Is applying to a combined critical care/anesthesia program a good idea?

[LeverArm]

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I realize this topic has appeared in the past but rather than bumping it I thought I would reask... So my story: I'm a 3rd year medical student halfway through 3rd year. I had long planned on going into IM only for the sole purpose of doing a fellowship in a more procedural specialty (GI, cards, intensivist). I ended up hating my IM clerkship for several reasons but loving my anesthesia elective.

What I hated most about IM was the amount of paperwork and work spent away from the patient in general. What I really liked about IM was the variety of pathology (including the different organ systems and pathologies), and making the diagnosis and plan.

What I did not like (although I did not hate) about anesthesia was how limited the problems were as they related to just anesthesia. I also hate CRNAs. I liked them as people and we would work well together but I hated how for most of the cases, the anesthesiologist was there for induction and then leave and I hated learning things about medicine from someone that never went to medical school. In no other rotation did I ever have this 'problem'. However, I loved just about everything else about anesthesiology.

So I spoke with the head internist about my dilemma and was recommended to try out a rotation in the ICU. I just started it but I can see that it really is a good fit in many ways. But when I tell anesthesiologists about doing a combined gas/cc they always suggest that I should just go into anesthesia and that I will most likely change my mind about ICU because of the hours/stress and decreased pay. While it sounds tempting to spread out a CC fellowship over the course of the residency and the work seems like a great fit for me, I feel really burnt out and I feel like the factors that anesthesiologists list may continue to become more and more important in my life.

I am really torn now. Should I:
a) just aim for an anesthesia residency
b) do the combined critical care + anesthesia programs
c) retry IM (as a SubI) in addition to a subspeciality month of cards or GI

 

[secants]

So I'm also an MS3 and in a similar position in that I have both IM and Anesthesia in mind come ERAS this summer. I briefly looked into the combined CC/Anes programs and the two main advantages I see are 1) you don't have to go through an application cycle to apply since you're guaranteed a spot 2) there's better integration of the ICU months during the whole Anesthesia residency.

That said, I think it's best to do an ICU rotation as early as possible this summer to really get a feel if your love of ICU on paper translates to it in real life application as well. That's my plan and I'm gearing my app towards possibly dual applying until I make a final choice after my Medicine SubI and Anesthesia home rotation.

Hopefully someone further up the totem pole can chime in.

 

[mikey014]

So I'm also an MS3 and in a similar position in that I have both IM and Anesthesia in mind come ERAS this summer. I briefly looked into the combined CC/Anes programs and the two main advantages I see are 1) you don't have to go through an application cycle to apply since you're guaranteed a spot 2) there's better integration of the ICU months during the whole Anesthesia residency.

That said, I think it's best to do an ICU rotation as early as possible this summer to really get a feel if your love of ICU on paper translates to it in real life application as well. That's my plan and I'm gearing my app towards possibly dual applying until I make a final choice after my Medicine SubI and Anesthesia home rotation.

Hopefully someone further up the totem pole can chime in.

I loved my ICU rotation. Some great pathology there. And very rewarding seeing the patient do better they can be very sick when they're admitted!

 

[imfrankie]

I say go for it man! Do it. Outstanding training. And how nice to have the unit time spread out. The disciplines will be synergistic so you'll be very skilled and highly sought out. GREAT plan if you can do an extra year IMHO. ( Wow, will you be good in the end ) Plus, I think by doing a combined program you'll be less likely pegged as one or the other. I hope you go for it.

 

[secants]

I say go for it man! Do it. Outstanding training. And how nice to have the unit time spread out. The disciplines will be synergistic so you'll be very skilled and highly sought out. GREAT plan if you can do an extra year IMHO. ( Wow, will you be good in the end ) Plus, I think by doing a combined program you'll be less likely pegged as one or the other. I hope you go for it.

That was pretty motivational. Now I want to apply for the combined programs 😀

 

[LeverArm]

Haha me too! But I feel like I'll regret it if for some reason I start getting tired of the ICU over the years of residency and will have wished that I did pain after residency instead. Ahh what a hard decision to make!

 

[wickedskillz]

At the end of the day the max you would lose is one year where you learned a lot of medicine. That can't be too bad!

 

[G0S2]

Don't do it or at least ask the program what happens if you decide to forgo the fellowship. I was told at one program that you will have to leave the program. Do well in any anesthesia residency and you will land a CC spot. As an MS 1 why would you commit to a specialty? Same goes for residency. You may like hearts or peds. Don't close yourself off.

 

[MD Dreams]

If you are a medical student wanting to go into anesthesia, you need to go into it with the mindset that you will do a fellowship. The days of the general anesthesiologist doing bread and butter cases are coming to an end. Don't put much fate in people who try to deter you from doing a fellowship, especially ICU. That is the wrong mindset. From what I understand, in some other countries anesthesiologist are also intensivists. We went to medical school for a reason, to use our knowledge of medicine. Don't worry about the one year of income that you will loose or one extra year of training, etc. You'll come out an intensivist and that's more than most people can say about themselves. Plus medicine is becoming less and less lucrative so the focus needs to shift on doing medicine because you love being a physician and not as much on doing a couple of easy OR cases, making lots of money and going home early. Those days are coming to an end.

I would agree, however, that to commit to a specific fellowship before residency may be a bit premature. You haven't experienced enough anesthesia to know what you do and don't like. But if you want a fellowship after residency you also have to do well in residency.

Good luck!

 

[TrustMe]

Haha me too! But I feel like I'll regret it if for some reason I start getting tired of the ICU over the years of residency and will have wished that I did pain after residency instead. Ahh what a hard decision to make!

I don't think you will ever look back and say "I wish I was sitting in a pain clinic listening to a middle age fat lady tell me about her back, neck, and knee pain".