Anesthesia based CC

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Bostonredsox

Bostonredsox

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Question. And I admit Im exhausted from a 23 year old IV drug user in MRSA septic shock with a big fat veg who has been trying to die on me for the last 2 hours.....but I had a thought.

Wifey not real keen on 2 year MICU (IM based) fellowship. Definite no to 3 year pulm/cc.

Anesthesia based 1 year CC slots go unfilled alot of the time, as they would rather make sweet bank in the OR.

If I was able to get a 1 year gas based CC slot, I would obviously not be able to take either the gas/cc or IM/cc boards....but......do you think I could still get a gig at a tertiarty care MICU as an intensivist? I will have completed the training...just because of the route cant get the FACCP.

I had a friend do 3 years EM back home followed by 1 year of gas based CC. He is not BE/BC....but he was offered jobs at tertiary care MICUs. All I care about is doing what I love. Less money and no initials for not having the BC dont bother me if I can do the job I want.

Think it is at all a possibility?

And I know MOST IM guys do **** for CC during their 3 years compared with Gas in their 4 hence the extra year of fellowship.....but I have literally double the amount of MICU exposure as the average IM grad.

thanks guys.
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It isnt supposed to be this way, but not having board certification will hurt you later. Either way, go for the option that will garner BC in CCM, if it's critical care that you really want to do.
 
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What about doing something easy that will let you moonlight and make some cash like ID and then doing a 1 Year CC fellowship after? That will allow you to make some 6 figure cash for 2 years while also letting you get a CC board cert for the last year.

But no I don't think they will let you in a fellowship program for critical care in another discipline when IM has a primary board cert in CC. Its alsp far fetched to expect that you will get hired this way with the trend for board cert intensivist picking up. It doesn't hurt to ask but I do not think its going to fly.
 
I know I know I'm just reaching lol. And no to ID then CC. For one, all that did is add an extra year and lost me money. I can make more as a hospitalist than most ID attendings without having to moonlight. And AIDS clinics blow.
And for the record....2 years of ID fellowship which entails 0 critical care allows you to do a 1 year CC fellowship.....but 2-3 years as a CC hospitalist running a 20 bed MICU full time doesn't get you the one year slot. Total bureaucratic bull****.

I know it's gonna take 2 years of CCM. I'm just wishing on a defunct star.
 
Bostonredsox said:
Total bureaucratic bull****.
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This has zero to do with bureaucracy and everything to do with ACGME-verified training. At least with an ID fellowship there is a hope that all fellows graduate with some common set of knowledge a skills. You can't say the same about being a hospitalist.
 
You need to stop focusing on money and realize that fellowship will significantly increase your earning potential. I was in your boat, but decided to go straight into fellowship, I'm glad I did, even if it cost me $15,000/year in interest, and made life difficult with kids and trying to make ends meet mandating I moonlight. If you want to do CC, then I'd highly recommend you suck It up and do at least a 2 year CC fellowship, you will have many more job opportunities with more income potential than CC-hospitalist will ever have.
 
Hernandez said:
You need to stop focusing on money and realize that fellowship will significantly increase your earning potential. I was in your boat, but decided to go straight into fellowship, I'm glad I did, even if it cost me $15,000/year in interest, and made life difficult with kids and trying to make ends meet mandating I moonlight. If you want to do CC, then I'd highly recommend you suck It up and do at least a 2 year CC fellowship, you will have many more job opportunities with more income potential than CC-hospitalist will ever have.
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Agree with this. Might as well rail that the sky is blue instead of green. The days when you can just do critical care based on experience alone are largely gone. Thank the lawyers, politcians, and a reactive healthcare administration (also don't miss the chance for intensivists to make it harder for others to get a piece of their action).

I'm one of those weirdos who actually likes Pulm so this was easy. I think bosox needs to have a long and realistic talk with wifey.
 
Whats the average salary of private practice pulm/cc dude vs that of PP hospitalist? Pulm/cc 275? Hospitalist 240? not a huge difference on average correct? I know this has nothing to do with topic but am curious. It is all about the Benjamin's correct? Not counting the 550k of lost income to train for 3yrs.
 
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VentdependenT said:
Whats the average salary of private practice pulm/cc dude vs that of PP hospitalist? Pulm/cc 275? Hospitalist 240? not a huge difference on average correct? I know this has nothing to do with topic but am curious. It is all about the Benjamin's correct? Not counting the 550k of lost income to train for 3yrs.
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PP Pulm/crit is doing much better than that. More like 350-400.
 
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VentdependenT said:
Whats the average salary of private practice pulm/cc dude vs that of PP hospitalist? Pulm/cc 275? Hospitalist 240? not a huge difference on average correct? I know this has nothing to do with topic but am curious. It is all about the Benjamin's correct? Not counting the 550k of lost income to train for 3yrs.
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Base is ~275. If you're efficient, you'll make way more than that. It depends on how much CC or pulm procedures you do.


mean $331,966
std deviation $114,619
25%tile $255,405
median $325,554
70%tile $396,341
90%tile $476,817
 
one of the fellows told me you could bill around 800 bones for measuring pleural pressures when doing thora. fairly close for reading CPETs as well. Is true?
 
VentdependenT said:
one of the fellows told me you could bill around 800 bones for measuring pleural pressures when doing thora. fairly close for reading CPETs as well. Is true?
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That I don't know about, but I suppose wouldn't surprise me. Make sure you can read CPETs before leaving fellowship.
 
deuist said:
This has zero to do with bureaucracy and everything to do with ACGME-verified training. At least with an ID fellowship there is a hope that all fellows graduate with some common set of knowledge a skills. You can't say the same about being a hospitalist.
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they do. for ID.

They do not partake in any critical care training during those 2 years apart from being an antibiotic recommendation consultant, so they have not increased their critical care knowledge, management skills, or procedural skills compared with the last day of residency. Yet they get to skim a year. Thats my point.
 
jdh71 said:
Agree with this. Might as well rail that the sky is blue instead of green. The days when you can just do critical care based on experience alone are largely gone. Thank the lawyers, politcians, and a reactive healthcare administration (also don't miss the chance for intensivists to make it harder for others to get a piece of their action).

I'm one of those weirdos who actually likes Pulm so this was easy. I think bosox needs to have a long and realistic talk with wifey.
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JDH is a bit more correct then Hern. Without question, if it were purely up to me, I would go from residency traight to 2 year CC fellowship to attending intensivist. My family situation prohibited that. So now, after I complete 2 years as an attending and get the family settled, I have to figure out how to go about getting fellowship trained. Everything is simple when it just you your supporting and you can just roll into whatever you want whenever you want to. Its a bit more "delicate" shall we say in my situation. And I know the future earning potential difference Hern, but the overworked, overtired Mom who is tired of functioning as a single parent cant always see the 'this is how it will be in 2 more years and will more than make up for the upfront loss". She sees "im tired enough is enough".
 
Bostonredsox said:
, but the overworked, overtired Mom who is tired of functioning as a single parent cant always see the 'this is how it will be in 2 more years and will more than make up for the upfront loss". She sees "im tired enough is enough".
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Been there done that, I've got 2.5 kids and a menagerie, youre, right, it isnt easy, personally, I would not have gone back to training after making money.
 
Hernandez said:
Been there done that, I've got 2.5 kids and a menagerie, youre, right, it isnt easy, personally, I would not have gone back to training after making money.
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Well I am planning on using the logic of, 'im already running the MICU here as a CC hospitalist, Im just being paid 75k+ less a year to the job then if I had the boarding. That adds up to >2million over a career.

Im also looking into the idea of the hospital funding the fellowship, essentially paying me the difference of my hospitalist salary and fellows salary during fellowship with the caveat of when I complete fellowship, I come back here to work, which is where i plan to be anyway. they seem interested in that.

And I have 5 kids, Ages 6 and under, and a menagerie lol. Crazy Irish Catholics...
 
Bostonredsox said:
Well I am planning on using the logic of, 'im already running the MICU here as a CC hospitalist, Im just being paid 75k+ less a year to the job then if I had the boarding. That adds up to >2million over a career.

Im also looking into the idea of the hospital funding the fellowship, essentially paying me the difference of my hospitalist salary and fellows salary during fellowship with the caveat of when I complete fellowship, I come back here to work, which is where i plan to be anyway. they seem interested in that.

And I have 5 kids, Ages 6 and under, and a menagerie lol. Crazy Irish Catholics...
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I'm not Catholic, and I'm just kidding, but does the RCC allow you to pull out? Ever?

I've got the one kid, another on the way, and my wife is pretty fried, so . . . I'm reasonably sympathetic, would be a hard thing to do all those kinds with you so busy.
 
jdh71 said:
I'm not Catholic, and I'm just kidding, but does the RCC allow you to pull out? Ever?

I've got the one kid, another on the way, and my wife is pretty fried, so . . . I'm reasonably sympathetic, would be a hard thing to do all those kinds with you so busy.
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ha. idk. We are catholic but not strict catholics. we just wanted alot of kids, though admittedly not this fast, thats just the way it shook out. thanks to my uro buddy there will def be no #6 though ha. so again, not strict catholics.

But yea, its a tough conversation around here regarding fellowship. Well see how these first 2 years go.
TBH, If they keep allowing me to run the unit and be part of the attending rotation with the current pay, I will probably be ok, after all, I just want to do the job and I wactually want to be at a community shop as compared with academia. That said, if a point comes when there is a plethora of boarded people that I can be replaced with then there will need to be serious changes in terms of my training and credentials.
 
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