View from the top floor: ICU as attending vs trainee

[Nivens]

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I've heard multiple times that critical care as an attending is worlds apart from the experience as a resident, and that a large part of the reason it isn't more popular as a career path is while it's difficult to love the ICU as a trainee, as a fellow/attending it can be really great. As someone about to start anesthesiology residency evaluating critical care as a career choice (evaluating many things, actually), what do I need to keep in mind as I start my ICU months to keep from falling into the trap of generalizing my time as a trainee to the rest of my life?

 

[kkinase]

I'm also very interested in any fellows or attending chiming in about this

 

[Doctor Bob]

The life as an attending is better than the life as a resident/student in pretty much any specialty.

Critical care fellowship is doing the toughest month of residency (the ICU) for an entire year/two years. It doesn't get worlds better when you're an attending. Unlike a hospitalist (where you can deal with a lot of the problems the nurses have over the phone), you frequently need to be at the bedside when called.

It's difficult to love the ICU because it's a big time commitment compared to other subspecialties of IM/anesthesia. EM adapts to the shiftwork pretty well. For surgery it's probably a lateral time commitment. But as with any field, if you enjoy doing it, then it's not that big of a deal.

 

[Nivens]

It's difficult to love the ICU because it's a big time commitment compared to other subspecialties of IM/anesthesia.

One resident called ICU fellowship after anesthesia residency "Defeat from the jaws of victory."

 

[PinkLithe]

Is life as an intensivist not better nowadays, especially with more shift-model based work? You put in your 10-12 hours/day x 1 week and still get to go home at the end of it. Then you've got the next week off.

 

[Doctor Bob]

Is life as an intensivist not better nowadays, especially with more shift-model based work? You put in your 10-12 hours/day x 1 week and still get to go home at the end of it. Then you've got the next week off.

Well, someone has to staff the ICU at night. So either your group hires some nocturnists, or you have occasional night shifts as well. If it was just 7 day shifts then off 7, that wouldn't be so bad. But it's more like 5 day shifts, 1 night shift, 2 days off, 6 day shifts, 1 24 hour shift, 5 days off, 2 night shifts, 3 days off, then repeat... or some craziness like that.

 

[EMIM2011]

Luckily, there is still a good number of places without an in-house intensivist after midnight (usually those that have residents on service)

 

[G-Man82]

At the places I interviewed at for Anesthesia/CCM, the schedules offered to us are pretty nice. In those places where we do 7 days on in the unit, that essentially covered my call and weekends requirement for the month. When on OR duty, I wouldn't be a part of the Generalist call schedule, nor weekend schedule.

To make it better, some places have a tele-ICU attending at night which acts as an extra barrier between me and coming back in. The downside to that is I would have to staff the tele-ICU at times too. I have to look into tele-Medicine and see what the pros/cons are. But in any of the above models, I was also compensated with extra time off, be it a bunch of academic/admin days or true post call days, to a full week off each month before moving on to the OR.

In some of the private practice models, each week in the unit would translate to extra vacation time that I could use whenever I felt, or the following week off completely.

I might be naive because I'll be fresh off training, but any of the above seem like a sweet deal to me. I'm sad to see fellowship end because my true responsibility is minimal, but I think I'm ready for all this training to be done.

 

[chessknt]

Well, someone has to staff the ICU at night. So either your group hires some nocturnists, or you have occasional night shifts as well. If it was just 7 day shifts then off 7, that wouldn't be so bad. But it's more like 5 day shifts, 1 night shift, 2 days off, 6 day shifts, 1 24 hour shift, 5 days off, 2 night shifts, 3 days off, then repeat... or some craziness like that.

Is that what academic centers do? I don't see how that would be sustainable for decades if you were being called constantly if you were alone. Why wouldn't a group just rotate night weeks as a float system like hospitalists instead of that bizarre schedule?

 

[Doctor Bob]

Is that what academic centers do? I don't see how that would be sustainable for decades if you were being called constantly if you were alone. Why wouldn't a group just rotate night weeks as a float system like hospitalists instead of that bizarre schedule?

The problem is, there just aren't a lot of people out there who want to be nocturnists. Or people who want to work blocks of nights. ED groups run into this problem all the time (which is why as someone who does prefer nights, I can ask for a premium when I go to a new hospital).

Throw in clinic, vacation, etc etc etc, and it's tough to make a strict 7 days on 7 days off, 7 nights on, 7 nights off, or something schedule. Groups struggle with it all the time. Some can manage it, a lot can't.

As soon as ICU recruiters found out I primarily prefer nights my email inbox got flooded.