jonsnowtaxguy

2+ Year Member
Sep 17, 2017
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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?
 

AdmiralChz

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Sep 8, 2008
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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!
 

bashwell

5+ Year Member
Mar 20, 2013
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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?
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.
 
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jonsnowtaxguy

2+ Year Member
Sep 17, 2017
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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.
 

chocomorsel

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May 24, 2006
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So your post medical school education is 10 years to be an ICU doc? Wow. That's insane.
How long is the IR training? How many more years for you rather?
 
Oct 18, 2017
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Medical Student
Intensive care is challenging, because depending on the patient you have to operate. Ignore politics, everything will be alright
 
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