sunnyjohn

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Hello folks,

I have been doing quite a bit of research and I think I almost have it all sorted out. I would like to ask a few more questions just to make sure I have it all right.

Internist – can do a fellowship in Critical care medicine.
1. Does this mean they are considered an Intensivist?
2. Does that Critical care fellowship entitle them to work in EM?

Hospitalist
3. Are most of these folks Internist?
4. Does this require any specialty training?

EM
5. If they do an EM/IM residency they are double boarded, right?
6. Since EM does critical care, can they work as Intensivist?

Anesthesia
7. I read that these folks also practice critical care. Does that make also them intensivist?
8. If they practice Critical care can they practice EM?


I get that all specialties are called to work on patients in an ED. I understand that EM is a relatively new specialty. I also understand that in many rural areas there’s lots of overlap. I would just appreciate some help clearing away the fog.

Agape
 

Apollyon

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If you want to do EM, EM residency is the way to go. The question "can [this person] practice EM" is vague - I mean, ANYONE can do ANYTHING - but, will you get hired for EM if you've done anesthesia critical care? Unlikely, unless you are in the rural hinterlands. Then, WHY would you want to work in the middle of nowhere, if you've done anesthesia and a fellowship? No one beyond EM-trained physicians is "entitled" to work in the ED, just as no one beyond anesthesia-trained physicians is entitled to do anesthesia in the OR. In the OR, it's hard to be a surgeon and not pick up on a lot of what anesthesia does over the years of residency, but no surgeon I know wants to be on the other side of the drape. Likewise, I know several anesthesia people that love watching the surgeries over the drape, but not enough to do surgery.

Hospitalists have done IM or peds (depending on what they do). There is no 'hospitalist' board (yet), since it is essentially being medical faculty without having to teach or supervise residents or students, and no clinic.

Critical care can be done as a fellowship (where you can get boarded) after IM, anesthesia, pediatrics, or surgery. EM residents can get critical care fellowships, but cannot get board-certified. There is one person who posts on SDN who is a great source of CCM info. He has said that one of his colleagues, that did EM then CCM, now runs a unit.

Anyone who works in an intensive care unit, by that fact, is an "intensivist". Surgery, IM, pediatrics, anesthesia, and EM (among others) give a moderate amount of dedicated critical care/ICU time in residency (in conjunction with moderately to critically ill floor patients), so, in rural/understaffed areas, you may have people working in the units that are not CCM trained/boarded.
 

2ndyear

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I have been doing quite a bit of research and I think I almost have it all sorted out. I would like to ask a few more questions just to make sure I have it all right.

Internist – can do a fellowship in Critical care medicine.
1. Does this mean they are considered an Intensivist? Yes
2. Does that Critical care fellowship entitle them to work in EM? Not anymore than anyone else with an MD/DO.

Hospitalist
3. Are most of these folks Internist? Yes (Though there are peds and some FP opportunities).
4. Does this require any specialty training? No, but there are fellowships available, not at all required.

EM
5. If they do an EM/IM residency they are double boarded, right? If they take both boards.
6. Since EM does critical care, can they work as Intensivist? If they do the fellowship. Without I'm not sure, though I know of internists who do this. My guess is that most EM people wouldn't want to.

Anesthesia
7. I read that these folks also practice critical care. Does that make also them intensivist? Again, if they do a fellowship.
8. If they practice Critical care can they practice EM? No.

There's also more than a few 'intensivists' who are not fellowship trained or boarded in CCM. Obviously not in your big academic centers, but most of the country isn't a big a big academic center. The trend, though, is to fellowship trained intensivists in house 24/7.

Same thing for ED physicians, big places will have all boarded EM physicians, smaller places might still be staffed by FP's on rotating call. Again, this all will eventually change someday. But not likely soon (unless more EM people want to move to Sioux City)
 
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Bobblehead

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Via internal medicine it's mostly pulmonary/critical care, not just "critical care" as a fellowship which is mainly what the surgeons and anesthesiologists end up doing for a fellowship. Critical care training (depending on the flavor) does allow you to become familiar with all sorts of badness that rolls through the ER but it's not just the initial stabilization that critical care is concerned with. But rather your job is to send them somewhere from the ICU, i.e. floor, surgery, rehab, morgue.
 

InductionAgent

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Apollyon said:
no surgeon I know wants to be on the other side of the drape.
I'm aware of numerous surgical residents who have jumped ship over to anesthesia, as well as a few board-certified surgeons who have made that change, whereas the reverse is much less common.
 

Apollyon

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InductionAgent said:
I'm aware of numerous surgical residents who have jumped ship over to anesthesia, as well as a few board-certified surgeons who have made that change, whereas the reverse is much less common.
It's where I'm a resident. These people are DRIVEN. I appreciate your point, though.
 

txdoc2b

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Apollyon said:
It's where I'm a resident. These people are DRIVEN. I appreciate your point, though.

Are you saying that Anesthesiologists aren't driven? Just wanted to see if I read that right..... :confused:
 
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