Medicine vs Anesthesia CCM for EM trained

Discussion in 'Critical Care' started by sonofva, Dec 21, 2016.

  1. SDN is made possible through member donations, sponsorships, and our volunteers. Learn about SDN's nonprofit mission.
  1. sonofva

    sonofva 7+ Year Member

    987
    276
    Aug 31, 2009
    I listed something similar in the em forum. Just want to get some opinions from you guys as to which fellowship an EM trained physician would be a better fit/get the most out of. Which would offer better carry over to someone trying to have a career focusing more on ed resuscitation? IM vs anesthesia ccm? Thanks!

    Sent from my SM-G930V using SDN mobile
     
  2. SDN Members don't see this ad. About the ads.
  3. Doctor Bob

    Doctor Bob EM/CC 7+ Year Member

    If your focus is ED resuscitation, one could argue you don't need a CCM fellowship
    But if you want to do one, anesthesia would be better.
     
  4. sonofva

    sonofva 7+ Year Member

    987
    276
    Aug 31, 2009
    Thanks for the input! I plan on doing split practice down the road, i just want to get the most carry over into the ed. Could you clarify as to why anesthesia, if you dont mind?

    Sent from my SM-G930V using SDN mobile
     
  5. psychbender

    psychbender Cynical Member 10+ Year Member

    If you ever plan on taking an academic job, where you may want to supervise IM residents in a MICU, do an ABIM-based fellowship. When I was interviewing last year, and spoke with some of the EM applicants, that was a big motivator for some in choosing an IM fellowship over the anesthesiology ones. If you're more of a Surgical/Trauma ICU, Burn ICU, Neuro ICU, Cardiac ICU fan, then maybe the anesthesiology fellowships, which tend to focus more time in these units, would be a better fit. Ultimately, should you put in the effort needed, any route to CCM should teach you what you need to become a competent intensivist.
     
    sonofva likes this.
  6. Doctor Bob

    Doctor Bob EM/CC 7+ Year Member

    IM loves going into the weeds looking at the minutae of vasculitides, blood smears, spun urine, etc, etc, etc. Stuff that really isn't relevant in the ED.
    Anesthesia is good at the acute resuscitation of hemodynamically unstable patients (usually because someone's cutting on their belly).
    But yes, as @psychbender said, it more gets back to what your long term interest is and where you think you'd want do spend your ICU time.
     
    sonofva likes this.
  7. CCM2017

    CCM2017

    37
    29
    Oct 11, 2016
    There are several multidisciplinary CCM fellowships, UPMC and SLU come to mind, that I think will serve you well. Many fellowships will train you to become a SICU doctor or a MICU doctor but a multidisciplinary fellowship will give you well rounded training with rotations in a variety of ICU settings. Also, I would argue that many community NeuroICU, SICU, Burn, and Cardiac ICUs are managed by IM trained intensivists.

    I think being trained in a multidisciplinary fellowship will be very valuable to an EM doc.
     
    Nash, Hamhock and sonofva like this.
  8. mochief2000

    mochief2000 10+ Year Member

    158
    10
    Jul 8, 2004
    timbuktu
    i personally think you would be better fitted with going to a IM based CC fellowship. My reasons are, 1. all critical care fellowships will teach you how to manage a hemodynamically unstable patients (or they are not that good to begin with) 2. My SICU (anesthesia based) counterparts can't cover the MICU, but our MICU attending can teach in the SICU at my institution.

    i have more reasons but thats they fall into the who got the bigger **** category which is all subjective.
     
  9. Doctor Bob

    Doctor Bob EM/CC 7+ Year Member

    This is not the case at most places
     
    AdmiralChz likes this.
  10. mochief2000

    mochief2000 10+ Year Member

    158
    10
    Jul 8, 2004
    timbuktu
    which part? You can cover the MICU? or we cannot cover the SICU?
     
  11. psychbender

    psychbender Cynical Member 10+ Year Member

    I've heard of anesthesiologist-intensivists covering MICUs, but not at academic centers that train internists because of the ABIM rule that they can only be trained by ABIM-boarded doctors. I have, though, seen IM-intensivists cover SICUs, as the ACS and ABA have no such rule. Again, if you're a Emergency physician that wants to be able to cover an academic MICU, do an ABIM fellowship. If you are sure you want to stick to community hospitals or more surgical ICUs, then you can go with an ABA program.
     
    mochief2000 likes this.
  12. pulmoblast

    pulmoblast 2+ Year Member

    252
    218
    Oct 17, 2014
    If your ultimate aim is to do Critical Care only, do IM-CC. Having said that ED-CC, Anes-CC or IM-PCC give you flexibility of practice and an alternate lifestyle.

    Doing only CC all the time WILL become a sap on your life once you do it for a few years


    Sent from my iPhone using SDN mobile app
     
  13. Doctor Bob

    Doctor Bob EM/CC 7+ Year Member

    Pulm/CC generally does not staff a SICU.
    But, really, anesthesia/surg doesn't belong in a MICU either.

    It's not to say that they both can't do it.. but they probably shouldn't... in an academic setting. Surgeons and anesthesiologists are the best trained to teach about the operative and perioperative management of patients; IM docs are the best trained to teach about the sick medical patient. Both can care for patients, but they'll each be better teachers in their respective fields.
     
  14. mochief2000

    mochief2000 10+ Year Member

    158
    10
    Jul 8, 2004
    timbuktu
    It's not to say that they both can't do it.. but they probably shouldn't... in an academic setting. Surgeons and anesthesiologists are the best trained to teach about the operative and perioperative management of patients; IM docs are the best trained to teach about the sick medical patient. Both can care for patients, but they'll each be better teachers in their respective fields.[/QUOTE]

    i can agree on that.
     
  15. physicsnerd42

    physicsnerd42 Member 10+ Year Member

    855
    37
    Feb 25, 2006
    I'm not sure that's true. I'm at Stanford and only had anesthesia-trained intensivists (well, I guess one of them did medicine and crit care fellowship prior to anesthesia) as attendings when I was in the MICU. The MICU attendings are probably 45% anesthesia, 45% medicine and 10% EM background. The SICU attendings are anesthesia, surgery and a couple of medicine. The CVICU is almost entirely anesthesia with a couple of medicine attendings. The resident teams are all combos of anes, EM, IM in the MICU. We have IM, anes, EM and neuro trained critical care fellows.
     
  16. G-Man82

    G-Man82 10+ Year Member

    369
    154
    May 16, 2005
    The Southeast
    Physician
    I work in academics as an anesthesia-trained intensivist. While my unit is primarily surgical, we admit a lot of medical overflow patients because we just don't have enough medical beds in the hospital. Those medical patients do leave my icu in one way or the other, with some actually leaving alive!


    Sent from my iPhone using SDN mobile
     
    Infexious likes this.
  17. jdh71

    jdh71 epiphany at nine thousand six hundred feet 10+ Year Member

    60,109
    30,138
    Dec 14, 2006
    FEMA Camp, USA
    Physician
    You'll get good at what you do and see after a critical care fellowship which will make you competent to pick up what you need to on the job. I think an IM fellowship would be much more broad based training, this is based on my experience managing SICU patients both in fellowship and now as an attending physician. But these days, and who knows maybe I'll change my mind on this some day, but if you can get away with a shorter fellowship and I think you can coming out of the ED (because a decent amount of IM-CC is getting IM trained folks, which isn't a terribly hyper-acute focused specialty comfortable doing things and managing things that are). I recommend doing the gas fellowship. Then go make money. You'll pick up the rest at your new job.
     
    AdmiralChz likes this.

Share This Page