Surgical Critical Care vs Regular Critical Care

[Kgizzle]

Is there a difference? I am an MS3 trying to figure out what I want to do and I am not sure I understand the nuance of surgical critical care programs vs IM CC programs. Obviously, I get that surgeons look after sick pts after surgery but is the medicine very different? From the ABS website "Although much of this knowledge and skills is common to critical care specialists from a variety of medical disciplines, the diplomate in surgical critical care has specialized expertise relating both to the physiologic responses to tissue injury from trauma, burns, operation, infections, acute inflammation, or ischemia and to the ways these responses interact with other disease processes. " This sounds hype af but I'm not sure what this actually means for the day to day life of an attending.

---

Members don't see this ad.

 

[nimbus]

Most surgical critical care docs are Acute Care Surgeons aka trauma surgeons. They take trauma call, operate, and round on trauma service patients in SICU. Completely different patient population than pulm/icu docs.

Introduction

to Acute Care Surgery Fellowship

www.aast.org

 

[ACSurgeon]

Is there a difference? I am an MS3 trying to figure out what I want to do and I am not sure I understand the nuance of surgical critical care programs vs IM CC programs. Obviously, I get that surgeons look after sick pts after surgery but is the medicine very different? From the ABS website "Although much of this knowledge and skills is common to critical care specialists from a variety of medical disciplines, the diplomate in surgical critical care has specialized expertise relating both to the physiologic responses to tissue injury from trauma, burns, operation, infections, acute inflammation, or ischemia and to the ways these responses interact with other disease processes. " This sounds hype af but I'm not sure what this actually means for the day to day life of an attending.

at academic centers surgeons who’ve done critical care fellowships do some combination of trauma, emergency general surgery and critical care. They cover mostly surgical ICU patients. Their knowledge of medicine varies. Some take pride in managing a lot things and some have a low threshold to consult cards/pulm/renal/hepatology for everything. Most are somewhere in the middle.

In the community you can (or might have to) cover medical/cardiac/neuro ICU patients as well. In our group our diverse backgrounds lends different type of experience and skills. I’m not as savvy with COPD or advanced heart failure, but I’m perhaps better with the surgical patients.

I’ll say my medical colleagues are quiet impressive and those who’ve been doing it for a while and routinely cover SICU do a great job.

also note that at small community hospitals the intensivist rounds and manages the vent and pressors, takes call from home and consults every specialty needed. This is different from larger hospitals with in house critical care.

your decision is thus: do you want to be a surgeon and intensivist or just an intensivist? If the former then do surgery. If the latter, then medicine followed by critical care will make you more robust at least early in your career.

 

[IMGASMD]

You can get to critical care from many routes.

Critical care in itself is 2 years without other fellowship from IM. 1 year from anesthesia.
Pulm/crit is three years.
From other IM fellowships ID/renal/endo if you’re crazy about it, I guess GI/cards can get there too for one year.

It boils down to what you want to do if/when you don’t want to do critical care. It’s tough to be on call all the time later in your career.

You are a third year, think about what you want to do first.
Surgery vs Medicine. Then go from there. Good luck.

 

[Angus Avagadro]

At the university where I used to work, anesthesia intensivists ran all the icu's