Surgical Critical Care after Urology?

[M.Furfur]

Is this fellowship only open to BC/BE general surgeons? Can a urology resident pursue a fellowship in critical care?

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[Winged Scapula]

While the SCC fellowship match run by the NRMP states that a minimum of 3 years of general surgery residency are required (and completion of a GS residency is preferred), there are programs that accept residents from other disciplines. OHSU, for example, accepts Urology residents.

I might imagine that you would be somewhat behind the GS fellows in terms of CC management and procedural skills (ie, PEG, trachs, etc.) but that would be a function of your Urology training and experience.

 

[maxheadroom]

Why on earth would a Urologist want to do a Critical Care fellowship??

 

[M.Furfur]

I cannot give a satisfying answer to anyone. My urology faculty already think that I am crazy and they often jokingly recommend that I see a psychiatrist.....I know that people choose urology for the lifestyle. I just like sick patients and I love the ICU.....I still want to practice as a urologist but I have no problem doing critical care for like a week/month.

 

[ESU_MD]

Go for it. Quite a few of the disasters I saw in sicu came from the urology service. Having a urologist able to take care of really sick people would be welcome

 

[porktaco]

Go for it. Quite a few of the disasters I saw in sicu came from the urology service. Having a urologist able to take care of really sick people would be welcome

Care to elaborate? Just curious, since I want to know what sorts of disasters I should look out for in my uro patients...

 

[BlondeDocteur]

I saw it too. Since a lot of urology patients are elderly men with cancer they have a host of medical comorbidities; then there's the neurogenic bladder population with cerebral palsy, spina bifida and the like who often need specialized postoperative or even preop care (lots of autonomic dysreflexia, enteral feeding issues, etc); stone patients often get septic; pediatric patients often have associated congenital anomalies requiring a stay in the PICU; and like any surgical patient you can have postoperative leaks, under-resuscitation, over-resuscitation, postoperative MIs, etc.

I remember being the intern on urology (with only 1 month of ICU experience) and we had an extremely sick patient who developed huge pleural effusions and postoperative heart failure. The uro attending kept thundering at his residents that he didn't want anybody but them managing the patient "since they were so much smarter than those general surgery guys." So I was updating the attending on the patient and mentioned hed been started on ionotropes and they were even contemplating an IABP when he stopped me and said "wait a second, what's milrinone again?"

So yeah, SCC experience in urology would be very valuable, I'd think.

 

[maxheadroom]

So yeah, SCC experience in urology would be very valuable, I'd think.

No, no , no, no. Urologists need to be good at urology.

Critical care doctors need to be good at Critical Care.

These are very different specialties with very different emphases. Pick one. Don't think for a minute that you can do both.

 

[BlondeDocteur]

I don't see much of a difference between a urologist who does a SCC fellowship attending 1 week/month in the Unit versus a general surgeon who did an SCC fellowship doing so. And as I said I think enough urological patients have critical care-level comorbidities that being able to at least follow, if not dictate, their patients' care while in the ICU would be very helpful. But then again, I don't think there's any such thing as wasted knowledge.

The Urology residents at UW do four months of critical care in their first two years of residency, plus 3 months in the ER running trauma. I think that's foundational enough to qualify for an SCC fellowship, don't you? Do I think that the average urologist should also become a critical care expert? By no means. But if someone has the interest, like the OP, why not?

And I fully support the trend of closed SICUs. I don't think anyone but board-certified intensivists should be attending in ICUs, general surgeons, urologists or otherwise.

 

[maxheadroom]

I don't see much of a difference between a urologist who does a SCC fellowship attending 1 week/month in the Unit versus a general surgeon who did an SCC fellowship doing so. And as I said I think enough urological patients have critical care-level comorbidities that being able to at least follow, if not dictate, their patients' care while in the ICU would be very helpful. But then again, I don't think there's any such thing as wasted knowledge.

The Urology residents at UW do four months of critical care in their first two years of residency, plus 3 months in the ER running trauma. I think that's foundational enough to qualify for an SCC fellowship, don't you? Do I think that the average urologist should also become a critical care expert? By no means. But if someone has the interest, like the OP, why not?

And I fully support the trend of closed SICUs. I don't think anyone but board-certified intensivists should be attending in ICUs, general surgeons, urologists or otherwise.

1. There would be a major issue when it comes to employment. In academics, you'd need a dual appointment in Surgical Critical Care and Urology. Urology is moving more and more out of the Dept of Surgery (Urology is frequently an independent department), so there are more entanglements there. In private practice this would be nearly impossible as you would almost certainly be employed by two separate corporate entities that will not coordinate well together (unless you're in a multi-specialty setting like Kaiser). You'll have two separate business managers beating on you for more time spent on X and less time spent on Y.

2. Call will be an issue. Take SCC call for X number of days per month and GU call for X number of days per month. I deal with a similar issue covering Plastics Hand call and Plastics Face call. I cover both. Some of my partners cover only one or the other. We essentially have two separate call schedules, which creates a major headache for our administrator who coordinates it. Multiply that by one thousand when it comes to making a schedule for two completely separate services (run by separate administrative staffs).

3. In lots of Trauma/SICU groups, there is a fairly defined rotation. Week #1 SICU attending, week #2 Trauma attending on days, week #3 Trauma attending on nights, week #4 beer patrol. When you try to introduce one person in who can take some call, but not all call, it makes a mess for the schedule (see point #2).

One of the lessons that we learn as we become surgical sub-specialists is that we have a very narrow scope of practice (ha, scope). There is a defined skill set of things that I do very well. There are a whole bunch of other things that I did at some point and I'm probably not terrible at them, but I'm not going to mess with it. Go be a urologist. Build yourself in to the king of the robotic prostatecomy. Trust me, you'll be much better off.