For those who are current intensivists -- does the job continue to challenge/satisfy you despite all the politics?
 
It is going to be very difficult to answer your question objectively - the vast majority of posters here are US-based and there is no straight pathway here for critical care. The biggest difference here is that most CC-docs fall back on their primary training typically during their "off" weeks (meaning alternating time with Anesthesiology/EM/Pulm/Surgery). There are some that only do critical care, but I imagine (with the exception of Peds and neonatal, a different story all together) >75-80% practice this way if not more which helps avoid burnout (and in many specialties like Anesthesiology/Surgery, CC pays much less).

IR is a very different specialty all together - you have CC which is heavily surgical and medically based and then IR which is entirely procedural in nature. There is a good deal of daily follow up and acute on chronic management in CC where you are usually doing dealing with acute issues or procedures in IR. I of course am oversimplifying, but they are very different models of care. Hope this helps!
 
jonsnowtaxguy said:
Hello, I am sorry for bombarding this board with yet another "versus" question. This dilemma is driving me crazy. I have spoken with a few seniors in my field who have given me different answers.

Background: I am an Intensive Care Trainee in Australia. The system here is slightly different to most countries. It is considered a primary speciality training program i.e when I finish my training program, I will have no other qualification other than being an intensivist.

I have loved intensive care since I was a medical student, I have come pretty far into the training program as a trainee and I have cleared my primary ICU board exams.

I don't mind the family discussions, breaking bad news, palliating patients who need to be palliated, long ward rounds, shift work etc etc.

My issues:
a) I only got exposed to interventional radiology as an ICU trainee. I am always in awe how technically challenging the procedures are, and how quickly incredibly unwell patients become stable.

b) I'm a work horse. I'm happy to change specialties and do all the studying/work required.

c) I am becoming a bit disenchanted of my ICU aspirations:
i) Our training is disorganised.
ii) We have a surplus of trainees relative to attending/consultant vacancies. Fully trained fellows continue to gain extra skills and negotiate one year contracts in their late 30s early 40s
iii) ICU private work is a soul crusher. I have picked up shifts in a few private ICUs now, and I feel like the consultants are the ward surgical registrar for the surgical attending/consultant.
iv) Older ICU consultants look exhausted all the time. Older radiology bosses seem to love what they do.

With this context in mind I have a few questions:

a) For those who were in a similar predicament as me i.e intensive care vs. another procedural speciality -- which field did you choose and why?

b) For those who are current intensivists -- does the job continue to challenge/satisfy you despite all the politics?
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I'm in Australia as well, but I'm not as far along as you are (intern/RMO). But have you considered anaesthetics (anesthesiology in USA)? I have known several ICU registrars who have become anaesthetics registrars. That seems to be fairly common-ish, though competitive. The anaesthetic Supervisor of Training (similar to a PD in USA) where I am recently told me there are still staff specialist jobs in anaesthetics. As well, private work is lucrative. And anaesthetics is a much better life and work balance.
 
Thank you for your input everyone. Bashwell, I'm reasonable far into the training program. Technically i only have 3 years (out of 7) remaining but it's usually hard to finish all the mandatory rotations given how disorganised the training program is.

I am well aware of the exodus of trainees from ICU to Anaesthetics. I have done 6 months of anaesthetics/anaesthesiology at a registrar/resident level. As much I appreciate the skills, real time physiology and pharmacology, I do not think it is the right field for me.

AdmiralChz -- thank you for pointing out how ICU physicians in the states tend to divide their time between ICU and their home speciality. I think one of the reasons why IR appeals to me is the lack of follow up with chronic diseases and it's procedural nature.

Given that i'm still young, i think now's maybe the time to make the switch before its too late. I have a feeling the cool pathology we see will get boring over the next few years, i'll want more control over my time.
 
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