Is critical care really that challenging?

[MD Dreams]

Advertisement - Members don't see this ad

I was talking to an IM doc and his opinion was that critical care is not all that intellectually challenging. He said that the specialty to go into for cerebral challenge would be cardiology or nephrology. For those of you who practice CC, could you please comment on this. Thank you.

 

[bullard]

No, you're right, it's not that challenging. I've also had general surgeons tell me that pedi CV surgery is also pretty unchallenging after 3 or 4 Fontan procedures, so you can strike that one off your list of potential specialties.



Dude, I dunno, maybe I'm a little slow, but every specialty of medicine I've been exposed to in medical school has made my head hurt. Just pick something you can see yourself doing in 20 years.

 

[militarymd]

I was talking to an IM doc and his opinion was that critical care is not all that intellectually challenging. He said that the specialty to go into for cerebral challenge would be cardiology or nephrology. For those of you who practice CC, could you please comment on this. Thank you.

That's funny...I've had cardiologists and nephrologists s hitting in their pants when their patients are crumping...calling me to PLEASE come and help because they're not sure what's going on.

 

[stephend7799]

That's funny...I've had cardiologists and nephrologists s hitting in their pants when their patients are crumping...calling me to PLEASE come and help because they're not sure what's going on.

ummm, the above statement is very hard to believe since critical care revolves around cardiac issues and pulmonary issues. and those two organs are very tightly interwoven. and the kidney is a very near half brother. . so i highly doubt a cardioogist wouldnt knw whats going on when his patient is crumping..

 

[stephend7799]

when iwas a medical student I though neurology was pretty intellectual.. with the whole wheres the lesion game.. and subtle neurologic signs and the whole neuro exam.. ocular lesion..

 

[Trisomy13]

He said that the specialty to go into for cerebral challenge would be cardiology or nephrology.

to quote the cardiologist i'm working with this month - "and this isn't even that hard if you think about it. i mean you have 4 chambers, some plumbing and some electricity. there's not that much to it."

 

[militarymd]

Here's the deal with CCM. As an intensivist, you are just the generalist for someone who is really sick.....

Cardiologists and nephrologists are specialists in single organ failure....the intensivist deals with mulit-organ failure.......

Is it more cerebral? You decide.

 

[cfdavid]

So, is the best path to critical care medicine through a 1 year fellowship after anesthesia? I know the pulmonary guys also do a critical care residency (combinded).

Also, what kind of money (NO, It's NOT all I think about!!! lol) do those guys make? (CCM) To do that full time it seems like it would be a pay cut for an anesthesiologist to do CCM, no?

Another question is that, if you're part of a private anesthesia group supporting a hospital, and someone calls you for assistance (say in the ER or ICU), how do you bill?? It seems like it's "extra" from doing anesth in the OR.

Can one of the attendings/residents shed some light on these issues??
Thanks.

cf

 

[automaton]

people who are looking for "cerebral" things should not be in medicine. medicine basically strips away everything that smart people enjoy. like thinking about complex puzzles? wrong field. like science? wrong field. like coming up with new ideas? wrong field. like using creativity to advance your field or fatten your pocket? wrong field. medicine is a stupid intellectually numbing field. let's all admit this and move on.

 

[lvspro]

I was talking to an IM doc and his opinion was that critical care is not all that intellectually challenging. He said that the specialty to go into for cerebral challenge would be cardiology or nephrology. For those of you who practice CC, could you please comment on this. Thank you.

They're different but equal types of intellectual challenges, IMHO. IM-Specialties have to reason their way through pathophysiological challenges, as do CC physicians. The difference is in the timing. CC docs do a "faster" more "critical" type of thinking, that leaves a very small margin for error. The drawback to this, intellectually speaking, is that the depth of detail is'nt needed ( tubular vs villous vs tubulovillous ). What you do need is a PRACTICAL working knowledge of fast acting medicines, and the expertise to manage a team while using said medicines. IM-Specialties usually have more time to think about different details (such as above example) b/c the patient isn't necessarily crumping in front of you.
Since we are on an Anesthesiology forum, I have to throw in a shameless plug for CC. In CC, your not really limited to one organ system, as are many IM-Specialties. You know a ton of stuff about all the systems, and how to make them do what you want, when you want. IM-Specialists are pretty lost when you leave their organ system, or when their organ system starts failing quick. Cardiologists still call Anesthesiology when they're in deep water with a critical heart patient.
Just to set the record straight, since there has been some belligerence around here lately, specialists are smart and important, and I'm glad we have them. They know how to manage all the outpatient stuff that I'm not really in to, and I thank them for it.
Later

 

[ThinkFast007]

jsut a msiv

but from what i've seen.

Pulmonology/CCM doc--> take care of MICU pts

Anesthesiology/CCM doc---> takes care of SICU pts.

I've heard there is overlap sometimes, meaning Anesthesiologists may work in the MICU, but I've never heard about it the other way.

CCM always fascinated me, cuz yes you are an anesthesiologist (with all that acute care stuff)...but teh cool part I think is that you get that "i'm the patients actual doctor' feeling in CCM. From what I've seen, you get to have that close relationship with the pt's family etc as a CCM, which I totally dig.

 

[nitecap]

The anesthesiologist Intensivist I have worked with were great. They all loved there jobs claiming they got more out of it personally than being in the OR. They were compensated pretty well and all happy. They run the CT/Surg ICU's like a machine.

 

[AJM]

jsut a msiv

but from what i've seen.

Pulmonology/CCM doc--> take care of MICU pts

Anesthesiology/CCM doc---> takes care of SICU pts.

I've heard there is overlap sometimes, meaning Anesthesiologists may work in the MICU, but I've never heard about it the other way.

I know a number of pulmonologists who work in the SICU, and I also know several anesthesiolosists who work in the MICU. It goes both ways. But yes, for the most part pulmonologists stick with MICU patients and anesthesiologists stay with the SICU.

 

[militarymd]

So, is the best path to critical care medicine through a 1 year fellowship after anesthesia? I know the pulmonary guys also do a critical care residency (combinded).

Also, what kind of money (NO, It's NOT all I think about!!! lol) do those guys make? (CCM) To do that full time it seems like it would be a pay cut for an anesthesiologist to do CCM, no?

Another question is that, if you're part of a private anesthesia group supporting a hospital, and someone calls you for assistance (say in the ER or ICU), how do you bill?? It seems like it's "extra" from doing anesth in the OR.

Can one of the attendings/residents shed some light on these issues??
Thanks.

cf

Going from anesthesia into CCM is harder, I think, than via the other routes because the residency in anesthesia prepares you poorly to be a physician in the ccm sense. I felt that I was way behind the pulmonary fellows during the fellowship interms of depth of knowledge and thinking process, in the ccm sense.

You will make less if you do only ccm.

Billing can be a pain....currently I don't bill for ccm services I render...However, I gain a lot of polictical capital for being able to help out in the hospital.

Capital that is very useful when it comes to negotiations wiht the hosiptal.

 

[E'01]

The fact that you see quite a few double/triple boarded (at least at our hospital) physicians manning the ICU is a testament to the kind of knowledge base and expertise needed to successfully run a unit. The department head here studied anesthesiology, nephrology and critical care - and he's not the only one.

 

[supahfresh]

one of our ICU guys is boarded in medicine, anesthesia, and CCM, and has a PhD in math and physics.

 

[KluverBucy]

one of our ICU guys is boarded in medicine, anesthesia, and CCM, and has a PhD in math and physics.

yea, but is he smart?