Whats the Deal with Mag / Phos

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Not biting. Don't care. You are lame.
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This has to be up there with one of the most bizarre arguments I've ever seen

Also yeah open ICUs blow
 
MedicineDoc said:
Even if we were doing outpatient pedis it was only after we had seen our patients in the hospital. Also as I have said before outpatient and inpatients are not separate species. Inpatient is a continuation of treatment of outpatient disease. This the push within IM to add more outpatient training. Otherwise you have a bunch of docs thinking everything needs to be treated in the hospital pushing up length of stay.
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this statement demonstrates the differences between IM and FM trained docs.
seen FM try to do ICU work and they struggle...and they consult everyone...partially for CYA, but many times because they are not comfortable with taking care of a complicated patient.
 
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Bostonredsox said:
FM vs IM doesn't really matter. In the next 3-5 years SHM is going to get approval for the hospitalist medicine boards. The so called "Fellow of hospital medicine". Whether you are fm or IM you will have to pass these boards to be a hospitalist. Once this happens, weak FPs, and sadly, weak IMs will be weeded out of the hospitalist world. Hospital medicine is its own world. being boarded in fm and to an extent even IM, does not mean you possess the skillset to be a hospitalist.
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How legit is this? I really had no idea anything like this was in the works.

So an IM who doesn't get boarded in SHM is forced it into private practice or another fellowship (assuming they can get in)?

(Disclaimer: I'm applying to residency this fall and weighing out IM & FM.)
 
CDI said:
How legit is this? I really had no idea anything like this was in the works.

So an IM who doesn't get boarded in SHM is forced it into private practice or another fellowship (assuming they can get in)?

(Disclaimer: I'm applying to residency this fall and weighing out IM & FM.)
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usually when a new board certification starts, there is a grace period of 18 months (maybe longer) that allows those who have practiced to take the board without a formal fellowship, but after that one will need to do the fellowship. The last one to do this I believe was Hospice/Palliative Care.
 
rokshana said:
usually when a new board certification starts, there is a grace period of 18 months (maybe longer) that allows those who have practiced to take the board without a formal fellowship, but after that one will need to do the fellowship. The last one to do this I believe was Hospice/Palliative Care.
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sleep too
 
rokshana said:
usually when a new board certification starts, there is a grace period of 18 months (maybe longer) that allows those who have practiced to take the board without a formal fellowship, but after that one will need to do the fellowship. The last one to do this I believe was Hospice/Palliative Care.
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Wow, thanks for the info. Never knew this. And they'd have to get recertified in IM & SHM every few years?
 
From what I understand, once it unveils, practicing hospitalists for x amount of years will get grandfathered in. Everyone else will have to take the boards in order to be a board certified hospitalist. So instead of taking your general IM or FP boards you would have to take the shm boards. Then the true difference in residency training will be exposed. I would guess most legit IM grads would be able to pass these boards right out of residency. Based on those I've worked with some, but not the majority, of FPs could pass these without additional inpatient training. This is the fault of the FP curriculums being so geared towards clinic. You get what you pay for
 
Bostonredsox said:
From what I understand, once it unveils, practicing hospitalists for x amount of years will get grandfathered in. Everyone else will have to take the boards in order to be a board certified hospitalist. So instead of taking your general IM or FP boards you would have to take the shm boards. Then the true difference in residency training will be exposed. I would guess most legit IM grads would be able to pass these boards right out of residency. Based on those I've worked with some, but not the majority, of FPs could pass these without additional inpatient training. This is the fault of the FP curriculums being so geared towards clinic. You get what you pay for
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You don't think that's just the typical self boosting BS propaganda that is pervasive in every area of life. Even North Korea claims to be the greatest country in the history of the world. It's interesting how the posts on sermo where practicing physicians post regarding FP hospitalist are very much pro FP hospitalist while the bs resident in training forum here on Sdn is full of juvenile crap self aggrandizing school yard school boy smack talk. The clowns on here on the one hand say in one thread they never studied just read on their patients but on the other hand are willing to post a bunch of crap about being IM certified as if you have to be IM certified to read on your patients.
 
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Bostonredsox said:
From what I understand, once it unveils, practicing hospitalists for x amount of years will get grandfathered in. Everyone else will have to take the boards in order to be a board certified hospitalist. So instead of taking your general IM or FP boards you would have to take the shm boards. Then the true difference in residency training will be exposed. I would guess most legit IM grads would be able to pass these boards right out of residency. Based on those I've worked with some, but not the majority, of FPs could pass these without additional inpatient training. This is the fault of the FP curriculums being so geared towards clinic. You get what you pay for
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I don't know if thats really considered a fault though. I mean, isn't that why someone goes into FP in the first place?

[Please don't say it's cause they scored lower on Step 1. :laugh:]
 
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MedicineDoc said:
You don't think that's just the typical self boosting BS propaganda that is pervasive in every area of life. Even North Korea claims to be the greatest country in the history of the world. It's interesting how the posts on sermo where practicing physicians post regarding FP hospitalist are very much pro FP hospitalist while the bs resident in training forum here on Sdn is full of juvenile crap self aggrandizing school yard school boy smack talk. The clowns on here on the one hand say in one thread they never studied just read on their patients but on the other hand are willing to post a bunch of crap about being IM certified as if you have to be IM certified to read on your patients.
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you know...no one is forcing you to come over to sdn and read this stuff...

and isn't the emphasis of FM geared to clinic...i mean if you wanted to do inpatient adult medicine and work in an ICU wouldn't you...ummm...do IM? and then a CC fellowship?

and its not just IM that does CC...there ARE some multi-disciplinary programs out there...but AFAIK, FM is NOT one of the disciplines that are eligible for these CC programs...i suspect because of the lack of inpt and CC experience in the typical FM residency...
 
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rokshana said:
you know...no one is forcing you to come over to sdn and read this stuff...

and isn't the emphasis of FM geared to clinic...i mean if you wanted to do inpatient adult medicine and work in an ICU wouldn't you...ummm...do IM? and then a CC fellowship?

and its not just IM that does CC...there ARE some multi-disciplinary programs out there...but AFAIK, FM is NOT one of the disciplines that are eligible for these CC programs...i suspect because of the lack of inpt and CC experience in the typical FM residency...
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I don't need to do a critical care fellowship because I don't want to do exclusively critical care. What becomes critical care in your book is cut and dry simple in my book. Septic and hypotensive. Broad spectrum antibiotics with fluids first and if that doesn't work pressors. If the oxygen is tanking despite optimization of fluids and pressor mix they get put on the vent. If I feel like a consultant can add something or I want pulmonology to manage the vent I consult pulmonolgy. As a matter of fact it can be so cut and dry simple that icu patients can be much easier than floor patients because alot of the time there is not even a question as to what needs to be done. The nice liitle "critical care" club doesn't exist in the real world outside your fellowships and academic institutions where you play your supposed "super doctor" roll. In the real world doctors do what they are comfortable with and that changes depending on what kind of work they do on a daily basis.
 
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MedicineDoc said:
I don't need to do a critical care fellowship because I don't want to do exclusively critical care. What becomes critical care in your book is cut and dry simple in my book. Septic and hypotensive. Broad spectrum antibiotics with fluids first and if that doesn't work pressors. If the oxygen is tanking despite optimization of fluids and pressor mix they get put on the vent. If I feel like a consultant can add something or I want pulmonology to manage the vent I consult pulmonolgy. As a matter of fact it can be so cut and dry simple that icu patients can be much easier than floor patients because alot of the time there is not even a question as to what needs to be done. The nice liitle "critical care" club doesn't exist in the real world outside your fellowships and academic institutions where you play your supposed "super doctor" roll. In the real world doctors do what they are comfortable with and that changes depending on what kind of work they do on a daily basis.
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Having spent a good third of my residency in dedicated ICU time and now fellowship, it scares me that someone with so little critical care experience would be so cavalier... perhaps you are a "super doctor". I think more likely it is a case of you don't know what you don't know.
 
MedicineDoc said:
I don't need to do a critical care fellowship because I don't want to do exclusively critical care. What becomes critical care in your book is cut and dry simple in my book. Septic and hypotensive. Broad spectrum antibiotics with fluids first and if that doesn't work pressors. If the oxygen is tanking despite optimization of fluids and pressor mix they get put on the vent. If I feel like a consultant can add something or I want pulmonology to manage the vent I consult pulmonolgy. As a matter of fact it can be so cut and dry simple that icu patients can be much easier than floor patients because alot of the time there is not even a question as to what needs to be done. The nice liitle "critical care" club doesn't exist in the real world outside your fellowships and academic institutions where you play your supposed "super doctor" roll. In the real world doctors do what they are comfortable with and that changes depending on what kind of work they do on a daily basis.
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the fact that you think critical care is "cut and dry simple" scares me beyond belief...because you're not just arrogant...you're dangerous.
 
I guess that's why my mortality is way below my expected mortality. "You don't know what you don't know". You think I can't listen to someone's lungs and see if they sound wet? I can't order a chest X-ray and see pulmonary edema? I can't order a bnp and see if it high or low? I cant see JVD?I can't measure fluid in and urine out per hour? I can't look to see if the urine is dark? I can't order an echocardiogram if needed? I can't titrate lasix? I can't order pan cultures? You think I don't know my antibiotics? You think i dont know my pressors there isnt exactly that many of them. What the hell are you people talking about. That crap is super easy. What the real deal is the people who think they are hot **** critical care docs get so absorbed in their egos and hypothesis that they only cover that one base instead of covering them all and the patient winds up paying the price sooner or later whether its waiting to long to start antibiotics or not going broad and strong fast enough.
 
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MedicineDoc said:
I don't need to do a critical care fellowship because I don't want to do exclusively critical care. What becomes critical care in your book is cut and dry simple in my book. Septic and hypotensive. Broad spectrum antibiotics with fluids first and if that doesn't work pressors. If the oxygen is tanking despite optimization of fluids and pressor mix they get put on the vent. If I feel like a consultant can add something or I want pulmonology to manage the vent I consult pulmonolgy. As a matter of fact it can be so cut and dry simple that icu patients can be much easier than floor patients because alot of the time there is not even a question as to what needs to be done. The nice liitle "critical care" club doesn't exist in the real world outside your fellowships and academic institutions where you play your supposed "super doctor" roll. In the real world doctors do what they are comfortable with and that changes depending on what kind of work they do on a daily basis.
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I have felt very comfortable in the MICU since day one of itnernship. I have always wanted to be an intensivist. Things just slow down for me in here and I always feel like I am in control. I have felt like I know what I am doing and how to handle nearly every situation thrown at me throughout residency, even when my attedning hospitalist was makign it clear they had no idea wtf to do.

that said.

I have told my self on a daily basis. Do not get complacent. Do not think you know everything you need to know. The day that happens is the day you start killing people. There is a reason critical care fellowships exist. There is a reason I will eventually be doing one.

Im sure you feel you know plenty of cardiology. Maybe enough that you dont ever need a consultant. I have met people along the way like you. And my thoughts echo Instates and Roks. You are dangerous. I dont care if I am a brand new intern and you are an attending with 10 years experience. You have reached a point where you feel you know what you need to know to run a MICU with nothing but a family medicine residency for a training platform. That is dangerous. I think I am pretty cavalier and I have spent nearly 40% of an IM residency exclusively in the ICU. And I will be running this ICU for 2 years as an attending. And at the end of those 2 years, I will still be talking to my wife about when can I do the fellowship. It is borderline insane to think that you are equipped enough to carryon otherwise and an insult to intensivists everywhere. But I have come to expect this from FPs who think that everyone should just do FP and not bother with fellowships because FP teaches you everything you need to know about everything. to use your own wording, the superdoc.

Dangerous.
 
I worked in a particular hospital for a year as a hospitalist with an icu that was "co-managed" with an intensivist that could be consulted or automatically picked up patients with a pulmonary consult if the pt went to the unit with a prexisting pulmonology consult. The pulmonologists at this hospital only saw floor patients and then picked their consults back up after the pt came out of the unit. I noticed the difference between the intensivist and the pulmonologists was the pulmonologists were better at working as part of a team while the intensivist was more likely to butt heads with other specialists such as cardiology or neurology and feel like it was beneath them to get on the phone and discuss a case. That is the role of the hospitalist to know what the patient needs and talk with everyone who could potentially help the patient. Of course i defer to specialists regarding their area of practice once consulted but when a particular specialist tries to take total control of all aspects of the care with stepping on other specialties im not all that excited about working with them unless i dont have a pulmonologist and have a complicated vent patient. Another thing I noticed was this particular intensivist had "NP intensivists" that covered them at night did a lot of questionable stuff.
 
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With rare exceptions, pulmonologists are cc trained
 
There are plenty of practicing pulmonologist without "critical care" training most of the older pulmonologist think "critical care" board certification was a bogus power move as stated above.
 
MedicineDoc said:
There are plenty of practicing pulmonologist without "critical care" training most of the older pulmonologist think "critical care" board certification was a bogus power move as stated above.
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Yeah, the older generation as in ancient generation. Most of these guys are going the way of the dinosaur, and "most" of them don't think that critical care was a "bogus power move". I can appreciate that at your boonies hospital you may find a few guys who think that way, but I've not run into that attitude at all, even from the pulmonary guys who came to critical care before there was a board.

So I don't know who's anecdote wins, but I'd bet money I know a few more pulmonologists than you do. Heh.

I'm personally not of the opinion that every patient in an ICU everywhere that requires the nursing also requires an intensivist. I'm not interested in closing every single ICU everywhere - though where I train a closed ICU is the best idea given the acuity and complexity of illness. Some of the cases you have described in here wouldn't even make it into our ICU where I'm training, and if you ever need someone to tell you how to deal with or run a vent, you are not a critical care doc.

I honestly don't know what you are personally getting out of posting in this thread still. I don't understand your angle here.
 
jdh71 said:
I honestly don't know what you are personally getting out of posting in this thread still. I don't understand your angle here.
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I could say the same thing about myself
 
I don't have an angle I'm posting replies by my cellphone to posts mostly while working nightshifts waiting for calls on new admits after they mounted the tv over the bed presumably to discourage me from watching tv while lying in bed.
 
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MedicineDoc said:
I don't need to do a critical care fellowship because I don't want to do exclusively critical care. What becomes critical care in your book is cut and dry simple in my book. Septic and hypotensive. Broad spectrum antibiotics with fluids first and if that doesn't work pressors. If the oxygen is tanking despite optimization of fluids and pressor mix they get put on the vent. If I feel like a consultant can add something or I want pulmonology to manage the vent I consult pulmonolgy. As a matter of fact it can be so cut and dry simple that icu patients can be much easier than floor patients because alot of the time there is not even a question as to what needs to be done. The nice liitle "critical care" club doesn't exist in the real world outside your fellowships and academic institutions where you play your supposed "super doctor" roll. In the real world doctors do what they are comfortable with and that changes depending on what kind of work they do on a daily basis.
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Wow.

Just wow.
 
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