Pulmonary and Critical Care Fellowship 2023-2024 Cycle

[imtopccm]

Thought I would go ahead and start the thread! Good luck!

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[imtopccm]

Did the application format change from last year? Limit on number of experiences along with the new “impactful experience” section?

 

[getfat]

Wow, time really flies! It seems like just yesterday I was anxiously discussing my residency application on this website.

 

[imtopccm]

Anyone get any direction from their program director on how many programs to apply to?

I have not asked. With them adding the regional preference now I wonder how different this application cycle will be from prior.

 

[Espressso]

Wow, time really flies! It seems like just yesterday I was anxiously discussing my residency application on this website.

Long time no see @getfat. I remember those days. Can't believe we're back at it.

 

[imtopccm]

Can anyone share/unlock last years pccm excel sheet?

 

[uishtiaq]

Can anyone share/unlock last years pccm excel sheet?

 

[Doctor Bob]

The APCCMPD (association of pulmonary and critical care medicine program directors) is again strongly recommending virtual interviews -only-.

I know that from an applicant point of view it's nice to be able to do a whole lot of interviews and not have to take much (if any) time off from residency. But it's just so difficult to really assess how good of a fit an applicant or a program would be with a virtual interview.

(sigh) If someone could go ahead and invent star trek style teleportation before the start of the interview season that would be really helpful.

 

[PorkChopSandwiches]

The APCCMPD (association of pulmonary and critical care medicine program directors) is again strongly recommending virtual interviews -only-.

I know that from an applicant point of view it's nice to be able to do a whole lot of interviews and not have to take much (if any) time off from residency. But it's just so difficult to really assess how good of a fit an applicant or a program would be with a virtual interview.

(sigh) If someone could go ahead and invent star trek style teleportation before the start of the interview season that would be really helpful.

I was sincerely hoping that by the end of my PGY-2 year we'd have been back to in-person. As the first class that went through virtual for fellowship it was very difficult to assess the true feel of the program over virtual meet & greets and happy hours. Would happily attend less interviews and spend more money traveling to them for that opportunity.

 

[getfat]

Hello everyone, I'm curious to hear your thoughts on geographic preferences. Some individuals have suggested that not having any preference is the optimal choice. However, I believe that having a compelling reason for selecting a specific region could prove beneficial. What are your thoughts on this matter?

 

[Espressso]

Hello everyone, I'm curious to hear your thoughts on geographic preferences. Some individuals have suggested that not having any preference is the optimal choice. However, I believe that having a compelling reason for selecting a specific region could prove beneficial. What are your thoughts on this matter?

I have geographical preferences, so I'm doing it. Granted, I have like three separate geographical preferences. And they're all legitimate . So I'm running with it. I think if you truly don't have them then don't fake one!

 

[Doctor Bob]

Hello everyone, I'm curious to hear your thoughts on geographic preferences. Some individuals have suggested that not having any preference is the optimal choice. However, I believe that having a compelling reason for selecting a specific region could prove beneficial. What are your thoughts on this matter?

If you don't have a tie to the area that's fine. If you have a strong tie to the area that's fine. But don't try to pretend like you have a strong tie to the area when you really don't.

It's way better to be honest and say you have no geographic preference and are applying broadly, than to give a real flimsy geographic draw. Avoid things like "My cousin lives an hour away from your program so I've been really interested in the area" or "My family took a vacation there when I was a kid and I've always wanted to return".

As with every question, just be honest. Don't try to give the answer you think I want to hear.

 

[Dr..]

Hey all, thanks for keeping this thread alive! Can someone provide feedback on the following questions?

1) Pros and cons of T32 programs
2) In the hometown section, can it be a place I have previously lived and have a strong sense of belonging to, but is not the "hometown" traditional definition.

 

[imtopccm]

Hey all, thanks for keeping this thread alive! Can someone provide feedback on the following questions?

1) Pros and cons of T32 programs
2) In the hometown section, can it be a place I have previously lived and have a strong sense of belonging to, but is not the "hometown" traditional definition.

Bouncing off your question, do you guys think putting a hometown at all leaves it as a potential "preference" when viewed by programs?

 

[getfat]

Hey all, thanks for keeping this thread alive! Can someone provide feedback on the following questions?

1) Pros and cons of T32 programs
2) In the hometown section, can it be a place I have previously lived and have a strong sense of belonging to, but is not the "hometown" traditional definition.

I put everywhere I lived at least a year.

 

[Showmetheinvites]

Excel link for this year's interview season. Includes a locked section of last year's program impressions.

May the odds be ever in your favor.

 

[Boson Kafir]

Hey all

As an old graduate applying for a critical care fellowship, I would like to know if there is a website where I can find a list of programs that sponsor visas ?

Thank you all in advance

 

[Showmetheinvites]

What are everyone's thoughts about applying to programs who have an "APP Critical Care Fellowship" or some other midlevel fellowship at the same hospital? Any concerns that they will prioritize the NPs/PAs over the physician fellows? Eg. Memorial Sloan Kettering, Duke, UNM, Orlando Health, etc.
Alternatively, anyone have any first hand experience with this and how it may or may not have an impact on fellow's education?

 

[miatadoc]

What are everyone's thoughts about applying to programs who have an "APP Critical Care Fellowship" or some other midlevel fellowship at the same hospital? Any concerns that they will prioritize the NPs/PAs over the physician fellows? Eg. Memorial Sloan Kettering, Duke, UNM, Orlando Health, etc.
Alternatively, anyone have any first hand experience with this and how it may or may not have an impact on fellow's education?

As someone who trained at such a site - the fellows get the "harder" cases and cases got moved to the NP service once they were stable so you could deal with the next disaster. It was one reason I wasn't thrilled about doing fellowship after seeing that as a resident - I didn't want to get walked over for three years." Mid-levels pan-consulted and patted themselves when their one-pressor sepsis made it out. Having taught residents as an attending - you give them the harder cases, cause you want them to learn, but also I know giving my mid-levels hard cases will just lead to more liability for me than having a strong intern/resident team pouring through the case.

I did speak with nursing/PD at a smaller community hospital with such a 'residency' and there was palpable friction between the residents and the NP. The NP 'resident' would carry 1-2 patients during the day then signout to the poor shmuck residents who had to cover the unit at night and for the weekend. Of course, easy to see why this was salt in the wounds. That hospital said they were 'working things out' between the two - not sure what that entails.

Nevertheless, I've had a few years to put on my big boy pants as a hospitalist covering several hospitals. This is the way CMGs manage patients. You WILL have a mid-level working with you at some point. Better to figure out how to handle them, build relations, and keep moving. Overt hostility won't pan out for us. The profession has sold out and with the lack of physician unity - sneering at mid-levels will just get you in trouble. No tears will be shed for the martyr.

As for logistics, the attendings would staff the resident/fellows service first then the mid-levels. Hence, rounds were damn early for the residents/interns/fellow. The attendings were engaged in teaching (large academic center). The mid-levels weren't in any of our morning reports, noon conferences, or didactics. Mid-levels just called anesthesia for the airway but did do their own lines from what I recall. Never recalled them 'competing' for our procedures. However, at the community program mentioned above, there was a struggle for procedures between the two.

At the end of the day - I need the fellowship to sit the boards to practice "board-certified" (unlike mid-levels lol). I'll get that through any accredited fellowship. Scrub out the years, sit the boards, and go back to work.

 

[Showmetheinvites]

As someone who trained at such a site - the fellows get the "harder" cases and cases got moved to the NP service once they were stable so you could deal with the next disaster. It was one reason I wasn't thrilled about doing fellowship after seeing that as a resident - I didn't want to get walked over for three years." Mid-levels pan-consulted and patted themselves when their one-pressor sepsis made it out. Having taught residents as an attending - you give them the harder cases, cause you want them to learn, but also I know giving my mid-levels hard cases will just lead to more liability for me than having a strong intern/resident team pouring through the case.

I did speak with nursing/PD at a smaller community hospital with such a 'residency' and there was palpable friction between the residents and the NP. The NP 'resident' would carry 1-2 patients during the day then signout to the poor shmuck residents who had to cover the unit at night and for the weekend. Of course, easy to see why this was salt in the wounds. That hospital said they were 'working things out' between the two - not sure what that entails.

Nevertheless, I've had a few years to put on my big boy pants as a hospitalist covering several hospitals. This is the way CMGs manage patients. You WILL have a mid-level working with you at some point. Better to figure out how to handle them, build relations, and keep moving. Overt hostility won't pan out for us. The profession has sold out and with the lack of physician unity - sneering at mid-levels will just get you in trouble. No tears will be shed for the martyr.

As for logistics, the attendings would staff the resident/fellows service first then the mid-levels. Hence, rounds were damn early for the residents/interns/fellow. The attendings were engaged in teaching (large academic center). The mid-levels weren't in any of our morning reports, noon conferences, or didactics. Mid-levels just called anesthesia for the airway but did do their own lines from what I recall. Never recalled them 'competing' for our procedures. However, as the program mentioned above, there was a struggle for procedures between the two.

At the end of the day - I need the fellowship to sit the boards to practice "board-certified" (unlike mid-levels lol). I'll get that through any accredited fellowship. Scrub out the years, sit the boards, and go back to work.

Thanks so much for your insight. I know that I will very likely be working with midlevels as an attending. I just don't want to compromise my education for them. Not to mention that it would be nice to get an easy "one pressor sepsis" win every once in a while, instead of just the really difficult cases. Also, I enjoy procedures (part of the allure of critical care) and don't want to fight for them all the time. With so many programs out there, it shouldn't be that difficult to at least avoid the APP fellowship associated programs.

 

[getfat]

What are everyone's thoughts about applying to programs who have an "APP Critical Care Fellowship" or some other midlevel fellowship at the same hospital? Any concerns that they will prioritize the NPs/PAs over the physician fellows? Eg. Memorial Sloan Kettering, Duke, UNM, Orlando Health, etc.
Alternatively, anyone have any first hand experience with this and how it may or may not have an impact on fellow's education?

My application isn't strong enough to be picky about programs. Midlevels aren't going anywhere. Gotta learn how to play nice in the sandbox and theres more than enough patients to go around.

 

[Espressso]

Is it RIP if I use my PCCM LORs to also apply to a few specific CCM programs? Would CCM programs expect LORs to be specifically CCM only? I have all my letters submitted thankfully. But they're all PCCM themed. My PS is PCCM. I'm debating if it's worth changing my PS a little to make a CCM version for a few specific programs. Overall, I'd much rather do PCCM but I understand that I want to match more than anything and my PD keeps saying it's smart to apply to CCM only too. I just don't know how to expect all my letter writers to now spend time writing another letter for CCM only.

 

[imtopccm]

Can someone here clarify:
- we can submit starting tomorrow but programs will not have access until July 19th?
- that means if I am still missing letters and as long as they are uploaded a week or so before 19th, the application will not appear delayed?

 

[uishtiaq]

In the impactful experience section, the question asks to describe any challenges or hardships that influenced your journey “to” residency. Can we mention any challenges or life altering experiences while being “in” residency as this is a fellowship application?

 

[Espressso]

Can someone here clarify:
- we can submit starting tomorrow but programs will not have access until July 19th?
- that means if I am still missing letters and as long as they are uploaded a week or so before 19th, the application will not appear delayed?

Yeah anything submitted before 7/19 I believe 9 AM EST will be time-stamped the same time/date. Anything after will be timestamped when submitted. So yes, you have until the 19th to get letters in and be complete.

In the impactful experience section, the question asks to describe any challenges or hardships that influenced your journey “to” residency. Can we mention any challenges or life altering experiences while being “in” residency as this is a fellowship application?

I would imagine so.

 

[Doctor Bob]

Bouncing off your question, do you guys think putting a hometown at all leaves it as a potential "preference" when viewed by programs?

It's just a conversation starter. "So I see you're from Mordor. Did your family ever take you to the Sea of Nurnen?"

Hey all

As an old graduate applying for a critical care fellowship, I would like to know if there is a website where I can find a list of programs that sponsor visas ?

Thank you all in advance

FREIDA still shows visa sponsorship. And you can sort by type of visa they sponsor.

What are everyone's thoughts about applying to programs who have an "APP Critical Care Fellowship" or some other midlevel fellowship at the same hospital? Any concerns that they will prioritize the NPs/PAs over the physician fellows? Eg. Memorial Sloan Kettering, Duke, UNM, Orlando Health, etc.
Alternatively, anyone have any first hand experience with this and how it may or may not have an impact on fellow's education?

I'm not sure I have enough space here to put my thoughts on this...
In general, I'm not a fan of having competing programs at one institution. No matter how much the program leadership tries to make it good for everyone, there will always be areas where one program detracts from another. It's why in the annual survey the ACGME asks whether or not you felt your education was impacted by the presence of other learners. And if programs have other learners interacting with their trainees, we have to explain how their educational expereince is affected.
If you look at the websites for the APP fellowships at those places, I guarantee that none of them say "as an APP trainee, you will only be taking care of the uncomplicated straight-forward patients, and doing the procedures on low-risk patients." So a place can try to minimize the effect... but it's there.

Is it RIP if I use my PCCM LORs to also apply to a few specific CCM programs? Would CCM programs expect LORs to be specifically CCM only? I have all my letters submitted thankfully. But they're all PCCM themed. My PS is PCCM. I'm debating if it's worth changing my PS a little to make a CCM version for a few specific programs. Overall, I'd much rather do PCCM but I understand that I want to match more than anything and my PD keeps saying it's smart to apply to CCM only too. I just don't know how to expect all my letter writers to now spend time writing another letter for CCM only.

It used to be that PCCM was the only route to do critical care. Then CCM came about as it's own standalone fellowship. Most CCM programs have you in the ICU more than PCCM programs. So if you want to have a career in the ICU, do a pure CCM fellowship. (I know, this isn't your question, but bear with me, I'm getting there). PCCM doesn't make you a better intensivist; there are just too many other things going on in the unit that aren't pulmonary related. And thinking that you'll do CCM for a few decades then "retire" to do pulm clinic is wishful thinking; both fields progress too quickly to stay up to date over the long haul. PCCM also found out what IM did when EM came along as it's own specialty... sure, an internist can work in an ED and take care of a lot of the stuff that comes through the door, but they weren't nearly as good as an EM doc at overall department management, the intensive EM stuff that people only get good at through repetition, and as the ED evolved the IM people were like "I didn't train for this" and burnout accelerated. PCCM is going through something similar now. The model of "round on your ICU patients in the morning then go to clinic" is slowly disappearing. Hospitals want the A+ leapfrog rating and having an in-house intensivist is part of that ranking. Sure... smaller hospitals still use that model because it's cost-efficient, but ICU telemed is expanding and ultimately if I can't get a doc physically at the bedside (because they're in clinic or a thousand miles away), then I might as well get the one who at least answers the call immediately. It may still take decades for the market to really shift (it took a long time for EM and that's the most recent equivalent we have).

If you want to do pulm clinic do a pulm fellowship. If you want to do ICU only, do a CCM fellowship. If you want to do both, be realistic about how good you will be at either relative to people who just focused on it. And realize that the market is changing; PCCM doesn't have the iron-lock on medical ICUs that it used to.

All of this is to say if you apply to a CCM-only program with PCCM letters I'm going to ask a lot of questions about what kind of practice you really see yourself having. And I'm going to assume I'm your backup plan.

Can someone here clarify:
- we can submit starting tomorrow but programs will not have access until July 19th?
- that means if I am still missing letters and as long as they are uploaded a week or so before 19th, the application will not appear delayed?

Yes. On July 19th I'm going to get a data-dump from ERAS. Everyone who has an application in the system before that point shows up to me as submitted on July 19th. It only starts differentiating by application date after that. Doesn't matter how many changes you make before the 19th.

In the impactful experience section, the question asks to describe any challenges or hardships that influenced your journey “to” residency. Can we mention any challenges or life altering experiences while being “in” residency as this is a fellowship application?

Yes, residency experiences are fine.

 

[Espressso]

It's just a conversation starter. "So I see you're from Mordor. Did your family ever take you to the Sea of Nurnen?"


FREIDA still shows visa sponsorship. And you can sort by type of visa they sponsor.


I'm not sure I have enough space here to put my thoughts on this...
In general, I'm not a fan of having competing programs at one institution. No matter how much the program leadership tries to make it good for everyone, there will always be areas where one program detracts from another. It's why in the annual survey the ACGME asks whether or not you felt your education was impacted by the presence of other learners. And if programs have other learners interacting with their trainees, we have to explain how their educational expereince is affected.
If you look at the websites for the APP fellowships at those places, I guarantee that none of them say "as an APP trainee, you will only be taking care of the uncomplicated straight-forward patients, and doing the procedures on low-risk patients." So a place can try to minimize the effect... but it's there.


It used to be that PCCM was the only route to do critical care. Then CCM came about as it's own standalone fellowship. Most CCM programs have you in the ICU more than PCCM programs. So if you want to have a career in the ICU, do a pure CCM fellowship. (I know, this isn't your question, but bear with me, I'm getting there). PCCM doesn't make you a better intensivist; there are just too many other things going on in the unit that aren't pulmonary related. And thinking that you'll do CCM for a few decades then "retire" to do pulm clinic is wishful thinking; both fields progress too quickly to stay up to date over the long haul. PCCM also found out what IM did when EM came along as it's own specialty... sure, an internist can work in an ED and take care of a lot of the stuff that comes through the door, but they weren't nearly as good as an EM doc at overall department management, the intensive EM stuff that people only get good at through repetition, and as the ED evolved the IM people were like "I didn't train for this" and burnout accelerated. PCCM is going through something similar now. The model of "round on your ICU patients in the morning then go to clinic" is slowly disappearing. Hospitals want the A+ leapfrog rating and having an in-house intensivist is part of that ranking. Sure... smaller hospitals still use that model because it's cost-efficient, but ICU telemed is expanding and ultimately if I can't get a doc physically at the bedside (because they're in clinic or a thousand miles away), then I might as well get the one who at least answers the call immediately. It may still take decades for the market to really shift (it took a long time for EM and that's the most recent equivalent we have).

If you want to do pulm clinic do a pulm fellowship. If you want to do ICU only, do a CCM fellowship. If you want to do both, be realistic about how good you will be at either relative to people who just focused on it. And realize that the market is changing; PCCM doesn't have the iron-lock on medical ICUs that it used to.

All of this is to say if you apply to a CCM-only program with PCCM letters I'm going to ask a lot of questions about what kind of practice you really see yourself having. And I'm going to assume I'm your backup plan.



Yes. On July 19th I'm going to get a data-dump from ERAS. Everyone who has an application in the system before that point shows up to me as submitted on July 19th. It only starts differentiating by application date after that. Doesn't matter how many changes you make before the 19th.



Yes, residency experiences are fine.

I really appreciate the thorough answer. My passion has been mostly CCM but then as training has gone on I've developed a strong interest in pulmonary medicine, to a point where I would like to pursue it as well. My mentors who are all PCCM trained have been pushing for this as well. Part of the older system as you speak of. Yet other mentors keep telling me to send some out to CCM only as well but I just don't see how feasible that is. Regardless, I appreciate the answer.

 

[Dominus]

Hi all, I am currently finishing my ERAS app and am struggling with the new experiences section. I have a few questions:

1. Is it okay to combine experiences under one heading? For example, I would have a GME committee experience were I then talk about the subcommittees I am on instead of separating them into different things. Likewise I would have a research experience were I talk about my ongoing projects. Also considering having a general "hobbies" experience.

2. What all should I be including from prior to medical school? I did work in the summers during college and I also did international volunteer work for several months before college. These are fairly distant events and don't necessarily tie into my application "narrative" so not sure if I should include them.

 

[chessknt]

I really appreciate the thorough answer. My passion has been mostly CCM but then as training has gone on I've developed a strong interest in pulmonary medicine, to a point where I would like to pursue it as well. My mentors who are all PCCM trained have been pushing for this as well. Part of the older system as you speak of. Yet other mentors keep telling me to send some out to CCM only as well but I just don't see how feasible that is. Regardless, I appreciate the answer.

One thing the academics might not get--pulm offers a crucial skillset that will be in demand for the foreseeable future (ie cannot be encroached upon by EM/surgery/anesthesia) and lets you do outpatient medicine. The option to do outpatient can separate you from hospital employment, offers business hours for family compatibility, and gives you a patient panel--in the increasingly hostile reimbursement environment this should not be overlooked. CCM pays well now but if trends continue as they are now I can see pulm (and many outpatient specialties) eventually surpassing it, keeping your options open for 1 extra year of training seems like a good deal to me.

 

[Espressso]

One thing the academics might not get--pulm offers a crucial skillset that will be in demand for the foreseeable future (ie cannot be encroached upon by EM/surgery/anesthesia) and lets you do outpatient medicine. The option to do outpatient can separate you from hospital employment, offers business hours for family compatibility, and gives you a patient panel--in the increasingly hostile reimbursement environment this should not be overlooked. CCM pays well now but if trends continue as they are now I can see pulm (and many outpatient specialties) eventually surpassing it, keeping your options open for 1 extra year of training seems like a good deal to me.

This sort of hits on multiple points of why I want the added training of pulm embedded into my fellowship.

 

[getfat]

Anybody else applying from a community program? Starting to realize that i'm at a bigger disadvantage then i realized and its becoming disheartening.

 

[Espressso]

Anybody else applying from a community program? Starting to realize that i'm at a bigger disadvantage then i realized and its becoming disheartening.

Same brother

 

[Doctor Bob]

Hi all, I am currently finishing my ERAS app and am struggling with the new experiences section. I have a few questions:

1. Is it okay to combine experiences under one heading? For example, I would have a GME committee experience were I then talk about the subcommittees I am on instead of separating them into different things. Likewise I would have a research experience were I talk about my ongoing projects. Also considering having a general "hobbies" experience.

2. What all should I be including from prior to medical school? I did work in the summers during college and I also did international volunteer work for several months before college. These are fairly distant events and don't necessarily tie into my application "narrative" so not sure if I should include them.

How you place things isn't as important as how succint it is. We're reading through hundreds of applications. The ERAS application isn't the place to write a paragraph to say one sentences worth of stuff.

Very little from before medical school will make a difference at this point.

Anybody else applying from a community program? Starting to realize that i'm at a bigger disadvantage then i realized and its becoming disheartening.

The name of a place is less important than what you did while you were there. Do lots of research, get involved with state and national committees, etc... and you can do those things from anywhere. I agree that big name academic places usually have the machinery in place to help you do those things with less effort.
Being at a small place, not known for academics can actually work to your benefit. If you do a lot of research and academic involvement, I know that the driving force behind those projects was you and it wasn't just that you made friends with a professor and helped out on a bunch of their ongoing projects. Both are good, but each scenario tells me a little something different.

 

[Showmetheinvites]

How you place things isn't as important as how succint it is. We're reading through hundreds of applications. The ERAS application isn't the place to write a paragraph to say one sentences worth of stuff.

So, less is more? If everything can be placed under one "experience type" seems like that might be better, than trying to find multiple things to put to have 10 different experiences?

These new questions are a pain.

 

[Dominus]

One other question: any thoughts on jobs during college era? I worked as a camp counselor/health care assistant during my summer breaks, not sure how relevant it is for fellowship at this stage. I am basically trying to figure out what to do with my last experiences category (college job vs elective rotations during residency).

 

[brownmencantjump]

Hey guys,

I am new to SDN, and applying this year to PCCM. This might be a silly question, but I was wondering which programs are considered the top PCCM programs in the country, just out of curiosity. Of course. I realize there are many different criteria, and each program has specific strengths and weaknesses but just generally speaking.

Also on a more personal note, I am wondering if anyone has had experience with going into PCCM after doing a neurocritical care fellowship. Does it make it harder or does it help your application. I suppose it would be important to indicate on your personal statement why you are pursing another fellowship, right?

 

[NewYorkDoctors]

Anybody else applying from a community program? Starting to realize that i'm at a bigger disadvantage then i realized and its becoming disheartening.

Hang in there and apply broadly. I’ve known many residents who were us IMG or fmg from community programs eventually get matched (whether in a second try or on a first try but while applying wide and far )

If you are limited by geography and can only be in nyc or LA then that might be a big handicap. Also be sure to apply to those few 2 year pulm only programs (as these were primarily select for those who are not AMGs from university academic IM residencies )

 

[Showmetheinvites]

What is everyone putting for significant experiences? I’m at 6 and honestly most are pretty weak …

 

[chessknt]

Hey guys,

I am new to SDN, and applying this year to PCCM. This might be a silly question, but I was wondering which programs are considered the top PCCM programs in the country, just out of curiosity. Of course. I realize there are many different criteria, and each program has specific strengths and weaknesses but just generally speaking.

Also on a more personal note, I am wondering if anyone has had experience with going into PCCM after doing a neurocritical care fellowship. Does it make it harder or does it help your application. I suppose it would be important to indicate on your personal statement why you are pursing another fellowship, right?

Don't do neuroCCM as an IM person, it makes no sense. It serves as a backdoor to a niche area for neuro and nsg who hate their primary speciality for some reason and that is it.

 

[brownmencantjump]

Don't do neuroCCM as an IM person, it makes no sense. It serves as a backdoor to a niche area for neuro and nsg who hate their primary speciality for some reason and that is it.

Thank you for getting back to me. I guess just to clarify I am asking what it would do to your application if you are already doing a neurocritical care fellowship and wanted to broaden your training. Do you think that will be a detrimental to the application? I mean the rationale is, as crazy as it is for some people to believe, I enjoy the challenge of treating ICU patients with neurological conditions but feel with my IM background doing PCCM will broaden my training and allow me to practice my passion that is NICU while at the same time not limit where I can work. Not sure if that makes sense

 

[chessknt]

Thank you for getting back to me. I guess just to clarify I am asking what it would do to your application if you are already doing a neurocritical care fellowship and wanted to broaden your training. Do you think that will be a detrimental to the application? I mean the rationale is, as crazy as it is for some people to believe, I enjoy the challenge of treating ICU patients with neurological conditions but feel with my IM background doing PCCM will broaden my training and allow me to practice my passion that is NICU while at the same time not limit where I can work. Not sure if that makes sense

There is no reason to do PCCM if you want to work in an academic neuro CC unit, just do neuro CC only if that is your goal. I am not a PD but my bias would instantly be that neuro CC was done because you couldn't get in to a CC/PCCM program since they are not competitive at all or that you had no idea what you were doing.

If you want to work everywhere do PCCM.

 

[sandwichelisa]

Anyone know when the last-ish interview dates are for most programs? Late October? Mid October?

 

[Showmetheinvites]

Late October as far as I know.

Good luck everyone!

 

[imtopccm]

How many places are people applying to on average?

 

[rrs3]

Only applying to about 30 programs, I refuse to venture out to middle of nowhere or somewhere where I don't want to be to pursue this. I'll just be a hospitalist if I don't get in.

 

[NSam]

It's just a conversation starter. "So I see you're from Mordor. Did your family ever take you to the Sea of Nurnen?"


FREIDA still shows visa sponsorship. And you can sort by type of visa they sponsor.


I'm not sure I have enough space here to put my thoughts on this...
In general, I'm not a fan of having competing programs at one institution. No matter how much the program leadership tries to make it good for everyone, there will always be areas where one program detracts from another. It's why in the annual survey the ACGME asks whether or not you felt your education was impacted by the presence of other learners. And if programs have other learners interacting with their trainees, we have to explain how their educational expereince is affected.
If you look at the websites for the APP fellowships at those places, I guarantee that none of them say "as an APP trainee, you will only be taking care of the uncomplicated straight-forward patients, and doing the procedures on low-risk patients." So a place can try to minimize the effect... but it's there.


It used to be that PCCM was the only route to do critical care. Then CCM came about as it's own standalone fellowship. Most CCM programs have you in the ICU more than PCCM programs. So if you want to have a career in the ICU, do a pure CCM fellowship. (I know, this isn't your question, but bear with me, I'm getting there). PCCM doesn't make you a better intensivist; there are just too many other things going on in the unit that aren't pulmonary related. And thinking that you'll do CCM for a few decades then "retire" to do pulm clinic is wishful thinking; both fields progress too quickly to stay up to date over the long haul. PCCM also found out what IM did when EM came along as it's own specialty... sure, an internist can work in an ED and take care of a lot of the stuff that comes through the door, but they weren't nearly as good as an EM doc at overall department management, the intensive EM stuff that people only get good at through repetition, and as the ED evolved the IM people were like "I didn't train for this" and burnout accelerated. PCCM is going through something similar now. The model of "round on your ICU patients in the morning then go to clinic" is slowly disappearing. Hospitals want the A+ leapfrog rating and having an in-house intensivist is part of that ranking. Sure... smaller hospitals still use that model because it's cost-efficient, but ICU telemed is expanding and ultimately if I can't get a doc physically at the bedside (because they're in clinic or a thousand miles away), then I might as well get the one who at least answers the call immediately. It may still take decades for the market to really shift (it took a long time for EM and that's the most recent equivalent we have).

If you want to do pulm clinic do a pulm fellowship. If you want to do ICU only, do a CCM fellowship. If you want to do both, be realistic about how good you will be at either relative to people who just focused on it. And realize that the market is changing; PCCM doesn't have the iron-lock on medical ICUs that it used to.

All of this is to say if you apply to a CCM-only program with PCCM letters I'm going to ask a lot of questions about what kind of practice you really see yourself having. And I'm going to assume I'm your backup plan.



Yes. On July 19th I'm going to get a data-dump from ERAS. Everyone who has an application in the system before that point shows up to me as submitted on July 19th. It only starts differentiating by application date after that. Doesn't matter how many changes you make before the 19th.



Yes, residency experiences are fine.

Question - I already submitted but if i edited sometime today to make a small modification on one of the experiences - would programs see a different time stamp or would it just be July 19? Wasnt sure if its just dated or dated AND timestamped

 

[miatadoc]

Non-traditional candidate. Applying to 70. Excluding those who have Cerner, Meditech, or Allscripts - because it is straight trash.

 

[Doctor Bob]

Question - I already submitted but if i edited sometime today to make a small modification on one of the experiences - would programs see a different time stamp or would it just be July 19? Wasnt sure if its just dated or dated AND timestamped

It shows me "most recent application status date". So an adjustment today would show up as 7/19.

Non-traditional candidate. Applying to 70. Excluding those who have Cerner, Meditech, or Allscripts - because it is straight trash.

Hehehe... I agree that Meditech and Allscripts are trash.
Cerner is... institution dependent. Same with Epic. They're both very very customizable so the quality of the EMR is very much dependent on how much time/money your institution puts into making it useful and functional. Cerner and Epic off the shelf are pretty lousy. But the institution can also go overboard putting in alerts and notifications and soon it's like a strobe light every time you log in.

 

[getfat]

Non-traditional candidate. Applying to 70. Excluding those who have Cerner, Meditech, or Allscripts - because it is straight trash.

I'm using epic right now for an outside rotation. Its so confusing haha. theres too many options. Maybe i'm just so engrained to using the old stuff i'm not used to it.

 

[getfat]

Apps are visible ! The waiting game begins! 👀