What-is-the-appeal-with-critical-care-medicine

[niceguydoc]

Hey-guys,just-wondering-what-about-this-subspecialty-excites-ya...i'm-a-medical-student-possibly-interested-in-doing-an-elective-in-the-SICU...Thanks!

---

Members don't see this ad.

 

[southerndoc]

Many people are attracted to how serious the patients' medical conditions are, some for the large number of procedures, while others like how complex the medical problems are for critical patients. Critical patients are difficult to manage, and with difficulty comes a big challenge -- to come up with the diagnosis, appropriate treatment, etc. Critical care requires a great deal of patience, but it also requires one to think on his or her feet quickly as things happen where seconds count.

Interests range widely from person to person.

By the way, what's up with your space key?

 

[markneil]

i like the idea of a systems-based approach for treating severely ill patients. i'm just a med student but am interested in anesthesia/ccm. on your feet thinking in the OR coalesces with my desire to apply the same set of knowledge in a slightly different setting (ICU). from previous posts, the idea of having a couple of days a week in the ICU in addition to OR work would be awesome.

 

[turkish]

What specialty gets to run an ICU and operate? I've never met a critical care specialist who was also a surgeon.

 

[markneil]

What specialty gets to run an ICU and operate? I've never met a critical care specialist who was also a surgeon.

surgeons: surgical critical care
anesthesiologist: anesthesia critical care
internal medicine: pulmonary/cc

they can all run the ICU.

 

[deleted87716]

By the way, what's up with your space key?

Maybe-the-space-bar-on-his-keyboard-is-broken.-This-sure-as-hell-isn't-any-easier-to-do.

 

[punjabiMD]

surgeons: surgical critical care
anesthesiologist: anesthesia critical care
internal medicine: pulmonary/cc

they can all run the ICU.

correction, through internal medicine you can add on a critical care year to most subspecialties. e.g. cadiology/cc, ID/cc, renal/cc

 

[markneil]

correction, through internal medicine you can add on a critical care year to most subspecialties. e.g. cadiology/cc, ID/cc, renal/cc

oops, how can i forget!
add that on the list.

 

[ariwax]

Also, there's a path to neuro critical care running the Neuro ICU, through neurology. That's a 2-year fellowship.

 

[turkish]

The question was "what specialty can run an ICU AND operate"

So the answer is surgery critical care, good enough. Unless pulmonologists and anesthesiologists are now cutting people.

 

[markneil]

you get your money's worth and more here...

 

[bulgethetwine]

surgeons: surgical critical care
anesthesiologist: anesthesia critical care
internal medicine: pulmonary/cc

they can all run the ICU.

EM trained: Intensivist in any of the above setting.

I say this not to invite criticism but to point out that there is a lot in common between EM training and life in the critical care world, and hasten to add that in Europe and Canada, EM-trained docs work shoulder to shoulder with the surgically, medically, and anesthesiology trained intensivists.

Still ridiculous that no pathway to CC certification exists in the U.S.

 

[KGUNNER1]

EM trained: Intensivist in any of the above setting.

I say this not to invite criticism but to point out that there is a lot in common between EM training and life in the critical care world, and hasten to add that in Europe and Canada, EM-trained docs work shoulder to shoulder with the surgically, medically, and anesthesiology trained intensivists.

Still ridiculous that no pathway to CC certification exists in the U.S.

Times are changing. The political pendulum is starting to swing in favor of a more open, non-traditional pathway leading to critical care training and certification.

kg

 

[lateness]

What specialty gets to run an ICU and operate? I've never met a critical care specialist who was also a surgeon.

actually when i did my icu i met a doc who was a surgeon for years then went into pulm/icu,

 

[idiot07]

The amount of procedures pulm/cc is doing is increasing to the point where it might be a good field for someone who likes procedures and critical care, but doesn't want to mess with general surg. They include the likes of complicated bronchoscopy (laser ablations of tumors, stent placements for emphysema) and basic thorascopy in addition to the basic icu procedures like central lines and percutaneous trach's. It's certainly not surgery, but you don't get beat down as bad, and if you do burn out there's always sleep medicine.

 

[proman]

I saw a talk by the head of interventional pulmonology at Brigham & Women's. Unbelievable amount of stuff they do now. Cardiologists took bread and butter cases from cardiac surgeons, IP will do the same for the thoracics.

 

[toxic-megacolon]

Cardiologists took bread and butter cases from cardiac surgeons, IP will do the same for the thoracics.

I think its great that IM people are taking these procedures, because it leaves us surgeons to OPERATE. Most of us went into surgery to actually do surgery, not mess with scopes/guidewires/flouro, etc. The only appealing part of these procedures is they pay well, despite being quick and relatively easy to learn. But that could change anytime....

 

[neurologist]

Hey-guys,just-wondering-what-about-this-subspecialty-excites-ya...i'm-a-medical-student-possibly-interested-in-doing-an-elective-in-the-SICU...Thanks!

The REAL appeal of critical care is: No long-term patient follow-up for chronic conditions. Either they die or they survive to get discharged to a stepdown unit. Either way, you are done with them.

 

[double elle]

The REAL appeal of critical care is: No long-term patient follow-up for chronic conditions. Either they die or they survive to get discharged to a stepdown unit. Either way, you are done with them.

Not to mention the fact that the people are in the critical care unit are REALLY ill. None of the office visit crap....Chronic pain, fibromyalgia, colds that demand antibiotics. No vague, non-discript symptoms that you are expected to do something about because the patient can't suck it up. Non-compliance goes out the window in the CCU. Come to think of it, these are probably the most compliant patients ever!! "Not going to take the norepi like I recommend? Well, have a good afterlife..."

 

[danielmd06]

Your medication choices and treatments generally yield quickly observable results - this can be gratifying.

 

[Furrball2]

Medicine ICUs are normally run by pulm critical care. Yes you can just do critical care from internal medicine or add it on to another fellowship, but you may have difficulty getting a position at a large hospital. As a pulmonologist you get to see your patients after they leave the ICU. You also have a clinic seeing everything from asthma and COPD to lung transplant patients. When in the ICU you get to still be an internist for very sick people.

Where I went to med school, the surgical intensivists were normally trauma surgeons and the surgical ICU was an integral part of the trauma team. Where I am now currently in residency, the anesthesia critical care folks work with the surgeons. The surgical ICU attendings are a mix of anesthesiology and surgery. The medical ICU is straight pulm critical care.

As far as neurology goes, while they can and do do critical care fellowships -- we have a very good neurology intensivist -- I don't know if they are actually boarded in CC. The only EM intensivists I have met are dual boarded in both IM and EM.

My 2 cents.

 

[Furrball2]

t

 

[VentdependenT]

The amount of procedures pulm/cc is doing is increasing to the point where it might be a good field for someone who likes procedures and critical care, but doesn't want to mess with general surg. They include the likes of complicated bronchoscopy (laser ablations of tumors, stent placements for emphysema) and basic thorascopy in addition to the basic icu procedures like central lines and percutaneous trach's. It's certainly not surgery, but you don't get beat down as bad, and if you do burn out there's always sleep medicine.

Anesthesia based CC fellowships afford you the opportunity to become certified in TEE's. So thats something else one can bill for. Does this exist in non-anesthesia based CC fellowships? I dunno.

 

[southerndoc]

Anesthesia based CC fellowships afford you the opportunity to become certified in TEE's. So thats something else one can bill for. Does this exist in non-anesthesia based CC fellowships? I dunno.

Certified, or credentialed?

Emergency physicians receive extensive training in ultrasound during residency. We can become certified by ARDMS, but that doesn't mean we can bill for it or practice ultrasound wherever we work. In order to actually do ultrasounds when we graduate and go to work in the real world, we must be credentialed by the hospital.

I think what you mean is that anesthesiologists can become credentialed to perform TEE's.

 

[proman]

National Board of Echocardiography has a Special Competence certification in perioperative TEE (PTEeXAM)

http://www.echoboards.org/certification/pte/reqs.html

 

[TerraMedicX]

Question for you all, if you do a residency in trauma surgery and a CCM fellowship, do you get to work on all the sick trauma AND the awesome sick medical patients? 'cause that would just be SWEET!!!

Nate.

 

[southerndoc]

National Board of Echocardiography has a Special Competence certification in perioperative TEE (PTEeXAM)

http://www.echoboards.org/certification/pte/reqs.html

Certification does not equal credentialing.

One can be certified by any organization, but only a hospital can credential you for privileges to perform a particular procedure or diagnostic test.

 

[sonso]

Come to think of it, these are probably the most compliant patients ever!! "Not going to take the norepi like I recommend? Well, have a good afterlife..."

 

[bob swerski]

Not to mention the fact that the people are in the critical care unit are REALLY ill. None of the office visit crap....Chronic pain, fibromyalgia, colds that demand antibiotics. No vague, non-discript symptoms that you are expected to do something about because the patient can't suck it up. "

Can I get an amen. I'm doing an ambulatory rotation right now, and I die a little every time I have to sit there and argue with the patient about colonoscopies, or being up to date with their pap and mammo, or when some ridiculously obese diabetic lady who smells like the McDonalds downstairs wants diet pills because she just can't understand why she isn't losing weight. Give me someone with a PE or ARDS any day.

 

[m1234d]

Can I get an amen. I'm doing an ambulatory rotation right now, and I die a little every time I have to sit there and argue with the patient about colonoscopies, or being up to date with their pap and mammo, or when some ridiculously obese diabetic lady who smells like the McDonalds downstairs wants diet pills because she just can't understand why she isn't losing weight. Give me someone with a PE or ARDS any day.

omg, few of my med school friends understand this, and non of my non-med school friends do. Im doing a crit care elective next (m3) i'm excited, but a little anxious! if i don't like this, my 200K of debt is going to be very hard to pay off when i say: f this, drop out and become a housewife. (i am fairly confident though, besides it would only take 3 days before i would go stir crazy sitting at home, i can't even handle a long weekend off)

 

[FionaS]

I have friends who live for this kind of long term follow up - because you get to form a long term relationship (not that way!) with the patients. I can think of few things more horrible!

I'm doing vascular surgery at the moment, and know that it is not what I want to go into long term - the thought of having to see yet another smoking, overweight, type 2 diabetic and tell them, yet again, to quit smoking, loose weight and eat healthily...

 

[bulgethetwine]

Question for you all, if you do a residency in trauma surgery and a CCM fellowship, do you get to work on all the sick trauma AND the awesome sick medical patients? 'cause that would just be SWEET!!!

Nate.

Ha. That would be funny -

General Surgery: 5 years
Trauma surgical fellowship: 2 years
CCM fellowship: 3 years.

Have fun with that.

 

[southerndoc]

Ha. That would be funny -

General Surgery: 5 years
Trauma surgical fellowship: 2 years
CCM fellowship: 3 years.

Have fun with that.

Most usually do not complete both a trauma and a critical care fellowship. A lot of the trauma fellowships include critical care training and allow certification. Likewise, a lot of the critical care fellowships include trauma training. You just have to look for a program that has both.

Surgical critical care fellowships are usually 1-2 years. Trauma fellowships are also 1-2 years.

 

[waterski232002]

Technically, trauma surgery is not a board certifiable fellowship. Although, you can get board certified in surgical critical care (which many, but not anywhere near all do). The vast majority of practicing trauma surgeons are general surgeons who like trauma, or who have done a 1 year critical care fellowship, or a 1-2 year trauma fellowship (often the 2 year fellowships are to give you extra critical care training).

So most trauma surgeons have at least 5, but usually 6 or 7 years training, and work exclusively in Trauma ICU's or Surgical ICU's and often take rotating call on the general surgery schedule too, b/c trauma surgery isn't very profitable (unless they're at one of the true McDonald style knife and gun clubs). And they do not work in MICU's or deal with medical patients.

 

[Hard24Get]

Most usually do not complete both a trauma and a critical care fellowship. A lot of the trauma fellowships include critical care training and allow certification. Likewise, a lot of the critical care fellowships include trauma training. You just have to look for a program that has both.

Surgical critical care fellowships are usually 1-2 years. Trauma fellowships are also 1-2 years.

Penn has a 2yr Traumatology and Surgical Critical Care fellowship that does what is says. And if you stay to be an attending, the schedule is supa fly- the attendings are one week on trauma surgery, then just on call 1wk, then 1 week on SICU, then just on call 1wk, rinse and repeat. It's about the sexiest thing I ever heard in medicine.

The sexiest thing I ever heard in medicine is the 1 yr fellowship for Emergency physicians at HUP, so you can rotate between being an EM and SICU attending.

 

[nvshelat]

Penn has a 2yr Traumatology and Surgical Critical Care fellowship that does what is says. And if you stay to be an attending, the schedule is supa fly- the attendings are one week on trauma surgery, then just on call 1wk, then 1 week on SICU, then just on call 1wk, rinse and repeat. It's about the sexiest thing I ever heard in medicine.

The sexiest thing I ever heard in medicine is the 1 yr fellowship for Emergency physicians at HUP, so you can rotate between being an EM and SICU attending.

K, thats hot, but how bout doing EM at Einstein (Philly) where you get to rotate in with trauma, then doing a CCM fellowship and jump into the SICU/MICU.. that would be sweet IMO.

 

[Hard24Get]

K, thats hot, but how bout doing EM at Einstein (Philly) where you get to rotate in with trauma, then doing a CCM fellowship and jump into the SICU/MICU.. that would be sweet IMO.

Yeah, same thing! My thought was to choose a 3 year program for EM, knowing I could do a 1 yr CCM fellowship somewhere else if I didn't/couldn't stay at the original program. The hot part I was referring to is doing EM AND SICU - like a dream come true!

Sounds like we may be heading towards similar career paths in the same region of the country - let's be friends!

What stage are you at? PM me sometime!