IM vs critical care

[faisal 2000]

Hi there
i'm intern now and i'm excellent at Internal medicine, but i love to take care of critical cases and being at ICU. now in my country there is icu residency(5yrs). some of my friends advice me to take IM residency(4yrs) then get ICU fellowship. i am confusing regarding this
could you please advice me regarding this in all bases(life of both fields, knowledge, salaries, and anything that can help)
and do you think that no subspecialty under ICU make it not good for physician ?
pros and cons of critical care in general ??

thank you

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[spacegun]

Hi there
i'm intern now and i'm excellent at Internal medicine, but i love to take care of critical cases and being at ICU. now in my country there is icu residency(5yrs). some of my friends advice me to take IM residency(4yrs) then get ICU fellowship. i am confusing regarding this
could you please advice me regarding this in all bases(life of both fields, knowledge, salaries, and anything that can help)
and do you think that no subspecialty under ICU make it not good for physician ?
pros and cons of critical care in general ??

thank you

If you're talking about your country, sorry, I don't think anyone can advise you about salary etc. unless they are from your country.

If you mean in the US, then ICU is a fellowship done after IM (or anesthesiology, surgery, emergency medicine, neurology, pediatrics, maybe some other ones). If you do IM in the US, then it's 3 years. If you do ICU-only after IM, then it's 2 years. IM + ICU only = 5 years.

But the most common route to become an intensivist after IM is by doing pulmonary and critical care = 3 years. IM + pulm/critical care = 6 years. However, if you do almost any other fellowship after IM, e.g. nephrology or ID, that's 2 years, then if you do ICU, it's 1 year. Still 6 years total. But if you do IM, then you do critical care, then you do another subspecialty, then it's 3 years for IM + 2 years + 2 years = 7 years.

People have posted salaries. Search for MGMA salaries. From what I know, outpatient IM is around $200K. Hospitalists I believe can get to $300K. Critical care only is usually $400K. Pulmonary and critical care I have heard starting around $300-$400K depending on various factors (e.g. location, payer mix), but can jump up much higher than that after becoming partner.

Lifestyle for hospitalists and ICU is generally shift work. You work 7 days for 12 hours, then you're off for 7 days. Repeat. This is just one example, I'm only speaking generally because lifestyle depends a lot on many factors. For example, if you work in private practice or academics (and then if you have support from residents and fellows, if you have commitments to research or teaching), and lots and lots of other factors. This is a very general idea.

ICU has a very bright future and lots of jobs opportunities in the future from what everyone seems to be saying here. Apparently there are increasingly more closed ICU's, I guess that means there's an increasing need for more intensivists also.

But if you're an IMG, then worry about getting into the US for IM first. You will have to do well on Step 1 and Step 2 CK/CS and also do IM rotations and get LOR's from US physicians. So you have to get into IM in the US first before thinking about critical care. Good luck.

 

[faisal 2000]

thank you for your input


what do you think about residency ICU, do you think that it is a good idea to be in it directly not through other specialty?
pros and cons of critical care in general ?
what skills should i have to be a good intensivist ?

 

[AdmiralChz]

what do you think about residency ICU, do you think that it is a good idea to be in it directly not through other specialty?

This is not currently possible in the US, you HAVE to be board-certified in another specialty before sitting for CCM boards. Critical care is a "fellowship" not a "residency"

There are some programs out there that may offer combined training all together from the start - ex: Anesthesiology/CCM or Emergency Med/CCM - but there are very few of these and probably extremely difficult to get into as an IMG.

 

[faisal 2000]

This is not currently possible in the US, you HAVE to be board-certified in another specialty before sitting for CCM boards. Critical care is a "fellowship" not a "residency"

There are some programs out there that may offer combined training all together from the start - ex: Anesthesiology/CCM or Emergency Med/CCM - but there are very few of these and probably extremely difficult to get into as an IMG.

thank you for your input
in KSA we have critical care residency

so what are pros and cons of critical care as specialty ?

 

[spacegun]

thank you for your input
in KSA we have critical care residency

so what are pros and cons of critical care as specialty ?

Is KSA = Kingdom of Saudi Arabia? Sorry I don't know anything about what critical care is like in Saudi Arabia.

I'm just a med student so take all this with a grain of salt, obviously attendings here know much better. But here's what I like and dislike about critical care in the US, however a lot of it is subjective (e.g. some people love procedures while others hate procedures).

Pros
Medicine at 100 MPH
Deranged physiology/pathophys is very cool
Lots of procedures
Good compensation ($400K, MGMA average)
Shift work, work hard when you're on, but you're off when you're off (e.g. 7 days on/off)
Lots of variety, critical care can be combined with other specialties (e.g. IM, pulm, anesthesia) so you can do something else if you get burned out from the ICU, you even do a lot of palliative care (but that can be a con depending on your point of view)
Mid-level threat seems farther away than some other specialties, patients and their families in the ICU want to see a doctor, not a mid-level
Exciting future, more closed ICU's, telemedicine, eICU's, various bronch procedures, ECMO, many research opportunities, it's not like cardiology or oncology where there are so many researchers already (many with MD-PHD's) it's hard to be a thought leader but easier to be a thought leader in critical care if you want to make an academic career

Cons
Many patients unfortunately die
High burnout
Long hours
Work a lot of nights and weekends for your career
Seems like there's a lot of non-EBM practice and interventions happening in the ICU (but flipside is this means good research opportunities in the future if you like research)

 

[SpartanDOnoharm]

If you're talking about your country, sorry, I don't think anyone can advise you about salary etc. unless they are from your country.

If you mean in the US, then ICU is a fellowship done after IM (or anesthesiology, surgery, emergency medicine, neurology, pediatrics, maybe some other ones). If you do IM in the US, then it's 3 years. If you do ICU-only after IM, then it's 2 years. IM + ICU only = 5 years.

But the most common route to become an intensivist after IM is by doing pulmonary and critical care = 3 years. IM + pulm/critical care = 6 years. However, if you do almost any other fellowship after IM, e.g. nephrology or ID, that's 2 years, then if you do ICU, it's 1 year. Still 6 years total. But if you do IM, then you do critical care, then you do another subspecialty, then it's 3 years for IM + 2 years + 2 years = 7 years.

People have posted salaries. Search for MGMA salaries. From what I know, outpatient IM is around $200K. Hospitalists I believe can get to $300K. Critical care only is usually $400K. Pulmonary and critical care I have heard starting around $300-$400K depending on various factors (e.g. location, payer mix), but can jump up much higher than that after becoming partner.

Lifestyle for hospitalists and ICU is generally shift work. You work 7 days for 12 hours, then you're off for 7 days. Repeat. This is just one example, I'm only speaking generally because lifestyle depends a lot on many factors. For example, if you work in private practice or academics (and then if you have support from residents and fellows, if you have commitments to research or teaching), and lots and lots of other factors. This is a very general idea.

ICU has a very bright future and lots of jobs opportunities in the future from what everyone seems to be saying here. Apparently there are increasingly more closed ICU's, I guess that means there's an increasing need for more intensivists also.

But if you're an IMG, then worry about getting into the US for IM first. You will have to do well on Step 1 and Step 2 CK/CS and also do IM rotations and get LOR's from US physicians. So you have to get into IM in the US first before thinking about critical care. Good luck.

How does ER to critical care work? Is it still the same 6 years? I know they can't do pulm, what do they do instead?

 

[deleted547339]

How does ER to critical care work? Is it still the same 6 years? I know they can't do pulm, what do they do instead?

Either 3y or 4y EM residency plus a 2y CCM fellowship.

What can they do instead......ummmmm.....EM?

 

[K31]

How does ER to critical care work? Is it still the same 6 years? I know they can't do pulm, what do they do instead?

EM residency grads can do critical care fellowships through Medicine, Anesthesia, or Surgery. All routes are an additional 2 years.

Medicine critical care fellowships are either 3 years combined Pulm/CCM (most common) or 2 years CCM only. EM grads are only eligible for the latter.

 

[spacegun]

How does ER to critical care work? Is it still the same 6 years? I know they can't do pulm, what do they do instead?

You might be interested in EMCrit, Scott Weingart

EMCrit Blog - Emergency Department Critical Care & Resuscitation

 

[deleted547339]

EM residency grads can do critical care fellowships through Medicine, Anesthesia, or Surgery. All routes are an additional 2 years.

Medicine critical care fellowships are either 3 years combined Pulm/CCM (most common) or 2 years CCM only. EM grads are only eligible for the latter.

CCM can also be 1 year for any IM grad that is subspecialty certified.