2 year CC fellowship after IM

[igcgnerd]

How is the job market for internists who do a 2 year fellowship in CC? Especially if they want the majority of their practice to be ICU shift work type of arrangement.

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[jdh71]

How is the job market for internists who do a 2 year fellowship in CC? Especially if they want the majority of their practice to be ICU shift work type of arrangement.

It's good generally but starting to saturate in certain "desirable" markets. You may end up with more night and weekends in those places starting off.

 

[ajleyva]

I don't mean to hijack the forum, but I thought this would be a relevant question: is there an avantage technically in doing a P/CCM over a two year CCM program? It may be premature for me to consider this, but right now it's what am interested in: IM and CCM, I don't want to bother with pulmonary but it seems the most conventional way to go through IM to CCM. I was wondering anyone's thoughts on this, preferably residents, fellows, and attendings.

 

[inspirationmd]

I don't mean to hijack the forum, but I thought this would be a relevant question: is there an avantage technically in doing a P/CCM over a two year CCM program? It may be premature for me to consider this, but right now it's what am interested in: IM and CCM, I don't want to bother with pulmonary but it seems the most conventional way to go through IM to CCM. I was wondering anyone's thoughts on this, preferably residents, fellows, and attendings.

Doing a Pulm-CC fellowship makes you more marketable from what I hear which translates into more job opportunities. This is mainly since you can truly be a part of the group and share in all the calls. There are some job openings out there for strictly intensivists but they are a bit more few and far between. Who you know is going to be key.

I am thinking about doing a critical care fellowship after my residency but I am doing very thorough research on practice patterns and demand for my desired areas before I commit. I am aware of a few ID and Nephro fellows who are doing 1 year CC fellowships after their original IM-subspecialty training which will be very marketable for them. Seems to me that if you are not Pulm-CC then you need to have something that will appeal to a Pulm-CC dominant group (private>academia) since you won't be able to do Pulm consults/clinic. If you are strictly IM-CC then maybe something like ECMO, TEE skills, still being able to Bronch, etc would be my guess but I am still looking into it so take it with a grain of salt.

Perhaps JDH or one of the other Pulm-CC experts will comment.

 

[redy]

If I am not mistaken the big thing about pulm CC is that once you burn out with ICU you can retreat/fall back on the pulmonary part for a more relaxed lifestyle. Like one of our attendings at my hospital who went to become chief of pulmonary at another hospital and no longer does any ICU.

Having said that if you did CC after IM I guess you could similarly fall back on IM for a relaxed lifestyle.

There may also be a slight advantage to doing pulmonary as it can help with vent mgmt although perhaps the same can be said of doing ID can help with Abx or doing Renal can help with fluid management.

The other issue is I actually thought that shift based work for intensivists is on the rise and demand for nocturnal intensivist also on the rise. I guess that kind of jobs dont leave much room for pulmonary.

Personally I love pulmonary too and so I chose that.

 

[ajleyva]

Doing a Pulm-CC fellowship makes you more marketable from what I hear which translates into more job opportunities. This is mainly since you can truly be a part of the group and share in all the calls. There are some job openings out there for strictly intensivists but they are a bit more few and far between. Who you know is going to be key.

I am thinking about doing a critical care fellowship after my residency but I am doing very thorough research on practice patterns and demand for my desired areas before I commit. I am aware of a few ID and Nephro fellows who are doing 1 year CC fellowships after their original IM-subspecialty training which will be very marketable for them. Seems to me that if you are not Pulm-CC then you need to have something that will appeal to a Pulm-CC dominant group (private>academia) since you won't be able to do Pulm consults/clinic. If you are strictly IM-CC then maybe something like ECMO, TEE skills, still being able to Bronch, etc would be my guess but I am still looking into it so take it with a grain of salt.

Perhaps JDH or one of the other Pulm-CC experts will comment.

The reason being is that I'm interested in primary care as well, which is what I would hope to do when I'm not in the ICU. As I understand it, few dedicate their entire practice to CCM for burnout reasons. With this being said, instead of falling back doing pulmonary clinic, I would return to my primary care patients. This is the reason I'm adverse to pulmonary; because I'm not interested in practicing it at all outside of the ICU, so I don't see it economically viable to spend the extra time for it.

I suppose I could go a step further and say (without knowing exactly how this works) if a patient of mine is hospitalized, then I can round on them on the general medicine floor and follow them to the ICU if needed. Of course, this depends on many things such as hospital privileges, institutional policies, open vs closes ICUs, etc. But I can dream.

 

[Hernandez]

The reason being is that I'm interested in primary care as well, which is what I would hope to do when I'm not in the ICU. As I understand it, few dedicate their entire practice to CCM for burnout reasons. With this being said, instead of falling back doing pulmonary clinic, I would return to my primary care patients. This is the reason I'm adverse to pulmonary; because I'm not interested in practicing it at all outside of the ICU, so I don't see it economically viable to spend the extra time for it.

I suppose I could go a step further and say (without knowing exactly how this works) if a patient of mine is hospitalized, then I can round on them on the general medicine floor and follow them to the ICU if needed. Of course, this depends on many things such as hospital privileges, institutional policies, open vs closes ICUs, etc. But I can dream.

 

[ajleyva]

Would you care to elaborate? I would love the input.

 

[Hernandez]

Would you care to elaborate? I would love the input.

It's like say IM/EM guys, it's ungodly rare to see someone actually do IM, often time due to the salary discrepancies. After working ICU, the last thing I want to deal with is the bull**** insurance companies and bogus complaints and pain seekers for a pittance. Then the next question is, who is going to cover your primary care office when your in the office? You can't run away from a code to see a sick visit, or push off doing a procedure to do a pap. If you're n the ICU, you need to be in the ICU. Then the next question is, who's going to hire you? There is a massive shortage of CC docs, many don't need a primary care intensivist. Then if you're doing the old school IM, where you have office, in pts, and even cover your ICU pts, good luck with that life style, you're pager will..... never ......stop.........

 

[ajleyva]

It's like say IM/EM guys, it's ungodly rare to see someone actually do IM, often time due to the salary discrepancies. After working ICU, the last thing I want to deal with is the bull**** insurance companies and bogus complaints and pain seekers for a pittance. Then the next question is, who is going to cover your primary care office when your in the office? You can't run away from a code to see a sick visit, or push off doing a procedure to do a pap. If you're n the ICU, you need to be in the ICU. Then the next question is, who's going to hire you? There is a massive shortage of CC docs, many don't need a primary care intensivist. Then if you're doing the old school IM, where you have office, in pts, and even cover your ICU pts, good luck with that life style, you're pager will..... never ......stop.........

I've thought of some of these things before as well, albeit (obviously) not extensively. So it is safer to assume that it would be easier to be a hospitalist working in the ICU, then? I feel like this (being only IM/CCM) would be easier to accomplish in academia versus in private practice (based on what you told me), I suppose unless I joined a hospitalist group?

Could I pick your brain about this, too: I'm also interested in anesthesiology. Do you know how common it is for an anesthesiologist-intensivist to practice in a MICU as well as a SICU (in both academic and private hospitals)? I, personally, would like to practice in both, but I suppose at the end of the day I'm more interested (or rather more motivated) to work in the MICU.

I really appreciate your responses; they're really informative and I feel like they're clearing up a lot of the assumptions I'm making (I am only premed after all). Thank you!

 

[Hernandez]

Re anesthisia, you like pay cuts? As you will make less as a gas-icu doc. Than as gas doc. So some work in MICU? Yes. It in theory, it's possible, but I'm theory America can still put a man on the moon.

 

[ajleyva]

Re anesthisia, you like pay cuts? As you will make less as a gas-icu doc. Than as gas doc. So some work in MICU? Yes. It in theory, it's possible, but I'm theory America can still put a man on the moon.

I am aware of the pay cut and I'm certain I wouldn't mind it. I'm not entirely concerned with the money, more with the art. I suppose at the end of the day I won't really know where I want to go until medical school. I do know I want to practice critical care medicine, though. Thank you for your time and replies, good sir.

 

[nlax30]

One of our hospitalists is IM/CC trained and so he sees a combo of regular floor pts as well as ICU pts. The other hospitalists on the group are strictly IM. At least here they're still allowed to manage pts in the ICU but will transfer to the IM/CC guy if they are vented or truly require CC.... procedures, bronch, etc...

That of course will vary on the hospital/ ICU policies and the hospitalist group.

Ultimately I guess he could give up the CC portion and just do IM work, but honestly, between the social work aspect/headaches of a general floor pt, I'm not sure that's much less stressful than his typical ICU duties...

 

[ajleyva]

One of our hospitalists is IM/CC trained and so he sees a combo of regular floor pts as well as ICU pts. The other hospitalists on the group are strictly IM. At least here they're still allowed to manage pts in the ICU but will transfer to the IM/CC guy if they are vented or truly require CC.... procedures, bronch, etc...

That of course will vary on the hospital/ ICU policies and the hospitalist group.

Ultimately I guess he could give up the CC portion and just do IM work, but honestly, between the social work aspect/headaches of a general floor pt, I'm not sure that's much less stressful than his typical ICU duties...

That's a really helpful sentiment. Do you have any idea what kind of pts the IM/CC doc manages in the ICU?

On a relative tangent, it's interesting. I was looking at Pitt's CCM fellowships websites and comparing the sample rotations between the IM pathway and anesthesia and it seems that anesthesia's training is geared strictly toward the surgical patient; this makes sense. However conversely, the IM fellows seem to rotate in both the medical and surgical ICUs. Granted, the surgical patients IM manages are primarily transplant pts, but I believe I saw a trauma/SICU rotation on there, too. This seems to echo a lot of what I read on here: IM/CC (and pulmonary) seem to manage both pts populations more than anesthesia (whom focuses primarily on surgical pts). Do I have the right idea here? Someone please correct me if I'm wrong.

 

[nlax30]

That's a really helpful sentiment. Do you have any idea what kind of pts the IM/CC doc manages in the ICU?

Basically all sorts of unit patients..... post surgical, intubated, intracranial hemorrhages, septic, CHF, etc.... Technically he doesn't do diagnostic bronchs since he's not pulm trained so on occasion may have to bring a Pulm guy on board but in practice operates like one of the other Pulm/CC teaching attendings.

 

[Hamhock]

That's a really helpful sentiment. Do you have any idea what kind of pts the IM/CC doc manages in the ICU?

On a relative tangent, it's interesting. I was looking at Pitt's CCM fellowships websites and comparing the sample rotations between the IM pathway and anesthesia and it seems that anesthesia's training is geared strictly toward the surgical patient; this makes sense. However conversely, the IM fellows seem to rotate in both the medical and surgical ICUs. Granted, the surgical patients IM manages are primarily transplant pts, but I believe I saw a trauma/SICU rotation on there, too. This seems to echo a lot of what I read on here: IM/CC (and pulmonary) seem to manage both pts populations more than anesthesia (whom focuses primarily on surgical pts). Do I have the right idea here? Someone please correct me if I'm wrong.

I don't think I would use Pitt's CCM program or the IM-CCM 'rotation schedule' as a represetative of "typical" of IM-based CCM fellowships...

HH

 

[ajleyva]

I don't think I would use Pitt's CCM program or the IM-CCM 'rotation schedule' as a represetative of "typical" of IM-based CCM fellowships...

HH

I'm under the impression that their bar is set a bit high?

 

[sylvanthus]

It's like say IM/EM guys, it's ungodly rare to see someone actually do IM, often time due to the salary discrepancies. After working ICU, the last thing I want to deal with is the bull**** insurance companies and bogus complaints and pain seekers for a pittance. Then the next question is, who is going to cover your primary care office when your in the office? You can't run away from a code to see a sick visit, or push off doing a procedure to do a pap. If you're n the ICU, you need to be in the ICU. Then the next question is, who's going to hire you? There is a massive shortage of CC docs, many don't need a primary care intensivist. Then if you're doing the old school IM, where you have office, in pts, and even cover your ICU pts, good luck with that life style, you're pager will..... never ......stop.........

Perhaps you want to read this. If by ungodly rare you mean 44% practice IM at least part-time then yes it is ungodly rare.

http://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2009.00503.x/full

 

[Hernandez]

Anecdotally that has not been my experience with a n>20. I only know 2 people who have done any IM post graduation. But anecdote < data.

 

[NNguyenMD]

As an IM/CC fellow looking for jobs, the jobs for PCCM are definitely more available. There are physician groups that only do CCM without pulmonary clinics or practices, the more often than not the group practices are PCCM. That said, a physician group that handles both a pulmonary practice AND critical care coverage for hospitals it is contracted with is a MUCH different job that someone who works in a group that exclusively does CCM. In a pulmonary practice the days you're not in the ICU you are expected to manage your pulmonary practice, that means taking calls at night for outpatient practice and for pulmonary consult, scheduling bronchs, getting to tumor board, and seeing your patients.
A critical care group practice is very similar to a Hospitalist group or an emergency Medici e group where it is designed around shift work. And when you are off, you are off. There are certainly areas in Pulmonary that are very interesting, and if you have a strong desire to make it apart of your career, such as lung cancer, CF, sleep, transplant, chronic ventilator management, or asthma, it's definitely something you should into. But keep in mind that a PCCM physician job will expect more output from you in the days you are not in the ICU.

 

[NNguyenMD]

As an IM/CC fellow looking for jobs, the jobs for PCCM are definitely more available. There are physician groups that only do CCM without pulmonary clinics or practices, the more often than not the group practices are PCCM. That said, a physician group that handles both a pulmonary practice AND critical care coverage for hospitals it is contracted with is a MUCH different job that someone who works in a group that exclusively does CCM. In a pulmonary practice the days you're not in the ICU you are expected to manage your pulmonary practice, that means taking calls at night for outpatient practice and for pulmonary consult, scheduling bronchs, getting to tumor board, and seeing your patients.
A critical care group practice is very similar to a Hospitalist group or an emergency Medici e group where it is designed around shift work. And when you are off, you are off. There are certainly areas in Pulmonary that are very interesting, and if you have a strong desire to make it apart of your career, such as lung cancer, CF, sleep, transplant, chronic ventilator management, or asthma, it's definitely something you should into. But keep in mind that a PCCM physician job will expect more output from you in the days you are not in the ICU.

 

[sirvandy]

I'm trying to figure out how to apply to the 2-year medicine critical care fellowships. It's surprisingly difficult, because none of the websites- NRMP, ERAS, etc., have any direct link to applying to the 2-y programs. NRMP seems to support the 3-y plum/CC fellowship match, but does not even mention the 2-y CC fellowship match. ERAS has a listing of the 33 CC fellowships, but no link for applying to them. It says that about 2/3 of them participate in the match, and the other 1/3 do not participate in the match and you have to apply directly to them. Furthermore, since I can't find the actual match for the 2-y CC fellowships, I don't have any information about the cost for applying.

The other issue about applying is the cost of applying beyond the application fee. Most of the programs probably require a flight, hotel stay, and rental car, so how one affords all this on a resident's salary is a big question. I'm starting to think the best option is just to work as a hospitalist for a year or two, and if I still have a hankering for CC medicine, to maybe consider applying at that time. My salary and schedule would be much more conducive to the application process.

Speaking of being a hospitalist, if you're able to get a hospitalist gig at a hospital that has an open ICU, then maybe you can gets your fill of ICU pts w/out doing a fellowship. Plus since you would have some less-intense floor pts and some ortho consults, perhaps the "ICU burnout" would be less.

The other thing I'm trying to figure out is the salary difference between working as a hospitalist versus as an intensivist. Any data out there?

Thanks!!

 

[deuist]

IM-CC is outside of the Match. That's probably why you don't see it. ERAS is used for applications to some programs, but many other want directly emailed CV's.

 

[NNguyenMD]

As I last remember from applying to fellowship, you can apply for CCM fellowship through ERAS, but there is no match. So you can get offers well before match day. You may even get an offer after your first interview.

As far as working as a hospitalist and covering ICU beds. This is more practical in smaller hospitals with lower acuity patients, where the ICU demands are less. There is a skill set you need to acquire to take care of higher acuity patients, such therapeutic bronchoscopy, chest tube placement, DIFFICULT airway management in addition to standard airway management, management of advance ventilator modes, and temporary pacemaker insertion and management.

Certainly there are institution where you can outsource many of these procedures and tasks to consultants, but the ability to perform these skills competently is among the many other prerequisites of what makes an intensivist.

Intensivist pay varies widely. There are some places where intensivists are paid less than hospitalist. In general, ICU billing is a high level of billing and a busy unit with more complex patients and procedure will lead to higher RVUs and higher billing overall. Hence, you will make more money if your contract is set up such as way where you benefit from productivity. This is a job you will find in a private practice physician group model.

If you are looking for salary pay, you are looking at a starting base salary starting as low as $210,000 academic centers, In community hospitals starting ranges from $230,000-280,000. However that is base pay, many jobs offer productivity incentives. I found one academic non-tenure track clinical instructor job where base salary was $230,000, with RVU bonuses over $50,000 for productivity. This was in a very major city. On the flip side, I found an academic job in the same city that paid a base of $180,000, with some billing incentives that is spilt among the physician group, and a $10,000 sign on bonus. That job was a nocturnal job, but in a mostly supervisory role over the fellows. None of these academic jobs were 7 on and off, there were 7 on in the ICU, and the off days where administrative.

Community jobs are better if you think about it as an hourly or "shift" wage. I found a community job, also in a very major city, that paid on the order of $1700 a 12hr shift, for a minumum of 15 shifts a month. That comes out to $306,000 a year. If you work more you get paid more. But not billing incentives.

There are lots of jobs out there. The burn out in ICU medicine is similar to the burnout faced by EM and Hospitalist. Hence why people do pulmonary as well. Jobs in Renal/CC and ID/CC are exceedingly rare, and difficult to find a scenario where you get to do both specialties. Pulmonary as I said in my last post is a harder job overall. There are fewer true off days, but you do have the back-up of have a pulmoanry practice to fall back on if you get tired of the ICU.

Feel free to email or IM if you have any other questions.

 

[Bostonredsox]

As I last remember from applying to fellowship, you can apply for CCM fellowship through ERAS, but there is no match. So you can get offers well before match day. You may even get an offer after your first interview.

As far as working as a hospitalist and covering ICU beds. This is more practical in smaller hospitals with lower acuity patients, where the ICU demands are less. There is a skill set you need to acquire to take care of higher acuity patients, such therapeutic bronchoscopy, chest tube placement, DIFFICULT airway management in addition to standard airway management, management of advance ventilator modes, and temporary pacemaker insertion and management.

Certainly there are institution where you can outsource many of these procedures and tasks to consultants, but the ability to perform these skills competently is among the many other prerequisites of what makes an intensivist.

Intensivist pay varies widely. There are some places where intensivists are paid less than hospitalist. In general, ICU billing is a high level of billing and a busy unit with more complex patients and procedure will lead to higher RVUs and higher billing overall. Hence, you will make more money if your contract is set up such as way where you benefit from productivity. This is a job you will find in a private practice physician group model.

If you are looking for salary pay, you are looking at a starting base salary starting as low as $210,000 academic centers, In community hospitals starting ranges from $230,000-280,000. However that is base pay, many jobs offer productivity incentives. I found one academic non-tenure track clinical instructor job where base salary was $230,000, with RVU bonuses over $50,000 for productivity. This was in a very major city. On the flip side, I found an academic job in the same city that paid a base of $180,000, with some billing incentives that is spilt among the physician group, and a $10,000 sign on bonus. That job was a nocturnal job, but in a mostly supervisory role over the fellows. None of these academic jobs were 7 on and off, there were 7 on in the ICU, and the off days where administrative.

Community jobs are better if you think about it as an hourly or "shift" wage. I found a community job, also in a very major city, that paid on the order of $1700 a 12hr shift, for a minumum of 15 shifts a month. That comes out to $306,000 a year. If you work more you get paid more. But not billing incentives.

There are lots of jobs out there. The burn out in ICU medicine is similar to the burnout faced by EM and Hospitalist. Hence why people do pulmonary as well. Jobs in Renal/CC and ID/CC are exceedingly rare, and difficult to find a scenario where you get to do both specialties. Pulmonary as I said in my last post is a harder job overall. There are fewer true off days, but you do have the back-up of have a pulmoanry practice to fall back on if you get tired of the ICU.

Feel free to email or IM if you have any other questions.

This is the job I have always wanted. I have talked to some of my friends higher up the chain in the hospitalist world and they said once the SHM comes out with its own hospitalist medicine boarding, the one year CCM fellowship for boarded hospitalists with 5 years experience will happen. The demand is just too high. And frankly if you are a IM trained hospitalist with 5 years experience caring for ICU patients, one year is sufficient IMO. 6 months of the current 2 years is research. the other 6 months is offset IMO by your 5 years experience as an IM attending caring for unit patients. So my plan now which coincides with the needs of my fam is 3-5 years as hospitalist, most of the time I will be solely seeing the unit patients as the primary attending, wait for the fellowship change, take a one year slot, then after its completed, take a job as a 7 on 7 off intensivist at a community hospital for 1500-2000 per shift. If I can make 325k to work week on week off as a pure intensivist.....well, that would be the life for me.

 

[NNguyenMD]

Best if luck to you Bostonredsox! The demand for CCM is definitely high, and I foresee a healthy job market in the coming years. A few general tips, during my own job search I was asked at each interview what procedures I knew and what my numbers were. I was also asked if I knew more advanced procedures such as percutaneous tracheostomy or any advanced bronchoscope modalities. My point is, the more things you know how to do, the more marketable you are as an intensivist. So in that one year you do fellowship, crank up your procedural numbers like crazy, ESPECIALLY for intubations! Also certifying in Echo and bedside ultrasound is the future of this field, and something you should seriously consider. The ACCP has an excellent albeit expensive process to certify in ultrasound. Goodluck!

 

[Bostonredsox]

Best if luck to you Bostonredsox! The demand for CCM is definitely high, and I foresee a healthy job market in the coming years. A few general tips, during my own job search I was asked at each interview what procedures I knew and what my numbers were. I was also asked if I knew more advanced procedures such as percutaneous tracheostomy or any advanced bronchoscope modalities. My point is, the more things you know how to do, the more marketable you are as an intensivist. So in that one year you do fellowship, crank up your procedural numbers like crazy, ESPECIALLY for intubations! Also certifying in Echo and bedside ultrasound is the future of this field, and something you should seriously consider. The ACCP has an excellent albeit expensive process to certify in ultrasound. Goodluck!

Im up near 400 procedures already at the start of pgy3. My perc trachs are nearing double digits. 4 ICU months this year still so I should easily break 500 by the end of residency. Therapeutic bronchs are in the teens still unfortunately. Transvenous pacers should be 10-12 by gradiation. I have difficult airway done and I'm enrolling in the accp US course with one of the MICU attendings this spring. Im doing bedside US on nearly every patient in the unit, purely for practice. Procedures definitely won't be a problem. The ABIM/ACCP granting me board eligibility if I can get a one year slot is the hurdle I'm hoping can be cleared.

 

[deuist]

The ACCP has an excellent albeit expensive process to certify in ultrasound. Goodluck!

I'm looking over the ACCP requirements for US credentialing and they're a bunch of ****. The knowledge you gain from a few away conferences is not enough to know how to properly perform these exams. In addition, the required number of images is a paltry introduction to ultrasound that emergency medicine interns perform in their first week on their ultrasound rotation. Typically, ED docs prefer the RDMS certificate. It requires 800 scans per organ system to be credentialed. The ACCP certificate seems like a money making scheme to me. I see that it offers additional certificates in bronchoscopy, vent management, and airway management. Aren't those things that any intensivist should know how to do anyway?

 

[Hernandez]

. I see that it offers additional certificates in bronchoscopy, vent management, and airway management. Aren't those things that any intensivist should know how to do anyway?

You're intensivists are comfortable with all difficult airway technique and do EBUS/TBNA in the ICU?

And there is vent management and there is vent management. Not every intensivist is the same.

 

[deuist]

You're intensivists are comfortable with all difficult airway technique and do EBUS/TBNA in the ICU?

And there is vent management and there is vent management. Not every intensivist is the same.

Some of the intensivists I've work with indeed do not handle difficult airways, but they should learn how. Anesthesiologists aren't in the building 24 hours a day if something goes wrong. As far as the bronchoscopy certificate is concerned, I see that you can learn Endobronchial Ultrasound in just 2 days. My friends who went into pulmonary have been wasting their time. I also see that ACCP is developing a Critical Care Management certificate

 

[Hernandez]

Some of the intensivists I've work with indeed do not handle difficult airways, but they should learn how. Anesthesiologists aren't in the building 24 hours a day if something goes wrong. As far as the bronchoscopy certificate is concerned, I see that you can learn Endobronchial Ultrasound in just 2 days. My friends who went into pulmonary have been wasting their time. I also see that ACCP is developing a Critical Care Management certificate

You seem to be very angry about people wanting extra training. Keep in mind that EBUS is a relatively new modality in routine use, and half of my partners don't use it as they've never seen one, so for people who weren't trained on it, that course makes perfect sense.

In a perfect world, yes all Intensivists should handle difficult airways, but the simple fact is many places there is a turf war with Anesthesia or the program PREFERS to let Anesthesia handle the airway. I'm fine with most airways and many difficult airways, but due to my training institution, I will never bill myself as a difficult airway master.

 

[deuist]

My problem with these courses is that for a lot of money, you get to have a few practice sessions with a mannequin and then all of a sudden you're an expert. I have no problem with people wanting to learn new skills. I do have a problem with the way ACCP is touting this training. The ultrasound requirements were particularly surprising to me given the many months of practice that are required to become competent, no less an expert. By the way, there are tons of free resources out there to get started:

http://vimeo.com/aeus
http://www.sonosite.com/education/learning-center