Staffing a CICU?

[DarkProtonics]

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In order to be competent enough to staff a CICU, should I do a one-year CCM fellowship after an (interventional) cardiology fellowship? Or would that make me overqualified and overtrained? I've heard many CCM docs are also subspecialists, like cardiologists, pulmonologists, and infectious disease specialists, or surgeons. Any advice?

 

[jeesapeesa]

In order to be competent enough to staff a CICU, should I do a one-year CCM fellowship after an (interventional) cardiology fellowship? Or would that make me overqualified and overtrained? I've heard many CCM docs are also subspecialists, like cardiologists, pulmonologists, and infectious disease specialists, or surgeons. Any advice?

you should go to med school or better yet transfer from cerritos college, then apply to med school.

 

[DarkProtonics]

you should go to med school or better yet transfer from cerritos college, then apply to med school.

Yes, I know. I will be transferring to a UC next year.

 

[jeesapeesa]

Yes, I know. I will be transferring to a UC next year.

ok then, in that case it just depends what you want to do. do you want to primarily be a medicine specialist (internal medicine) - cardiology, GI, ID, PCCM etc., or do you want to exclusively be an intensivist? for CCM there are multiple routes and i'm sure you can find lots of threads about this (search anesthesiology forum in particular).

i'm sure you can staff an ICU being an interventional cardiologist, but why? i think there are three predominant types of intensivists out there right now (PCCM, ACCM, and internal med/ER Critical Care specialists). i think PCCM is the longest route, but again, it just depends what you want to do.

it's great you have an interest in these things, but take it one step at a time. even in medical school you will be a bit uncertain about these things.

 

[howelljolly]

Yes there are some specialized units that have CCM trained cardiologists. CCM after Interventional Cardio is probably overkill. Thats Med school (4), + Internal Med (3) + Cardiology (3) + Interventional Cardio (1) + Critical Care (1 yr specialist program). Being a PGY-8 is gonna stank.
Interventional Cardio has just about nothing to do with CCM. Most of the interventions that are specific to that specialty will not be done on a critical patient. The useful interventions will more likely be done by interventional radiology, pulmonology, or you garden variety CCM.

A good bit of advice that was given to me... think about what certifications you are talking about racking up. Do you really want to take four separate boards, every ten years? If you're stuck in the cath lab, are you going to have time to attend in the CCU? If you're an attending in a CCU, will you have time to work in the cath lab? If you want to tailor your practice so that you are only in the cath lab on Tuesday afternoons, to make time for everything else... Is anyone going to send patients to you?

I was motivated once too.

 

[DarkProtonics]

ok then, in that case it just depends what you want to do. do you want to primarily be a medicine specialist (internal medicine) - cardiology, GI, ID, PCCM etc., or do you want to exclusively be an intensivist? for CCM there are multiple routes and i'm sure you can find lots of threads about this (search anesthesiology forum in particular).

i'm sure you can staff an ICU being an interventional cardiologist, but why? i think there are three predominant types of intensivists out there right now (PCCM, ACCM, and internal med/ER Critical Care specialists). i think PCCM is the longest route, but again, it just depends what you want to do.

it's great you have an interest in these things, but take it one step at a time. even in medical school you will be a bit uncertain about these things.

Well, from my research online, I find both interventional cardiology and CCM to be very interesting. I've been narrowing my list of proposed subspecialties down over the years, from heme/onc, cards, ID, allergy, CCM, and Rheum, to just cardiology and CCM.

Is there anyway I could shadow a cardiologist or intensivist?

 

[jeesapeesa]

Well, from my research online, I find both interventional cardiology and CCM to be very interesting. I've been narrowing my list of proposed subspecialties down over the years, from heme/onc, cards, ID, allergy, CCM, and Rheum, to just cardiology and CCM.

Is there anyway I could shadow a cardiologist or intensivist?

more likely a cardiologist i think. i was a respiratory therapist before medical school for about 4 years so i worked pretty closely with intensivists in the icu (ccu, neuro icu, nicu, etc), but i don't know about shadowing them. patients are very sick, family is there, procedures, and most of the information will probably be over your head (ventilator/hemodynamics/nutrition/ID/etc), but if you can find one willing, why not. i would be pretty stoked.

 

[howelljolly]

At the risk of being the killjoy, give yourself some time to experience things... Go to med school first. When I started med school, I had a top 5 list, and IC and PCCM were in the top three. Ive since ruled out Interventional Cards. Kinda...

You never know what is going to make or break a field for you. It might be things that you havent thought of yet, such as lifestyle, the day-to-day aspects of the job, the economic aspects of running a practice; and even if you are still a competetive applicant for Cards (which is the most competitive IM subspecialty at this point).

Shadowing is a good idea, but you really cant get a good idea of the field until you are up to your elbows in it. It will be one thing to watch a cardiac cath being done, and a different thing to actually be the one doing it. Watching the doc make decisions is different from actually having to make the decisions on your own. An intensivist will have to make decisions based on partial information while they wait for the lab, whereas someone like a dermatologist already has most of the information they need to make their clinical decisions. Is this something that you want to do?

Actually, you arent in that bad of a position. Either way, you will have to complete a 3 year Internal Medicine residency. By that time you will have had plenty of time to decide. You'll also have a chance to do electives in Cardio, Interventional, and CCM. With the added responsability of being the resident on that service, you'll have a much better idea if its right for you.

The bottom line is, keep an open mind. Its good to have some idea of what you want to do on the way in to medical school. I have a feeling that if you don't have any idea, not even between pathology (no patients, diagnostic) vs. psychiatry (lots of patients, therapeutic), or FP vs. neurosurg, you just want to be caled Doc... and you really dont want to be one.

And try not to sweat it right now. You might be in my position, after 10 years in the medical field, and 3 years of med school, I still dont know what i want to do. At that point, you should probably sweat it.

But your job right now, is to get into med school, and then get into a good IM program and become a rockin' internist. Ten years from now, if you still have this problem, call me.

Now, about me...
I cant decide between EM and IM.... And Im applying next year.
help me

 

[pseudoknot]

Shadowing is a good idea, but you really cant get a good idea of the field until you are up to your elbows in it. ... Watching the doc make decisions is different from actually having to make the decisions on your own.

I have a feeling that if you don't have any idea, not even between pathology (no patients, diagnostic) vs. psychiatry (lots of patients, therapeutic), or FP vs. neurosurg, you just want to be caled Doc... and you really dont want to be one.

I strongly agree with your post, but especially the above parts. My interest in shadowing has declined over time in med school...it's cool to see procedures but the real action is inside the doctor's head and you can't appreciate it until you're there yourself.

 

[DarkProtonics]

At the risk of being the killjoy, give yourself some time to experience things... Go to med school first. When I started med school, I had a top 5 list, and IC and PCCM were in the top three. Ive since ruled out Interventional Cards. Kinda...

You never know what is going to make or break a field for you. It might be things that you havent thought of yet, such as lifestyle, the day-to-day aspects of the job, the economic aspects of running a practice; and even if you are still a competetive applicant for Cards (which is the most competitive IM subspecialty at this point).

Shadowing is a good idea, but you really cant get a good idea of the field until you are up to your elbows in it. It will be one thing to watch a cardiac cath being done, and a different thing to actually be the one doing it. Watching the doc make decisions is different from actually having to make the decisions on your own. An intensivist will have to make decisions based on partial information while they wait for the lab, whereas someone like a dermatologist already has most of the information they need to make their clinical decisions. Is this something that you want to do?

Actually, you arent in that bad of a position. Either way, you will have to complete a 3 year Internal Medicine residency. By that time you will have had plenty of time to decide. You'll also have a chance to do electives in Cardio, Interventional, and CCM. With the added responsability of being the resident on that service, you'll have a much better idea if its right for you.

The bottom line is, keep an open mind. Its good to have some idea of what you want to do on the way in to medical school. I have a feeling that if you don't have any idea, not even between pathology (no patients, diagnostic) vs. psychiatry (lots of patients, therapeutic), or FP vs. neurosurg, you just want to be caled Doc... and you really dont want to be one.

And try not to sweat it right now. You might be in my position, after 10 years in the medical field, and 3 years of med school, I still dont know what i want to do. At that point, you should probably sweat it.

But your job right now, is to get into med school, and then get into a good IM program and become a rockin' internist. Ten years from now, if you still have this problem, call me.

Now, about me...
I cant decide between EM and IM.... And Im applying next year.
help me

Here's a combined EM/IM residency: http://www.ecu.edu/cs-dhs/em-imresidency/em-im-residency.cfm

My FP is trying to work out something w/ the site administrator to let me shadow him. I think he believes I'd make a good internist, based on my over-the-phone analysis of my own abnormal test results, which he said "good job!" to. He said "I think you'd make a great observer, based on the level of knowledge and analysis skills you possess for your age; most 17 year olds don't have that level of medical knowledge, and even if they did, they most likely wouldn't know how to apply it, which you do".

Here's the story: my CBC came back showing an abnormallly high RBC and Hct, w/ normal erythropoietin levels. Now, a high Hct by itself could mean dehydration, however my CMP's electrolytes were normal and my urine was dilute. Coupled w/ the high RBC though, it could mean hypoxia, but I've had no changes in breathing nor fatigue, and hypoxia would cause my erythropoietin levels to be elevated. Since they weren't, the problem must be myleoproliferative in nature. And the only disease that can cause the above constellations of findings is primary erythrocytosis. I asked for my FP to run a blood film to check the reticulocyte production index, a whole blood viscosity, a bone marrow aspiration/biopsy, and a MRI w/ contrast of my spleen. I believe my headaches and other occasional aches are due to the thicker blood trying to force its way through my blood vessels. My FP said he'll consult a hematologist to determine whether or not those tests are necessary, and if my prospective diagnosis is correct. Now he's trying to force the hematologist to see me, b/c he won't take 17yr olds, even though any medications I need would be titrated for an adult, and pediatric hematology deals w/ leukemias and thallasemias, not erythrocytoses.

Think it'd be worthwhile to shadow my FP on Fridays?

 

[howelljolly]

I think you should shadow Dr House.

There are 11 EM/IM programs, and since im indecisive, thats what Im aiming for. But the bit of advice which I posted above. If I do EM/IM, I will wind up doing fellowships in Prehospital EM, Wilderness and Travel med, Pulmonary disease, critical care, Sleep. Seven board exams, and eleven years later, I'll select one, and do that exclusively, but still study for all seven boards every ten years.

 

[DarkProtonics]

i think you should shadow dr house.

lol

 

[Trifling Jester]

i'm sure you can staff an ICU being an interventional cardiologist, but why? i think there are three predominant types of intensivists out there right now (PCCM, ACCM, and internal med/ER Critical Care specialists). i think PCCM is the longest route, but again, it just depends what you want to do.

I don't know if I'd classify the ER-trained ICU docs as one of the predominant types. In the MICUs I've been to the attendings have all been IM trained and then done fellowships in CC or pulm/CC. I understand that there are some programs which do accept ER-trained physicians, but I don't think that they are allowed to sit for the American boards. I'm not saying that ER docs staffing the ICU doesn't ever happen, but I do think that it's quite rare and not something "predominant."

SICUs may be a different story. I haven't had a reason to be in many SICUs.

-The Trifling Jester

 

[howelljolly]

SICUs are usually staffed by a general surgeon or anesthesiologist with a "surgical critical care" fellowship.

Not fair. Surgeons don't have to decide between emergency/trauma surgery, vs. attending in the SICU. The surgical critical care fellowship qualifies them for both.

 

[emergiQ]

I don't know if I'd classify the ER-trained ICU docs as one of the predominant types. In the MICUs I've been to the attendings have all been IM trained and then done fellowships in CC or pulm/CC. I understand that there are some programs which do accept ER-trained physicians, but I don't think that they are allowed to sit for the American boards. I'm not saying that ER docs staffing the ICU doesn't ever happen, but I do think that it's quite rare and not something "predominant."

SICUs may be a different story. I haven't had a reason to be in many SICUs.

-The Trifling Jester

Agreed. There's not enough of us to call them "predominant". But the numbers are growing, driven by demand (i.e. even without the board certification -- which you can't currently get with an EM background -- there are plenty of intensivist jobs for ER-trained/fellowship trained CC docs).