IM or Anesthesia fellowship for EM folks?

[EMIM2011]

Now that IM and soon Anesthesia offer critical care pathways for EM-trained docs...what do you guys think is going to be the better option? Anesthesia is probably easier to get into, and, at least if you completed a 4yr-EM residency, it will not require additional rotations during residency, as opposed to the 6 months of medicine for the IM pathway.

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[Dr.CCM]

I believe the IM pathway for EM guys is 2 months medical sub specialty and 3 months icu. Since the new guidelines for EM residency have increased ICU required time, one shouldn't have too much trouble with finding a program that will allow you two months medicine floor time (can be cards, plum, nephro, wards, etc). I'm a third year that has started looking at programs with all this in mind.

 

[inspirationmd]

Now that IM and soon Anesthesia offer critical care pathways for EM-trained docs...what do you guys think is going to be the better option? Anesthesia is probably easier to get into, and, at least if you completed a 4yr-EM residency, it will not require additional rotations during residency, as opposed to the 6 months of medicine for the IM pathway.

I think it depends on your interests. If you are more IM minded and enjoy treating severe manifestations of chronic disease then you should go IM-CC. I think your differential skills and diagnostic abilities would also be stronger as well relatively speaking. Your curriculum will emphasize MICU more as well which is to be expected since IM will be the primary board.

However, I think that if you are more EM minded then Anesthesia and, eventually, Surgical CC programs are going to get better. While you will be a good diagnostician after these fellowships I feel that your procedural skills are going to be a bit stronger compared to IM-CC since airway and more advanced percutaneous techniques can be learned just by nature of the fact that these attendings are going to be more comfortable doing them. Also most of your time will be spent in SICU and CVICU.

I think most EM grads are going to gravitate more towards the Anesthesia prograns just because there is more in common with their training. Also your average EM doc likes procedures a lot more than the average IM doc and is generally more "just fix it" than exhaustive work-up which I am starting to appreciate. The differential is just a lot more focused. Also I have done more Chest tubes, Intubations, and Central Lines than most Pulm-CC fellows at my home institution and 1st/ 2nd year Pulm-CC fellows at a couple other institutions I am aware of. This would be frustrating if you are more procedurally inclined. In addition, there are more Anesthesia CC programs in the nation so that can give you the option of going to a more desirable city for your 1 year of training.

I personally am leaning more toward Anesthesia CC training myself since I want broader CC locations and I like the Surgical/Anesthesia mindset more so I would prefer to be in the SICU compared to the MICU.

 

[Dr.CCM]

I am wondering how all this fits in the private world and if hospitals or groups would prefer you to be IM/CC trained since many private groups are pulm/cc and im/cc trained.

 

[inspirationmd]

I am wondering how all this fits in the private world and if hospitals or groups would prefer you to be IM/CC trained since many private groups are pulm/cc and im/cc trained.

No one has really able to answer that for me so far. Most of the groups are Pulm-CC so they have a natural bias for training they understand. IM-CC trained people still experience some bias out in the community from a few IM-CC attendings I have here at my academic institution. Overall I am still looking into this myself. I am going to try to go to a SCCM or Chest meeting in the next year or two to ask about this.

Anyone else know?

 

[castaway]

I completed a 3 year EM residency and am now looking at doing an anesthesia CC FELLOWSHIP. a number of such programs have expressed an interest in applications from EM grads-- but for the 1 year program they are designed for. Is there any way to talk to the directors about the possibility of actually designing a 2 year program for an EM grad? Some of these programs have recently become open to EM GRads applying but don't seem to have anything in place that would fulfill the 2 year requirement that will probably be required for an EM grad to become eligible to sit for the ACC boards. Can you please give me advice about what options I have for completing that 1 st preliminary year as a prerequisite. I'm aware I can apply to transitional or preliminary year programs, but that sounds like applying for residency all over again. And he idea of doing a surgery prelim year is frightening. Any good ideas? Thanks!!

 

[Bostonredsox]

what is the anesthesia requirement? Gas + CC is 4 +1. IM + CC is 3 + 2. EM + IM-based CC is 3 + 2. If they will only make you do 1 year of CC in the anesthesia route alongside the anesthesiologists thats 3 EM + 1 CC for 1 less total year. go that route.

 

[dotcb]

The anesthesia document states 4 yrs EM + 1 CCM, or 3yrs EM + 2 yrs of fellowship. The key is it must be 5 years in total duration.

https://www.abem.org/PUBLIC/_Rainbow/Documents/ABA-ABEM FAQs 9-21-12 FINAL-to post.pdf