Pulm/cc for adults and peds possible?

[kellen914]

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hello SDN, hope all is well, and feel free to move this if it's in a bad location..

I'm interested in pulm/CC currently, but recently did peds, and enjoyed that as well. I was wondering what would be the pathway to do both adult and peds in pulm/CC?

If I got certified in IM then did pulm cc would I be able to deal with kids? (Above neonates)

Do you have to do a pulm/cc fellowships specific for adult and peds, or can you do an IM/peds residency followed with a general pulm/cc specialty?

 

[Rutgers06]

hello SDN, hope all is well, and feel free to move this if it's in a bad location..

I'm interested in pulm/CC currently, but recently did peds, and enjoyed that as well. I was wondering what would be the pathway to do both adult and peds in pulm/CC?

If I got certified in IM then did pulm cc would I be able to deal with kids? (Above neonates)

Do you have to do a pulm/cc fellowships specific for adult and peds, or can you do an IM/peds residency followed with a general pulm/cc specialty?

If you want to do pulm/CC for both peds and adults, you would need to do med-peds (4 years) and then do a combined adult/peds fellowship (usually another 5-6 years). If you drop the pulm part and want to just do critical care for peds and adults, then there are some combined fellowships that are 4 years. You can't deal with kids if you only do IM.

 

[michigangirl]

As Rutgers said, need to do med-peds followed by PICU fellowship and also pulm CC fellowship-- at least 6 years. So 10-11 years of training. A bit unique of a path, I don't know anyone who actively practices both adult CCM and peds CCM but I'm sure there's someone out there. Need to keep in mind how feasible it would be to straddle two departments and faculty groups. I think it's best to choose one and go with it, or do med-peds and decide which ICU you'd rather be in if ccm is your passion. Having IM skills definitely is an asset for the PICU. Many of my colleagues are med peds trained.

 

[Stitch]

Just to echo the others, it's best to pick one. IM/Peds people are excellently trained and those skills will apply no matter what you end up doing. The extra year is not 'wasted' in any way. But PICU and MICU are pretty different. Physiology is physiology, but diseases, outcomes and even interventions are pretty different between the two. Peds pulm is a separate 3 year fellowship, whereas adults often co train, so you'd need to decide which one you want to do. Even within PICU, many are now requiring extra training to take care of hearts because the physiology and patients can be quite different. Better to pick one and truly master it than try to straddle different worlds.

 

[kellen914]

As Rutgers said, need to do med-peds followed by PICU fellowship and also pulm CC fellowship-- at least 6 years. So 10-11 years of training. A bit unique of a path, I don't know anyone who actively practices both adult CCM and peds CCM but I'm sure there's someone out there. Need to keep in mind how feasible it would be to straddle two departments and faculty groups. I think it's best to choose one and go with it, or do med-peds and decide which ICU you'd rather be in if ccm is your passion. Having IM skills definitely is an asset for the PICU. Many of my colleagues are med peds trained.

Thanks for the help all. People that do med/peds to just PICU, do they end up never seeing adults? Or people that do MICU never end up seeing kids after? Or do these physicians somehow continue to practice their combined training

 

[Stitch]

I can't say that 'no one' does it, but I think it would be very difficult. PICU is a full time job, as is MICU. And as I mentioned both have very different populations and diseases. There's certainly some overlap, and PICUs do take care of 18-21 year olds, but that's pretty different than taking care of a COPD patient or one with bad coronary artery disease.
I have seen some people do med/peds--> pediatric cardiology fellowship then take care of adults with congenital heart disease. This is a population that is only now just living long enough to require care as adults, and many IM/MICU people are not experienced taking care of Fontan physiology/single ventricle stuff (just one example). Perhaps a similar example would be cystic fibrosis and pediatric pulmonology. They are generally living long enough to need adult care, but often stay in the care of peds people.

 

[michigangirl]

That's the cool thing about peds subspecialties. Almost all of us have the opportunity to take care of young adults (18-22) frequently during our careers. The advantage of age heterogeneity. Can't say the same thing for medicine taking care of kids.

 

[m081216]

With all due respect to the other posters, it is entirely possible to do Pulm/CCM and PICU, and has been done several times by physicians through University of Chicago and University of Pittsburgh, among other places.

You would first have to do a residency in Med-Peds. This is a 4-year residency, which is not a bad deal when you consider that either IM or Peds by itself take 3 years each. Moreover, you can technically do a Med-Peds "chief" year during your fourth and final year of training.

Afterwards, you have to decide how badly you want to train in Pulmonology. If you're primarily interested in becoming an intensivist, you can pursue training in MICU-PICU over 4 years, and there are some programs that will compensate you as an attending during the fourth and final year of training. To be fair, these "combined" fellowships have to be arranged outside of the match, but there is definitely a precedent for such training, and others have pursued it. If you're interested in Pulm/CCM-PICU, there are 5-6 year programs, but this is also negotiable.

I also disagree that you "have to pick one". Becoming a combined MICU-PICU or Pulm/CCM-PICU physician will pose some additional challenges in terms of finding employment after completing your training, but you will also be highly sought after by large academic programs because of your unique training. Moreover, there is A LOT of overlap between MICU and PICU pathology and physiology, but they are also unique in certain ways, and I think the differences on either side will help make you a more effective physician overall, and give you unique insight into ICU care relative to your MICU or PICU only counterparts.

Feel free to PM me if you have any questions. I am currently pursuing combined training, so I may be helpful.

 

[michigangirl]

m081216 that's great to hear! Thanks for posting and hopefully OP can gain helpful insights from you. Welcome to the forum! Are you currently training as Pulm/CCM-PICU? Where in the process are you? Would be very helpful information for all med studs/trainees out there investigating their options.

 

[Cytarabine]

In case it's helpful, list of combined fellowships

http://www.medpeds.org/residents/fellowship-guide/#pulmonology