Question for anesthesia trained CC

[docr3]

Hi all,

Entering medical school in august, and have been interested in anesthesia for years. Recently had a transformative experience in the ICU with my father whose life was saved by the amazing ICU staff(thank you all for your service) this experience has really inspired me to pursue critical care medicine after anesthesia. My question is(may be a stupid one), as an ICU physician, do you basically never do any OR work and exclusively work as an Intensivisit, or is it a possibility to do both OR cases and Work in the ICU? Sorry if this is a dumb question

---

Members don't see this ad.

 

[tartesos]

Give it some time.... like a few years.

You can do both or time and Icu time as specialist depending on where you are btw. As much or as little as you want to depending on the practice/hospital/group you end up, just rarely the same day.


Sent from my iPhone using SDN mobile

 

[psychbender]

I think the majority of Anes/CC grads end up doing both in academic hospitals. Some do both in non-academic hospitals (that's where I'm headed), some just to CC, and others go back to the OR exclusively. A lot depends on what you intend to get out of fellowship, what kinds of practices you are willing to entertain (solo cases vs supervision/direction in the OR; teaching vs NP/PA service vs solo in the ICU) and what is available when/where you want to work.

 

[deleted547339]

Most of the anesthesia trained CCM folks where I practice do 50:50. About half work SICU and about half cticu.

 

[CCM-MD]

A lot of the anesthesia critical care physicians I know work only in the OR. I know of one that exclusively does eICU work only.

 

[spacegun]

Hi all,

Entering medical school in august, and have been interested in anesthesia for years. Recently had a transformative experience in the ICU with my father whose life was saved by the amazing ICU staff(thank you all for your service) this experience has really inspired me to pursue critical care medicine after anesthesia. My question is(may be a stupid one), as an ICU physician, do you basically never do any OR work and exclusively work as an Intensivisit, or is it a possibility to do both OR cases and Work in the ICU? Sorry if this is a dumb question

Just a med student here. I've heard a lot of anesthesia/CCM tend to work in the SICU or sometimes CTICU rather than other ICU's like the MICU. Different patient populations and pathologies in each of these different units, though there's some overlap too. If you have a preference for certain patients or pathologies, then you might prefer to do a different base specialty than anesthesia. For example, if you want to work with MICU patients (e.g. ARDS sepsis) then you might want to do IM, then pulm/CCM (or ID then CCM, neph then CCM, etc.). Or if you really like dealing with ischemic strokes, subarachnoid and intracerebral hemorrhages, TBIs, then you might want to do neurology then neurocritical care. If you like kids, then pediatrics has the NICU and also PICU. Just throwing out some other options for you.

 

[bigdan]

I did anesthesiology and CCM training.

I do 7 days CTICU/mo, with the remaining 3w/mo in the ORs.

 

[CUBR]

8 to 12 weeks in the ICU a year, the rest in the OR's.

 

[pocafx]

can anesthesia ccm. work in the micu and how often des that happen?

 

[psychbender]

can anesthesia ccm. work in the micu and how often des that happen?

Academic MICU, or community general ICU? I'm working in the OR and a mixed population med-surg ICU post-fellowship (anesthesia). I have heard of other anesthesiology trained intensivists working in non-academic MICUs. I'd say the majority of our small pool, though, stick to our surgical roots.

Sent from my SM-G930V using SDN mobile

 

[pocafx]

Either or. Didnt know the rules or training differences in the icu's

 

[icuanesthesiology]

can anesthesia ccm. work in the micu and how often des that happen?

I am an anesthesiology trained ICU doc. I do 100% ICU. I work in a community tertiary care hospital. We have an 80 bed ICU. We have a trauma ICU service and the MICU ICU service. The trauma ICU docs only see their trauma patients, and we see the rest...70% MICU, the rest SICU, neuro and CTICU/CVICU patients. In general once we are consulted the general surgeons and CT surgeons pretty much let us run the show. They would rather be operating. In private practice, the MICU "service" usually sees all kinds of patients. Our practice is mostly IM/CCM trained, but there are a couple of us who are anesthesia trained.
As ICU has changed to 24 hour in house coverage, there are more private practice jobs for anesthesia trained ICU docs. Most private practice set ups are not regimented ICUs like in academics. I love the variety of seeing all the different kinds of patients. If there is a patient with some weird pulmonary disease like lymphangioleiomyomatosis I ask the other docs I work with for advice, if there is an airway issue they ask me for advice. We all have our strengths and weaknesses, and we all help each other out. We are all ICU docs though, no matter the background.
When you train in fellowship, train to be an intensivist...not a neuro intensivist or a cardiothoracic surgical intensivist, etc. If that is what you ultimately want to do, get a job in academics after a broad based fellowship and specialize then. You may be surprised how much your interests change over time.

 

[CCM-MD]

I am an anesthesiology trained ICU doc. I do 100% ICU. I work in a community tertiary care hospital. We have an 80 bed ICU. We have a trauma ICU service and the MICU ICU service. The trauma ICU docs only see their trauma patients, and we see the rest...70% MICU, the rest SICU, neuro and CTICU/CVICU patients. In general once we are consulted the general surgeons and CT surgeons pretty much let us run the show. They would rather be operating. In private practice, the MICU "service" usually sees all kinds of patients. Our practice is mostly IM/CCM trained, but there are a couple of us who are anesthesia trained.
As ICU has changed to 24 hour in house coverage, there are more private practice jobs for anesthesia trained ICU docs. Most private practice set ups are not regimented ICUs like in academics. I love the variety of seeing all the different kinds of patients. If there is a patient with some weird pulmonary disease like lymphangioleiomyomatosis I ask the other docs I work with for advice, if there is an airway issue they ask me for advice. We all have our strengths and weaknesses, and we all help each other out. We are all ICU docs though, no matter the background.
When you train in fellowship, train to be an intensivist...not a neuro intensivist or a cardiothoracic surgical intensivist, etc. If that is what you ultimately want to do, get a job in academics after a broad based fellowship and specialize then. You may be surprised how much your interests change over time.

This is similar to how things are where I am. I wondered if we worked in the same place for a second but we don't have an anesthesiology/ICU docs. 100% agree that a broad fellowship is key otherwise you may not feel comfortable with certain groups of patients. I also think that going to a place that lets you be THE fellow in various ICUs is key. Be careful of fellowships where the "MICU" fellow just hangs out on the side, doesn't have much responsibility during his Trauma/SICU month and the trauma/CC fellow does everything and has all the responsibility. You need to be making (some) decisions under the supervision of an attending and be responsible for the unit to really learn.

 

[spacegun]

I am an anesthesiology trained ICU doc. I do 100% ICU. I work in a community tertiary care hospital. We have an 80 bed ICU. We have a trauma ICU service and the MICU ICU service. The trauma ICU docs only see their trauma patients, and we see the rest...70% MICU, the rest SICU, neuro and CTICU/CVICU patients. In general once we are consulted the general surgeons and CT surgeons pretty much let us run the show. They would rather be operating. In private practice, the MICU "service" usually sees all kinds of patients. Our practice is mostly IM/CCM trained, but there are a couple of us who are anesthesia trained.
As ICU has changed to 24 hour in house coverage, there are more private practice jobs for anesthesia trained ICU docs. Most private practice set ups are not regimented ICUs like in academics. I love the variety of seeing all the different kinds of patients. If there is a patient with some weird pulmonary disease like lymphangioleiomyomatosis I ask the other docs I work with for advice, if there is an airway issue they ask me for advice. We all have our strengths and weaknesses, and we all help each other out. We are all ICU docs though, no matter the background.
When you train in fellowship, train to be an intensivist...not a neuro intensivist or a cardiothoracic surgical intensivist, etc. If that is what you ultimately want to do, get a job in academics after a broad based fellowship and specialize then. You may be surprised how much your interests change over time.

Thanks for this! If you don't mind saying, why did you pick anesthesiology vs. IM (or another specialty) as your base specialty for critical care medicine? I know in the end everyone gets there (critical care), but interested in your thoughts here.

 

[icuanesthesiology]

Thanks for this! If you don't mind saying, why did you pick anesthesiology vs. IM (or another specialty) as your base specialty for critical care medicine? I know in the end everyone gets there (critical care), but interested in your thoughts here.

I started out in general surgery, I did not want to do medicine. EM/ICU at the time had not really gotten started, and I did not want to deal with the primary care side of EM anyways. When switching from gen surg to anesthesiology, I did not realize at the time that I would do an icu fellowship. It was certainly on the list, but I was also interested in cardiac and general anesthesiology. When choosing a base specialty, I tried to imagine myself performing the job if I did not do a fellowship. I would have been happy doing general anesthesiology, but I did not know if I would be happy doing general medicine. My advice to people choosing a residency is do not base your choice on only a future fellowship. You may not match, a spouse may be tired of your training, you may be tired of being broke...you just never know. If you can't stand the residency, you likely should't do the residency just to get into a fellowship.

 

[G-Man82]

Just a med student here. I've heard a lot of anesthesia/CCM tend to work in the SICU or sometimes CTICU rather than other ICU's like the MICU. Different patient populations and pathologies in each of these different units, though there's some overlap too. If you have a preference for certain patients or pathologies, then you might prefer to do a different base specialty than anesthesia. For example, if you want to work with MICU patients (e.g. ARDS sepsis) then you might want to do IM, then pulm/CCM (or ID then CCM, neph then CCM, etc.). Or if you really like dealing with ischemic strokes, subarachnoid and intracerebral hemorrhages, TBIs, then you might want to do neurology then neurocritical care. If you like kids, then pediatrics has the NICU and also PICU. Just throwing out some other options for you.

So I’m anesthesia-critical care trained and work in academics. My mix is about 60% CCM and 40% OR time. My CC mix is split between SICU, eICU, and CTICU. Part of my eICU time commitment takes place in Australia working during the day to cover the night in the US. I’m responding from Australia

For next year, I may decrease my CVICU time and pick up some RICU time. We in the CVICU handle the most severe cases of ARDS because if ECMO is a possibility, they come to us anyway. There’s going to be another unit opening that focuses on advanced acute respiratory illness (aka ARDS) which we will staff jointly with PCCM. I imagine it’ll essentially become MICU #2. However my place is a spot where we in Anesthesiolgy do (and very successfully I might add) manage non-surgical patients who need critical care. There are no true borders on any of our ICUs so even in the CVICU, I have about 20-30% MICU patients who are mine.

It can be done and we are well-trained to manage acute and critical illnesses.

If you have questions, PM me.


Sent from my iPhone using SDN mobile

 

[chocomorsel]

GMan 82, you live in Australia? Thought you were in GA. Or do you travel to Australia often?