I sincerely apologize for which I may have started.
Did IM at a ghetto Univeristy hospital then finished at a bougie community program. Worked for a few years as hospitalist. Entered and finished anesthesia at a community program. I moonlight during anesthesia training as nocturnists whenever I can.
I’ve had ~14 formal ICU months throughout my training. (CCU, MICU, SICU, CTICU). I’ve managed my own ICU patients in between my residencies.
My two cents. IM has absolutely no clue what anesthesia does and vice versa. And no matter how many intubations/extubations and even vent management IM had done, the numbers don’t compare.
I’ve administered thousands of anesthetics after three year of anesthesia training. I push any drugs, prop, benzo, and opioids without anyone verifying the dose, speed, or worried about penicillin or morphine allergies on daily basis. That’s not something most IM residents or surgical residents ever get to do. I’ve placed and took out thousands of tubes on elective/urgent/emergent basis.
Certainly I have not gone through CCM training, so I may be totally off base here; however, I think my anesthesia CCM trained colleagues are trying to say based on the “numbers alone”, IM residents, even fellowship CCM graduates are at a disadvantage. I’ve intubated more than the whole ENT residency program “combined” and that’s not an exaggeration. They are much more interested doing their surgeries than take care of airways. I certainly have extubated more times than any board certified pulmonologists. I’ve managed laryngospasms/bronchspasms on monthly basis. When was the last time CCM attending rushing a prego for crash C-section without pre-oxygenation, as soon as the facemask is off the patient, sats already down to 70s, oh and ob is already cutting? Or a 2 year old laryngospasm, unable to break and the sats now in the 30s and bradying down? Probably never, or very very very rarely. What I am trying to say is that these are the scenarios that anesthesiologists have to deal with confidently. So what if anesthesia CCM pulled the tube a little too early? We have the tools and trainings to deal with it. We don’t need to call someone when the airway “might” be difficult. Does that translate to vent management style? Sure it does. I don’t remember the last time I checked RSBI when I pulled the tube, the respiratory therapists freak out regularly when I just pull. The answer nowadays is, oh the patient looks good. Because I’ve seen thousands of patients that may or may not fly after extubation. I have the gestalt what the optimal condition suppose to look like. Do I get fool? Sure, but I’d guess my track record is pretty good. Maybe as good as someone who gets ABG, calculate out all the indices.
Regarding sick patients? I’ve done ASA 4,5,6. My experience in OR certainly translate whether they can be wean off the vent or not. If I try to extubate at the end of surgery/procedure or not. Heck, I’ve fought with surgeons not to bring OR, or tell them to finish the **** up, the patient is going to code on the table. Do I manage ARDS long term as well as IM, at this time, no.
My comprehension isn’t the best, but we are not saying one is bette than the other. What I heard is, anesthesia CCM do certain things better than IM CCM and vice versa.
It’s a numbers game after all. Just like I would not want an anesthesia CCM attending to manage my DKA. Because by my second month in ICU as a medical intern I’ve seen a dozen of them. During my IM residency, I’ve managed a couple hundred. I don’t think most anesthesiologists during their residency they actually manage any, other than the ones in their internship.
Lastly, I don’t appreciate the swipe taken with the CRNA comment. It feels a little personal. I’d rather have them intubate me than some of the CCM attendings ANY DAY. Since it is a numbers game after all. One of my attending told me that he could confidently teach a monkey to intubate; but anesthesia residency is three years for a reason.
Every speciality have their own strengths, vent/sedation/airway management in general, anesthesia comes out ahead.