Paths to CCM: IM vs EM vs Gas vs Surg ???

[chmd]

You should consider the anesthesia/im combined pathways. 5 years total plus one for crit care, add an extra year for ct anesthesia and be a total bad ass.

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[Petypet]

Thank you very much for all your helpful responses; this discussion has been very useful so far.

I'd like to do very basic research; X-ray crystallography, NMR, and molecular dynamics simulations of RNA complexes involved in epigenetic regulation. My PhD work is very disease agnostic, and can be taken in the direction of neuroscience, immunology, cancer, infectious disease, etc. I have an engineering background, and find the physiology in the ICU appealing (as well as the diverse organ systems). All of the physician scientists I know in this field are internists doing at least 80% research. I know a few anesthesiologists doing work at a comparably basic level, but with a different focus. I don't know of a single surgeon or EM physician who is doing that sort of work, which is why I've assumed that those routes aren't feasible.

However, if I weren't going to be a scientist, my ideal career would be a trauma/CC surgeon splitting time between the OR and ICU (which would also be my ideal role on a deployment with the reserves). Since I know surgery doesn't work with my basic science interests, my ideal "compromise" would be to find another clinical specialty that at least lets me work in the ICU (MICU may actually be more appealing than SICU if not a surgeon), while having a civilian job with 80% research.

As for the reserves: if I'm not a surgeon, I'll be happy to take on whatever role in which I can to contribute the most, whether critical care or anesthesia (if I go that route).

Not that I totally belong here since I am just an MS2, but I did complete my PhD prior to med school. My mentor is a trauma/CC surgeon that does the typical 1 week in ICU, 1 week on the floor, and really 1 week admin work. He is in a large community hospital and does about 20% research, and runs a team of trauma surgeons with a dedicated research staff. Further, I attended academic surgical congress conference and I was happily surprised about the level of basic science research being done in surg/CC. It exists and it is becoming more and more commonplace. There are 2 groups of work, clinical work like I am currently doing at a non-academic center, and bench work done across the street at the ivory tower.

Further, I proposed the idea in the EM forums, and was told that basic/clinical research is up and coming. Further conversations with several faculty at the ivory-towers EM program said they are looking for faculty that do 80% research, 20% clinical. Seems like now is a great time for EM/Surg/CC research type jobs.

 

[jdh71]

Thank you very much for all your helpful responses; this discussion has been very useful so far.

I'd like to do very basic research; X-ray crystallography, NMR, and molecular dynamics simulations of RNA complexes involved in epigenetic regulation. My PhD work is very disease agnostic, and can be taken in the direction of neuroscience, immunology, cancer, infectious disease, etc. I have an engineering background, and find the physiology in the ICU appealing (as well as the diverse organ systems). All of the physician scientists I know in this field are internists doing at least 80% research. I know a few anesthesiologists doing work at a comparably basic level, but with a different focus. I don't know of a single surgeon or EM physician who is doing that sort of work, which is why I've assumed that those routes aren't feasible.

However, if I weren't going to be a scientist, my ideal career would be a trauma/CC surgeon splitting time between the OR and ICU (which would also be my ideal role on a deployment with the reserves). Since I know surgery doesn't work with my basic science interests, my ideal "compromise" would be to find another clinical specialty that at least lets me work in the ICU (MICU may actually be more appealing than SICU if not a surgeon), while having a civilian job with 80% research.

As for the reserves: if I'm not a surgeon, I'll be happy to take on whatever role in which I can to contribute the most, whether critical care or anesthesia (if I go that route).

You sound like a surgeon. Start looking for programs that have surgeons looking into critical care basic science. A place like Stanford would be perfect for a guy like you.

 

[friedtomato]

Thanks for your reply; I've spent the past month reading up more on the possibility of doing surgery + basic science. If I could pull that off well, I would love to. However, when I critically think about the time it takes to produce (hopefully) high impact basic science, I'm not sure I could do that for less than 60-70 hours per week in the lab, plus more reading, programming, and writing at home.

I'll keep looking into the surgery route since that's the specialty most appealing to me from a purely clinical standpoint. But from a holistic perspective that takes research into account, IM or anesthesia + CC probably makes more sense. It sounds like it would be possible to work one or two weeks in the ICU every couple months, and spend the rest of the time in lab.

In that case, would doing IM + CC without pulm make sense? My non-ICU time would be spent in the lab and I have little interest in doing pulm clinic, but is the pulm fellowship still necessary to learn airway/vent skills for the ICU?

 

[todds]

From what I've gathered through SICU rotations during med school and interacting with surgery staff in the multidiscipline ICUs during my IM residency is that the Surgeons who did research as well have very narrow surgical practice. This makes them lose quite of bit of skill in other areas. They do take trauma call. To do CC, Surgery plus run a lab, well something will give it seems.

I was thinking about doing a research career as well at one point but it seems very difficult even nowadays to practice one specialty and run a lab let alone practice two and run a lab. Being involved in clinical research would seem more doable.

 

[jdh71]

Thanks for your reply; I've spent the past month reading up more on the possibility of doing surgery + basic science. If I could pull that off well, I would love to. However, when I critically think about the time it takes to produce (hopefully) high impact basic science, I'm not sure I could do that for less than 60-70 hours per week in the lab, plus more reading, programming, and writing at home.

I'll keep looking into the surgery route since that's the specialty most appealing to me from a purely clinical standpoint. But from a holistic perspective that takes research into account, IM or anesthesia + CC probably makes more sense. It sounds like it would be possible to work one or two weeks in the ICU every couple months, and spend the rest of the time in lab.

In that case, would doing IM + CC without pulm make sense? My non-ICU time would be spent in the lab and I have little interest in doing pulm clinic, but is the pulm fellowship still necessary to learn airway/vent skills for the ICU?

No. You don't need Pulm to learn the vent. Pulm won't necessarily give you airway experience either.

(I do think that Pulm does help me think around corners on the vent better. My bias.)