ICU without fellowship

[MelMcT2009]

hello all!

I'm currently an EM PGY1 facing a quick decision to be made. I'm considering switching to EM/IM now vs. doing EM --> critical care fellowship after.
I would prefer the versatility of being EM/IM trained. Would likely split my time in the ED and ICU.

We plan to live in a rural city in east Texas most likely. From what I saw in med school, IM trained docs can often work in ICUs in small cities without fellowship. I'm wondering if this is common/easily doable.

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[psychbender]

It's becoming less and less common, although I do still see ICU hospitalists every once in a while (just like I'll rarely see non EM-trained physicians in the ED). If your goal is to do EM and CCM, then just train in EM and CCM, rather than EM and IM. Doing IM when your goal is to do CCM is doing a disservice to both you and your patients.

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[jdh71]

hello all!

I'm currently an EM PGY1 facing a quick decision to be made. I'm considering switching to EM/IM now vs. doing EM --> critical care fellowship after.
I would prefer the versatility of being EM/IM trained. Would likely split my time in the ED and ICU.

We plan to live in a rural city in east Texas most likely. From what I saw in med school, IM trained docs can often work in ICUs in small cities without fellowship. I'm wondering if this is common/easily doable.

They work trere but are very bad at being adaquate to the job.

I'll admit my confirmation bias and having to clean up messes from outlying smaller hospitals with hospitalists running ICUs. The problem isn't what you know. But what you don't know that you don't know.

 

[chocomorsel]

hello all!

I'm currently an EM PGY1 facing a quick decision to be made. I'm considering switching to EM/IM now vs. doing EM --> critical care fellowship after.
I would prefer the versatility of being EM/IM trained. Would likely split my time in the ED and ICU.

We plan to live in a rural city in east Texas most likely. From what I saw in med school, IM trained docs can often work in ICUs in small cities without fellowship. I'm wondering if this is common/easily doable.

How long is EM/IM training? 5 years? Because if so, you aren't shaving off anytime.
Whatever the case, do what psych bender suggested and formally train in ICU if that's what you want to do.

 

[deleted547339]

hello all!

I'm currently an EM PGY1 facing a quick decision to be made. I'm considering switching to EM/IM now vs. doing EM --> critical care fellowship after.
I would prefer the versatility of being EM/IM trained. Would likely split my time in the ED and ICU.

We plan to live in a rural city in east Texas most likely. From what I saw in med school, IM trained docs can often work in ICUs in small cities without fellowship. I'm wondering if this is common/easily doable.

EM + CCM is 5 years. That would make you better trained in the same period plus give you more options. I suspect if you’re the type of person who likes EM and CCm, you probably won’t love a small, rural ICU. I’m EM/CCM. Feel free to PM if you have specific questions.

 

[MedicineZ0Z]

There was a recent instagram post with a bunch of ICU nurses talking about how much more they know than a lot of doctors. Hey I mean, if RNs know enough to run the ICU, why on earth would you need a fellowship??

 

[engineeredout]

If what you actually want to do is critical care, do a fellowship. I think EM/IM is great and definitely enhances your education/experience (although it is definitely a marathon), but it is no substitute in the ICU for a critical care fellowship.

 

[AdmiralChz]

It's becoming less and less common, although I do still see ICU hospitalists every once in a while (just like I'll rarely see non EM-trained physicians in the ED). If your goal is to do EM and CCM, then just train in EM and CCM, rather than EM and IM. Doing IM when your goal is to do CCM is doing a disservice to both you and your patients.

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This is a great point - those of us that have worked/rotated in more rural settings have seen this sort of stuff and it can definitely be concerning. There's a lot of very old medicine being practiced out there and it is pretty daunting to stay up with CCM literature if you aren't very comfortable/exposed to it to begin with.

 

[Bostonredsox]

I would also recommend you complete the CCM fellowship following your EM years if you want to practice as an intensivist. There is no benefit to doing a combined 5 year EM/IM residency when you could do 5 years of EM/CCM.

That said, do not paint your brush so broadly regarding Critical care hospitalist's with assumptions they are all idiots. 99% of typical community ICU patients are standard septic shock, decompensated heart failure, post MI cardiogenic shocks, GI bleeds, overdoses and run of the mill vent patients. An intelligent Internist with experience running an ICU for years can manage these patients and in fact must manage these patients or the tertiary care centers would be overrun with transfers of patients they cannot possibly manage from a volume perspective. The shortage of board certified intensivist's particularly in mid sized (150-300 bed) hospitals in more rural areas not near major cities is staggering. The intelligent critical care hospitalist will also know when the patient has reached the limit of his/her, or more commonly, the facility's, capabilities in terms of resources and or skill set and will appropriately transfer the patient to a tertiary center. By all means, you should complete the fellowship. Just don't assume once you have completed it that patients you receive in transfer were necessarily managed by an idiot.

Edit: I realize the OP was not directly alluding to this but more as a general response.