- Joined
- Oct 9, 2010
- Messages
- 191
- Reaction score
- 109
Made a pro/con list for each. Ultimately my goal is to do critical care, since that is what I have found most exciting/interesting during clinical years.
Please tell me what you think. Please tell me where you think I am delusional, etc.
Internal Medicine then Pulmonology/CCM
· Pros
o Has a decent amount of what I love about medicine from an intellectual standpoint.
o Best medical management preparedness for CCM.
o Most well-established pathway currently for CCM.
o Moderately good variety in IM.
o Get the excitement/joy of ordering tests, working people up, managing their meds, etc.
o Most frequent patient contact, most longitudinal care with patients (not a complete pro).
o Would have option for part-time outpatient treatment to avoid burnout (pulmonology).
o Lowest malpractice costs relative to other options.
o Probably best option for teaching medical students if at that type of program.
o Lots of other subspecialty options if I change my mind.
· Cons
o Lowest opportunity to learn the procedures and various tools (i.e. ventilators, ultrasound, etc.) I really want for CCM (before fellowship).
o Would have to fall back on general IM if fellowship doesn’t work out (which would be bad).
o Most frequent patient contact, most longitudinal care with patients (not a complete con).
o Long fellowship (3 years). 6 years total.
o Lots of social work non-sense that would drive me crazy.
o Play 2nd fiddle to every other specialty in the hospital (until fellowship and after).
o Lots of care coordination (until fellowship and after).
o Certain outpatient IM rotations could get old and annoying relatively quick.
o Not well-valued by hospital administrators (largely seen as replaceable by nurse practitioners with 1/6th the education). Not very much political power in the hierarchy.
Emergency Medicine then CCM
· Pros
o Probably the most fun residency of all options.
o Probably the greatest day-to-day variety of all options.
o Decent but not amazing procedural preparedness for CCM.
o Good experience taking care of emergent medical problems.
o Medium-length training. (2 year ABIM-CCM fellowship or surgical critical care fellowship). Residency + fellowship = 3 + 2 = 5 years.
o Shift-work.
o Personality fits in generally well with other EM physicians.
o Extremely well compensated (, for now.)
· Cons
o Being a lifeguard at the shallowest end of the gene pool (drug-seeking trash, bums, workers comp scammers, etc.)
o Probably would get burned out the fastest of all options.
o Not the greatest medical management preparedness for CCM.
o Basically 90% primary care.
o Strictly limited to hospital work even with fellowship.
o Lower but still decent amount of social work.
o Moderately valued by hospital administrators (somewhat seen as replaceable by nurse practitioners with 1/6th the education). Not very much political power in the hierarchy (but still more than IM).
Anesthesiology then CCM
· Pros
o Has the MOST of what I love about medicine from an intellectual standpoint (physiology and pharmacology). Love ventilators, ultrasound, procedures, etc.
o Best procedural preparedness for CCM.
o Lots of time in the OR (not necessarily a complete pro)
o Highest stress consults (difficult/botched airways) = Most opportunities to knock it out of the park in a bottom of the 9th, bases loaded situation.
o Very well compensated (as of right now).
o Medium-length training. Residency + fellowship = 4 + 1 = 5 years.
o Option to add pain management for 1 year fellowship if I completely lose my mind.
o Best specialty path to CCM in terms of diversity of options later on (high-acuity SICUs, CTICU, Neuro ICU, MICU, etc.)
o Extremely well compensated (, for now.)
o Least social work garbage of all options.
· Cons
o Not the greatest medical preparedness for CCM.
o Don’t get the excitement/joy of ordering tests, working people up, managing their meds, etc.
o Lots of time in the OR (not necessarily a complete con)
o Playing 2nd fiddle to surgeons. Dealing with surgical egos.
o Dealing with CRNAs.
o Highest stress consults (difficult/botched airways) = Most opportunities to fall flat on your face when everyone’s counting on you to fix their problem.
o Moderately high malpractice costs.
o Least amount of direct patient interaction.
o Not as many opportunities in private practice compared to traditional IM/CCM/Pulm route.
o Not at all valued by hospital administrators (seen as very replaceable by nurse practitioners with 1/6th the education – already happening or happened in many places). Pretty much no political power in the hierarchy.
Please tell me what you think. Please tell me where you think I am delusional, etc.
Internal Medicine then Pulmonology/CCM
· Pros
o Has a decent amount of what I love about medicine from an intellectual standpoint.
o Best medical management preparedness for CCM.
o Most well-established pathway currently for CCM.
o Moderately good variety in IM.
o Get the excitement/joy of ordering tests, working people up, managing their meds, etc.
o Most frequent patient contact, most longitudinal care with patients (not a complete pro).
o Would have option for part-time outpatient treatment to avoid burnout (pulmonology).
o Lowest malpractice costs relative to other options.
o Probably best option for teaching medical students if at that type of program.
o Lots of other subspecialty options if I change my mind.
· Cons
o Lowest opportunity to learn the procedures and various tools (i.e. ventilators, ultrasound, etc.) I really want for CCM (before fellowship).
o Would have to fall back on general IM if fellowship doesn’t work out (which would be bad).
o Most frequent patient contact, most longitudinal care with patients (not a complete con).
o Long fellowship (3 years). 6 years total.
o Lots of social work non-sense that would drive me crazy.
o Play 2nd fiddle to every other specialty in the hospital (until fellowship and after).
o Lots of care coordination (until fellowship and after).
o Certain outpatient IM rotations could get old and annoying relatively quick.
o Not well-valued by hospital administrators (largely seen as replaceable by nurse practitioners with 1/6th the education). Not very much political power in the hierarchy.
Emergency Medicine then CCM
· Pros
o Probably the most fun residency of all options.
o Probably the greatest day-to-day variety of all options.
o Decent but not amazing procedural preparedness for CCM.
o Good experience taking care of emergent medical problems.
o Medium-length training. (2 year ABIM-CCM fellowship or surgical critical care fellowship). Residency + fellowship = 3 + 2 = 5 years.
o Shift-work.
o Personality fits in generally well with other EM physicians.
o Extremely well compensated (, for now.)
· Cons
o Being a lifeguard at the shallowest end of the gene pool (drug-seeking trash, bums, workers comp scammers, etc.)
o Probably would get burned out the fastest of all options.
o Not the greatest medical management preparedness for CCM.
o Basically 90% primary care.
o Strictly limited to hospital work even with fellowship.
o Lower but still decent amount of social work.
o Moderately valued by hospital administrators (somewhat seen as replaceable by nurse practitioners with 1/6th the education). Not very much political power in the hierarchy (but still more than IM).
Anesthesiology then CCM
· Pros
o Has the MOST of what I love about medicine from an intellectual standpoint (physiology and pharmacology). Love ventilators, ultrasound, procedures, etc.
o Best procedural preparedness for CCM.
o Lots of time in the OR (not necessarily a complete pro)
o Highest stress consults (difficult/botched airways) = Most opportunities to knock it out of the park in a bottom of the 9th, bases loaded situation.
o Very well compensated (as of right now).
o Medium-length training. Residency + fellowship = 4 + 1 = 5 years.
o Option to add pain management for 1 year fellowship if I completely lose my mind.
o Best specialty path to CCM in terms of diversity of options later on (high-acuity SICUs, CTICU, Neuro ICU, MICU, etc.)
o Extremely well compensated (, for now.)
o Least social work garbage of all options.
· Cons
o Not the greatest medical preparedness for CCM.
o Don’t get the excitement/joy of ordering tests, working people up, managing their meds, etc.
o Lots of time in the OR (not necessarily a complete con)
o Playing 2nd fiddle to surgeons. Dealing with surgical egos.
o Dealing with CRNAs.
o Highest stress consults (difficult/botched airways) = Most opportunities to fall flat on your face when everyone’s counting on you to fix their problem.
o Moderately high malpractice costs.
o Least amount of direct patient interaction.
o Not as many opportunities in private practice compared to traditional IM/CCM/Pulm route.
o Not at all valued by hospital administrators (seen as very replaceable by nurse practitioners with 1/6th the education – already happening or happened in many places). Pretty much no political power in the hierarchy.
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