Would you do Critical Care without pulmonology or primary care fallback?

[Kahreek]

Would you chose this career if you didnt have the option to change to outpatient later in life?

Is it something intensivists frequently do?

Is it possible to work in CC through your sixties with joy?

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[Nephro critical care]

I took a rather long and convoluted path to get to critical care and in hindsight I would have done things differently. I did my residency in internal medicine and initially I did not have an idea about what I would do in future. By third year of residency I became interested in nephrology. I though at that time wanted to fix my visa and therefore I became a hospitalist .
Hospitalist jobs especially visa jobs are very busy and after 4 years I was quite burned out. After getting my green card I applied and got into nephrology. Nephrology is simple as a field but the job prospects , the driving around and low salaries are a major drawback. At the end of fellowship I got an opportunity to do a critical care fellowship and took it. Now I work as an intensivist . The job by itself is pretty good and pay is much better than nephrology ( although not much better than hospitalist ) , not busy but the CC part is a killer. Patients are sick , families are upset and worried and sometimes you have a young patient who is going to have a bad outcome and there is absolutely nothing you can do about it. You are constantly hustling and yet you will find other specialities that you depend on i.e GI , heme/onc , IR , surgical specialities dragging their feet and slowing care. The goals of care discussion wear you down after a while .
Ideally I would do part time nephrology and part time CC but unfortunately there are hardly any neph - CC jobs. The job market for straight CC is OK but not as good as pulm - CC . If I had done pulm CC and sleep I would probably do 1 in 4-6 weeks of CC and get some time to decompress in output clinic and read sleep studies. And as I time went by and I grew older I would cut back on the CC and transition to more output stuff. But I don't have that option , so I am not sure what I will do when I am 50. If anyone asks me what I would do I would always advise do pulm - CC not straight CC.

 

[SurfingDoctor]

No one wants to be paged over the noise of their CPAP machine in their 60s.

 

[CCM-MD]

There are several physicians trained in Pulm/CC at the institution I am currently at that have been working as intensivists for 20+ years. Many of the intensivists at my hospital are 50+ and I know for a fact that 2 are over 60. They work a model of 14 shifts per month covering mainly the CTU and MICU but also occasionally the SICU. The fact is that there is a huge demand for intensivists currently as many hospitals are moving towards 24h intensivist coverage. Compensation favors CCM than pulm and I will disagree with whats mentioned previously that compensation for CCM work is not much higher than hospitalist work - its a good 100-150k more than hospitalist work. I can say this based on the most recent MGMA survey and based on offers some of my friends have gotten recently.

There are various models for intensivist work both +/- pulmonary. Pulm/CC jobs are generally 1 week of ICU time per month and the rest in pulmonary clinic and consults. Intensivist work is generally 14-15 shifts per month either 7 on 7 off like the hospitalist model or scattered shifts throughout the month like the ED model.

Some people seem to think working in an outpatient setting is relaxing. I don't find seeing 20+ usually chronically ill patients in the pulmonary clinic "decompressing" at all. Also, sleep is an extra year and since the push for home sleep studies over the last few years, sleep labs have been losing revenue.

There will be a lot of different opinions on this but I personally would much rather work 14 ICU shifts and spend the rest of the time with my family. If you have no interest in outpatient medicine but love everything about the ICU like me, you can safely skip the extra year and do CCM alone. The intensivists I have gotten to know well at my institution, including the older ones, are happy and enjoy what they do. If you're not sure, train in a Pulm/CC program and decide what kind of job you want after you are done.

 

[SurfingDoctor]

An article to peruse. It won't specifically answer your question, but it fits my general experience of no in house calls, weekend only coverage, reduced total work hours, etc. for aging intensivists...

https://www.ncbi.nlm.nih.gov/pubmed/22571306

 

[CCM-MD]

An article to peruse. It won't specifically answer your question, but it fits my general experience of no in house calls, weekend only coverage, reduced total work hours, etc. for aging intensivists...

https://www.ncbi.nlm.nih.gov/pubmed/22571306

Interesting article, I also recommend reading a The Intensivist’s Challenge: Aging and Career Growth in a High-Stress Medical Specialty written by several of the UPMC critical care faculty.

An important thing to note is that these challenges related to aging are not limited to CCM and affect many other specialties as well.

 

[YoungDoc25]

Are you able to do a CCM fellowship after a med/peds residency? Possibly floating back and forth between a MICU and PICU?

 

[SurfingDoctor]

Are you able to do a CCM fellowship after a med/peds residency? Possibly floating back and forth between a MICU and PICU?

Yes. You can pick either, I have never seen someone do both. I suppose one could, but that would be a lot of training.

 

[CCM-MD]

Are you able to do a CCM fellowship after a med/peds residency? Possibly floating back and forth between a MICU and PICU?

If you want to work in both MICU and PICU you will have to do separate fellowships in both adult CCM (2 years) and peds CCM (3 years) after med/peds.

 

[YoungDoc25]

If you want to work in both MICU and PICU you will have to do separate fellowships in both adult CCM (2 years) and peds CCM (3 years) after med/peds.

Ouch! Thanks for the info!

 

[WheezyBaby]

If you want to work in both MICU and PICU you will have to do separate fellowships in both adult CCM (2 years) and peds CCM (3 years) after med/peds.

This isn't strictly true to my knowledge. NMPRA page lists a couple programs that have done 4 year micu/picu fellowships. Regardless, it's certainly an uncommon route

 

[inspirationmd]

If you want to work in both MICU and PICU you will have to do separate fellowships in both adult CCM (2 years) and peds CCM (3 years) after med/peds.

I had an attending who did a combined MICU/PICU fellowship in 4 years at Pitt. Did 50/50 split with some admin on the Adult side. Just left to go back to Pennsylvania to be closer to family. Will do academic adult CCM and private PICU for same health system. Guy is boss and knows his stuff. Not common but can certainly be done.


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[so4u2004so]

If somebody would like to work only for 8-10 years make some cash as young then do business. Would you guys recommend ICU only or Pul/CC?

Thanks

 

[AdmiralChz]

If somebody would like to work only for 8-10 years make some cash as young then do business. Would you guys recommend ICU only or Pul/CC?

Thanks

You're only planning to practice for 8-10 years? I'll spend more than that with medical school + training, but OK...

You'd be better off doing a faster residency and making money sooner. Peds/FM/IM are all 3 years, why add on 2 or 3 more to do a subspecialty when you could be making faculty money?

 

[BigRedBeta]

You'd be better off doing a faster residency and making money sooner. ... you could be making faculty money?

Hahahaha @ "faculty money"

The point is true though, don't spend time in training, go into private practice as quickly as you can because the opportunity cost is so high. Money today is worth more than money in three years.

But if you just want to do business, then go do business. Why waste 4 years on med school and another 3 in training, when you could be making money from age 22 on rather than putting yourself in debt for a couple hundred thou?