Trauma, SICU, Anes

[Trisomy13]

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Yes. Another... "I'm a 4th year thinking about fellowships" post. I have incredible foresight, so just humor me 😉


Currently leaning towards anesthesiology for residency, as I enjoyed my 3 weeks in an anes. rotation, and have 4 more coming up as a sub-i to confirm that. Didn't really enjoy general surgery so much, so I ruled that out, but I liked the OR and the critically ill patient. I really enjoyed a 3 week rotation in our level 1 trauma center and SICU last year, and am in the middle of another month of that as a sub-i right now.

I've read some threads about CCM as an anesthesiologist, and how it is not worth it from a reimbursement perspective according to most responses. I imagine it comes down to financial vs. intrinsic reimbursement and how much I really want to be in the OR or ICU. I get that. But my first question is - if (big IF) I find that I really want to end up in an ICU when all is said and done, would I be better off going the IM-PCCM route, or is it still safe and reasonable to proceed through anesthesiology-CCM? Does anyone ever hear of people having trouble finding work in an ICU because they are primarily an anesthesiologist and not a pulmonologist?

Ok. Another one... maybe for UTSW or someone at UMMC or Jackson Mem can help me out - regarding the Trauma fellowship for anesthesiologists. I am very happy where I am now, as a sub-i, responding to trauma alerts and codes, helping to resuscitate in the trauma bay, proceeding to the OR if necessary, and following the patient in the ICU for who knows how long. The only thing keeping me from doing surgery with a trauma fellowship is my lack of interest in ... surgery. So I have found some programs that have a trauma fellowship, and have anesthesiology present as part of the trauma team. My question for anyone who is at such programs or involved in the fellowships is to what extent does anesthesiology follow into the ICU? Provided someone is trained in anesthesiology, and perhaps has done both trauma and CCM fellowships, could he find a niche in a SICU owning the patients, but consulting general surgery for trachs, debridements, ex laps, etc?


or should i just sell peanuts at the ballpark? those guys always seem happy.

 

[militarymd]

You can find a job with every option you mentioned above.

Just do what you like.....or you can sell peanuts.

 

[Trisomy13]

You can find a job with every option you mentioned above.

Just do what you like.....or you can sell peanuts.

ok so none of them are way off base. that calms me a little.


i've reserved this afternoon for freaking out over my future. i'm looking forward to it.


and looking forward to going back to the trauma SICU tomorrow bright and early. the pager has been going crazy this weekend with car crashes and the like. they were condition red for a few hours last night. makes me wish i had stayed and taken call...

 

[beezar]

Trauma's great until you have to miss out on some event with your kids for the umpteenth time because some ******* strung out or drunk driver crashes into a tree. And doing the primary / secondary survey for the billionth time gets real old real fast. And writing "will consult ortho/neurosurgery" for the trillionth time gets old as well. And trauma surgery isn't very technically demanding at all, and definitely not elegant in the least.

But go for it...

(can you tell i hate trauma?)

 

[Atropine]

IM residency plus Pulm/CC fellowship = 6 years
Pros: Presumed proficiency in endo/ID/Rheum/Pulm/Renal/GI/Allergy/Immunology/Cards due to IM residency
Cons: Reimbursement is not as good. For instance, the same central line placed by a Pulm/ccm doc is reimbursed far less than if it was placed by surgery(and presumably anesthesiology).

Anesthesiology residency plus CCM fellowship = 5 years.
Pros: That's obvious.
Cons: not much

 

[Molly Maquire]

Are you sure about this? Why would reimbursment be any different? So this means that an anes.-trained intensivist will always make more money than a IM (CC/Pulm) trained intensivist?

 

[jetproppilot]

Trauma's great until you have to miss out on some event with your kids for the umpteenth time because some ******* strung out or drunk driver crashes into a tree. And doing the primary / secondary survey for the billionth time gets real old real fast. And writing "will consult ortho/neurosurgery" for the trillionth time gets old as well. And trauma surgery isn't very technically demanding at all, and definitely not elegant in the least.

But go for it...

(can you tell i hate trauma?)

Man, this is a great post that I hope all you dudes/dudettes take to heart. If you havent experienced the "real world" yet, and are still consumed with med school/residency, please remember that

BETA ADRENERGIC STIMULATION IS A YOUNG MAN'S GAME!!!

Yes, there are some mutants out there that enjoy being workaholics, but with this prestige comes great personal sacrifice. You'll probably be estranged from your spouse eventually, you'll be an uncle to your kids instead of a dad (mom), and burnout will hover over you incessantly. SO, unless you are a martyr, try and think ahead...do I want to be stressed out on every case I do for the rest of my life? Do I want to use my adrenals on every case/patient?

Think hard before picking a career path that will totally engulf you. You are at a point in your training where this is very attractive. But will it feel the same in 5-10 years?

 

[Gator05]

Amen.

You're not the same person you were in high school, so why would you expect to be the same person 10 years from now?

 

[ermonty]

Think hard before picking a career path that will totally engulf you. You are at a point in your training where this is very attractive. But will it feel the same in 5-10 years?

This is EXACTLY what I try to tell my classmates that are 4-5 years younger than me. Although I'm just in my 3rd year, I've been in the medical field long enough to know that in the long run its a job. I want to enjoy my work, but I work to live - not the other way around.

Thanks for trying to give people a different perspective Jet, although you may be preaching to the Choir - this is the Anesthesiology forum 😉

Monty

 

[Trisomy13]

Man, this is a great post that I hope all you dudes/dudettes take to heart. If you havent experienced the "real world" yet, and are still consumed with med school/residency, please remember that

BETA ADRENERGIC STIMULATION IS A YOUNG MAN'S GAME!!!

Yes, there are some mutants out there that enjoy being workaholics, but with this prestige comes great personal sacrifice. You'll probably be estranged from your spouse eventually, you'll be an uncle to your kids instead of a dad (mom), and burnout will hover over you incessantly. SO, unless you are a martyr, try and think ahead...do I want to be stressed out on every case I do for the rest of my life? Do I want to use my adrenals on every case/patient?

Think hard before picking a career path that will totally engulf you. You are at a point in your training where this is very attractive. But will it feel the same in 5-10 years?

i appreciate the concern. but i've thought through all of this and still come to the decision that i want to be active in the ICU. perhaps less involved in trauma, but more so in managing patients in the SICU or trauma ICU. that's just my personality. i've been in the "real world" before, worked several different jobs, went to grad school, lived in different states, different countries, and managed to destroy a couple of great relationships. i'm not too worried about losing anything else at this point. if i can run my unit, do some solid research on VAP or traumatic brain injury outcomes, whatever, i'll be happy enough. and i'm already an uncle to my nieces and nephews... i don't need my own kids.

this is all assuming i live through this insane lightning storm outside.

whoa whoa.. i heard the router near the window make noise with that flash. i'm logging out.

 

[jetproppilot]

i appreciate the concern. but i've thought through all of this and still come to the decision that i want to be active in the ICU. perhaps less involved in trauma, but more so in managing patients in the SICU or trauma ICU. that's just my personality. i've been in the "real world" before, worked several different jobs, went to grad school, lived in different states, different countries, and managed to destroy a couple of great relationships. i'm not too worried about losing anything else at this point. if i can run my unit, do some solid research on VAP or traumatic brain injury outcomes, whatever, i'll be happy enough. and i'm already an uncle to my nieces and nephews... i don't need my own kids.

this is all assuming i live through this insane lightning storm outside.

whoa whoa.. i heard the router near the window make noise with that flash. i'm logging out.

more power to you, bro. Tear it up.