If you are planning to live on East Coast, then there are lots of CCA (Crit Care Anesthesiology) jobs out there, probably more in academia than PP.
If you are planning a life in academics, then a career in CCA is viable--just don't be too upset when you never do your own cases in the OR since there are usually residents and CRNAs/SRNAs for that.
On the west coast, academics has always been where CCAs feel they have to be.
However, the options for PP anesthesia combined with crit care are about to get broader, especially with mature anesthesia groups starting to understand the value of providing services and leadership outside the OR (and I don't mean giving anesthesia for an MRI that a patient doesn't friggin need
...for the resident thinking this, a few things to check off:
-make sure you are one of the strongest residents in your program--the group(s) offering PP CCA are choosy and you need to be very good; in PP you will be expected to do OB, and be very good at regional blocks and catheters
-get really good at ultrasound (TTE, TEE, lung, nerve blocks, etc.)
-fellowship name doesn't mean as much--I went to a "no name" place simply because I got to have a lot more say in what I wanted to learn--time to do advanced TEE, tracheostomy (perc), some neuro, etc.--what matters is the skills level and maturity you display when you step into private practice. worked with some people from certain "big name" progams and found them to be mired down in dogma based on what they were told the "right way" was at their institution. They were also not very self-sufficient--can't handle situations at night and god...terrible, terrible hands and procedural skills! Make sure your co-fellows are there because they were cream of crop and had their choice and chose CC because they love it..not because they are too slow to function in a fast-paced OR.
I did medicine, then surgery, then anesthesia, then CC and neuro-CC. I agree that micu type patients can often seem more complex, but as often as not, I think the intensivist's job is to simplify management since patients have gone down one of a few paths by the time they get to the unit--with similar management strategies...
-ALI
-shock of some kind
-AKI
-shock liver
-hypoperfused splanchnic organs
-delirium
-anemia
-muscular weakness
No offense to those who are actually smart--but all the therapies with really really good efficacy are "low-lying" fruit (aggressive attempts at extubation, PT/OT, bedside cares, GI/DVT prophylaxis, early goals of therapy talks with families, aggressive efforts to reverse shock and frequent reassessments of organ perfusion, excellent communication)
A mentor once told me that most of what he does is:
1. Weigh risk vs. benefit
2. Manage expectations
keep your eyes open--pulm/cc doesn't have a monopoly on the business anymore
