WHy is critical care silly?

[deleted171991]

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That sounds enough for me to pursue CCM, figuring that I wont be earning less whilst doing what I like

IF you find a job doing both. IF! Also, don't expect to really like that combined job, because, if the job were good, they wouldn't hire fresh grads for it (most academic places have more than enough intensivists already). Basically, by doing CCM, you severely limit both your future job market (mostly to academia), and your future earnings.

Unless CCM is THE ONE (or you want to do 100% critical care and give up anesthesia), stay away, my friend. Just my 2 cents. For me, it is, but I am also the kind of guy whose definition of fun includes reading a good CCM or IM book (while reminding myself how little I know).

 

[Dam272]

IF you find a job doing both. IF! Also, don't expect to really like that combined job, because, if the job were good, they wouldn't hire fresh grads for it (most academic places have more than enough intensivists already). Basically, by doing CCM, you severely limit both your future job market (mostly to academia), and your future earnings.

Unless CCM is THE ONE (or you want to do 100% critical care and give up anesthesia), stay away, my friend. Just my 2 cents. For me, it is, but I am also the kind of guy whose definition of fun includes reading a good CCM or IM book (while reminding myself how little I know).

Thank you for your honest opinion. That practically defines me as well. Love CCM but I love money too .

 

[deleted547339]

This is real life ICU care in the US:

ACP Journals

Setting:
123 ICUs in 100 U.S. hospitals.
Patients:
101 832 critically ill adults.

Conclusion:
In a large sample of ICU patients in the United States, the odds of hospital mortality were higher for patients managed by critical care physicians than those who were not. Additional studies are needed to further evaluate these results and clarify the mechanisms by which they might occur.

Not really all that surprising. I try to send as few patients as possible to an LTAC. I send a lot of my patients to palliative instead of putting them through hell for a couple more months. Family uniformly thank me. I also suspect a lot of the non-intensivists were surgeons who need to keep folks alive for numbers.

 

[MoMoGesiologist]

Editors’ Notes

Context

• Critical care physicians or physicians without specialized critical care training may manage patients in intensive care units.

Contribution

• This study described 101 832 patients in 123 intensive care units in the United States. Patients managed by critical care physicians were sicker, had more procedures, and had higher hospital mortality rates than those managed by other physicians. Analyses that adjusted for severity of illness and the tendency for sicker patients to be managed by critical care specialists still showed higher mortality among patients managed by the specialists.

Caution

• Unrecognized confounders might diminish or invalidate the unexpected finding of higher mortality among patients managed by critical care specialists.

—The Editors

But did crit care docs generate more RVUs?! That’s all that matters in our healthcare system unfortunately...

 

[deleted547339]

But did crit care docs generate more RVUs?! That’s all that matters in our healthcare system unfortunately...

So myopic, people also care about clabsis and cautis and anything else that is publicly reportable, lol.

 

[Drangue]

I liked ICU. However, I did not like having patients die. The central conceit of anesthesia that sold me on it was that none of my patients are ever supposed to die. I’m always tasked with saving. ICU violates that principle.

What? Anesthesia is high risk. I always read and was taught that you prepare for the worst. You expect death.

I picture an Anesthesiologist as a war-torn hero who has seen death and survived through it all.

 

[Laryngophed]

What? I don’t even understand what you’re asking.

Where I did fellowship (top ivory tower institution), everyone used to get admitted under the name of the MICU medical director. For about a decade, he had the highest mortality in the state, maybe the country. He was probably the best doctor I’ve ever met but his numbers were arguably the worst, as we were the last house on the block. He was the kind of guy that could walk by a room and say “they have tularemia” “sounds like EBV-induced HLH” or stop the intern and say “go ahead and page heme, it’s going to be TTP” two sentences into a presentation - and always be right.

I get that it looks like fentanyl, propofol, low volume ventilation, seroquel, insulin, vanc/zosyn and consults to the outside world, but that’s a very myopic view.

It’s a bummer he left. His contemporary is still awesome and has taught me so much in the few weeks I’ve gotten to be on service with him.

 

[deleted547339]

It’s a bummer he left. His contemporary is still awesome and has taught me so much in the few weeks I’ve gotten to be on service with him.

Not who you’re thinking of. The guy before him.

 

[Twiggidy]

What? Anesthesia is high risk. I always read and was taught that you prepare for the worst. You expect death.

I picture an Anesthesiologist as a war-torn hero who has seen death and survived through it all.

Anesthesia is as safe as it has ever been. Why do you think they let nurses administer it? Think about all the patients age 70 > greater with multiple co-morbidities that walk in and out of surgery, sometimes multiple times. An anesthesiologists walking into work expecting his patients to die is like a pilot expecting the plane to crash, and for God's sake I hope the latter isn't true.

 

[Drangue]

Anesthesia is as safe as it has ever been. Why do you think they let nurses administer it? Think about all the patients age 70 > greater with multiple co-morbidities that walk in and out of surgery, sometimes multiple times. An anesthesiologists walking into work expecting his patients to die is like a pilot expecting the plane to crash, and for God's sake I hope the latter isn't true.

Alright, poorly worded. I didn't mean they are expecting, but at least 'prepared' for the worst?

 

[leviathan]

I liked ICU. However, I did not like having patients die. The central conceit of anesthesia that sold me on it was that none of my patients are ever supposed to die. I’m always tasked with saving. ICU violates that principle.

It's a reasonable perspective. Your job in the OR is to never palliate, but it's our job to do so when we're providing futile care. It's sadly not that infrequent that we're palliating patients who started getting that futile care in the OR before landing in the ICU.

 

[dannyboy1]

It's a reasonable perspective. Your job in the OR is to never palliate, but it's our job to do so when we're providing futile care. It's sadly not that infrequent that we're palliating patients who started getting that futile care in the OR before landing in the ICU.

I don’t book the procedures. But no way in hell is a patient dying on me in the OR if it can be avoided. The can die in the ICU as god intended.....

 

[chocomorsel]

I don’t book the procedures. But no way in hell is a patient dying on me in the OR if it can be avoided. The can die in the ICU as god intended.....

Sometimes it cannot be avoided.

 

[deleted171991]

I don’t book the procedures. But no way in hell is a patient dying on me in the OR if it can be avoided. The can die in the ICU as god intended.....

Actually, they should die at home, in their own bed, among their loved ones.

 

[MoMoGesiologist]

Actually, they should die at home, in their own bed, among their loved ones.

How much can the hospital bill for that?