Best Critical Care Programs

[waterski232002]

What are some of the best critical care programs??? Particularly the 2 year IM/CCM programs?

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[medgator]

I am at Pitt right now as a medicine intern and from what I can tell, UPMC is a pretty solid place for critical as there is literally an entire hospital full of ICUs with multiple specializations on top of MICU and SICU (Liver ICU, CTICU, Neuro ICU, Transplant ICU etc.)

 

[southerndoc]

Also heard good things about Hopkins.

 

[DrRobert]

UPMC is arguably the top program.

 

[gutonc]

UPMC is arguably the top program.

...on the East Coast.

U Washington is probably the best program in the country.

BE

 

[placebo_B12]

UPMC is arguably the top program.

I was looking at their website and noticed that most of the fellows are IMG's.... what's up with that?

 

[cchoukal]

2 year CCM programs? Most of the better programs are expanding from 3 years to 4. These are combined pulmonary/CCM fellowships, but it's much less common to do just CCM. University of Chicago has a fantastic program. Hall, Schmidt, and Wood are here, although Schmidt just left to head Iowa's units.

 

[Apollyon]

2 year CCM programs are just CCM. Likewise, there are 2 year pulmonary programs. The 3 year programs are pulmonary/critical care.

My vote for best in country also goes to UPMC - for either coast.

 

[bigtuna]

and just to clarify, UPMC may be the best CCM program but the pulmonary is not the best there

 

[r54918]

I was looking at their website and noticed that most of the fellows are IMG's.... what's up with that?

Is this true? I find it hard to believe that the so called "best" CCM program is filled with IMG's.

 

[coolbabe76]

ever pause for a moment and think.??? ....maybe those IMG s are there because... ...well maybe COS THEY ARE GOOD AT WHAT THEY DO????????????

 

[trkd]

ever pause for a moment and think.??? ....maybe those IMG s are there because... ...well maybe COS THEY ARE GOOD AT WHAT THEY DO????????????

A lot of foreign grads who also have trained abroad for residency a VERY good at what they do. This often has to do with the fact that training is much, MUCH longer overseas. Three year residencies in the US are often 5,6,7, or more years to qualify for in many countries. That equals more experience and often better clinical skills due to less luxuries (like MRIs and CTs all the time). Just a thought.

 

[GasEmDee]

A lot of foreign grads who also have trained abroad for residency a VERY good at what they do. This often has to do with the fact that training is much, MUCH longer overseas. Three year residencies in the US are often 5,6,7, or more years to qualify for in many countries. That equals more experience and often better clinical skills due to less luxuries (like MRIs and CTs all the time). Just a thought.

The IMGs I have met along the way have been really oustanding. The U.S. does not have the monopoly on intellects, and many of the ppl who come here to train are amongst the best of their country's best.

 

[Plastikos]

A lot of foreign grads who also have trained abroad for residency a VERY good at what they do. This often has to do with the fact that training is much, MUCH longer overseas. Three year residencies in the US are often 5,6,7, or more years to qualify for in many countries. That equals more experience and often better clinical skills due to less luxuries (like MRIs and CTs all the time). Just a thought.

I thought the reason for the longer residencies in other places is b/c they dont train as hard, ie the UK where there is a very strict rule regarding resident hours. Its something ridiculous....here is their plans:

From 1 August 2004, doctors in training will be subject to weekly working time limits, which will be phased in as follows:

* 58 hours from 1 August 2004 to 31 July 2007.
* 56 hours from 1 August 2007 to 31 July 2009.
* 48 hours from 1 August 2009.

This is likely the ONLY reason, so someone here in surgery as a PGY-2 has about as much experience as a PGY-3 there and so on.

 

[waterski232002]

Most other countries (including the U.K., most of europe, and australia) also go striaght into medical school from high school. Thus, they are almost 2 years behind (b/c they haven't taken the equivalent U.S. undergrad pre-med courses) when they start medical school.

I'm not trying to be argumentative, but if it were true that IMG's were on average better trained than U.S. grads, than why wouldn't all the most competitive specialties be filled with IMG's??? (plastics, derm, rads, ENT, Neurosurg)

I don't see why critical care would be any exception based on this logic? The best cardiology programs aren't filled with IMG's, are they?

 

[coolbabe76]

thats because some top programs as a rule dont prefer to take img s. i mean this is USA so US citizens shud get first priority .....i am not cribbing ....
but the fact is that some of the top schools may choose not to take an IMG over an AMG.even thougfh the IMG maybe outstanding and the AMG maynot be.
which is fine , cos this is their country.
the fact that an IMG can come here, give exams and aspire to get into a good , if not the best school, is encouraging enough considering we are not citizens of this country.
i think i am grateful to this country for giving me this chance.

 

[Hog Daddy]

I've heard good things about U Utah

 

[trkd]

Most other countries (including the U.K., most of europe, and australia) also go striaght into medical school from high school. Thus, they are almost 2 years behind (b/c they haven't taken the equivalent U.S. undergrad pre-med courses) when they start medical school.

I'm not trying to be argumentative, but if it were true that IMG's were on average better trained than U.S. grads, than why wouldn't all the most competitive specialties be filled with IMG's??? (plastics, derm, rads, ENT, Neurosurg)

I don't see why critical care would be any exception based on this logic? The best cardiology programs aren't filled with IMG's, are they?

Many UK and Aus are now becoming 4 years after a college degree. Then they put in 10-12 years with decent hours to do surgery for example. This is in no way saying which country produces better doctors. I really don't think there is point in arguing this. Its just to say they are very good at what they do. That's all. As was said above, regardless of how good they are, there will still be a bias against. Far enough. People will choose the known above the unknown comodity.

For myself, I would rather a superior doctor from India (for example) than a bottom of the barrel US grad to treat me or my family. But that is besides the point.

 

[KGUNNER1]

Is this true? I find it hard to believe that the so called "best" CCM program is filled with IMG's.

This is multifactorial and not easy to explain unless you are part of the system, but I'll try.

1) Most US IM grads that don't flock to cards or G.I. are attracted to the traditional pulm/ccm programs, primarily because they see themselves wanting a pulm practice or they don't want to burn out with just ccm. Plus there really are more job opportunities now with a pulm training (especially with the option of covering sleep along with out patient care).

2)Pitt's program is huge, it has a total of about 25 fellows for 2 years. They need to fill for staffing purposes.

3) The first year you work your butt off. Every rotation is in the ICU, no bronch month etc... you are in the ICU taking every 3 or 4th night IN HOUSE call. Many US IM grads just don't want to work this hard in their fellowship. The vast majority of CCM/Pulm programs have home call systems and your unit months are spread out over 3 years.

4) The majority of units (about 120 beds) are surgical and the fellow is right there with the CCM attending for about 10-12 patients. No resident or med student, just you and the attending who probably wrote several chapters in the latest CCM text book (take your pick). The great thing about this system is except for the VA, the fellow just resuscitates the patient and the attending is responsible for all the documentation (dictation for billing purposes)

5) Because the units are mostly surgical (vast majority of CCM attendings are IM based) this may be intimidating to IM grads.

These are just a few of the nuances of the program, which I thought was a very strong one. Hard to say what is the "best" since we don't have a CCM Olympics.

Hope this helps.

kg

 

[neutropenic]

As elaborated previously and echoed below.

Many US superstars don't go into IM. They prefer more intellectually challenging pursuits like dermatology, ophthalmology, orthopaedics, and the like.

Those that do tend to try to go to a few programs which I'll label MGH et al. And many of these go into GI or cards.

Which doesn't leave that many US superstars for P/CC. My $0.02.

The well balanced medical student that exists today in the US cares about the finer things in life: time for a family, time to have babies, a nice glass of red wine, boating to Martha's Vineyard, making more money with less call...the adcoms have to reap what they sowed.

 

[Winged Scapula]

I thought the reason for the longer residencies in other places is b/c they dont train as hard, ie the UK where there is a very strict rule regarding resident hours. Its something ridiculous....here is their plans:

From 1 August 2004, doctors in training will be subject to weekly working time limits, which will be phased in as follows:

* 58 hours from 1 August 2004 to 31 July 2007.
* 56 hours from 1 August 2007 to 31 July 2009.
* 48 hours from 1 August 2009.

This is likely the ONLY reason, so someone here in surgery as a PGY-2 has about as much experience as a PGY-3 there and so on.

While the above hours listed are true, bear in mind that a 2nd year Surgical resident in the US is NOT comparable to a 3rd year Surgical resident from abroad. This is because people in other countries don't match into specialty training right out of medical school.

Rather everyone does an general intern year, an RMO (registered medical officer) and a Registrar (like a Chief resident) year before even attempting to start specialty training. Many will not succeed in getting a specialty the first or second year attempt and will keep working as a Registrar until they get the specialty spot. I worked with an ortho resident who was a PGY-11 - he had spent no time in the lab, but rather the 3 "baseline" years and then several more just trying to get into ortho - all the while still working and learning.

 

[Astrocyte]

Most other countries (including the U.K., most of europe, and australia) also go striaght into medical school from high school. Thus, they are almost 2 years behind (b/c they haven't taken the equivalent U.S. undergrad pre-med courses) when they start medical school.

I'm not trying to be argumentative, but if it were true that IMG's were on average better trained than U.S. grads, than why wouldn't all the most competitive specialties be filled with IMG's??? (plastics, derm, rads, ENT, Neurosurg)

I don't see why critical care would be any exception based on this logic? The best cardiology programs aren't filled with IMG's, are they?

I think residency programs get less money from fed gov for IMG than AMG. It's about money, not quality!

 

[Apollyon]

and just to clarify, UPMC may be the best CCM program but the pulmonary is not the best there

Whereas at Duke, pulmonary is rock solid, but CCM (MICU) leaves much to be desired (the SICU, though, is a different story).

 

[Eidolon6]

As elaborated previously and echoed below.

Many US superstars don't go into IM. They prefer more intellectually challenging pursuits like dermatology, ophthalmology, orthopaedics, and the like.

Those that do tend to try to go to a few programs which I'll label MGH et al. And many of these go into GI or cards.

Which doesn't leave that many US superstars for P/CC. My $0.02.

IM is the largest specialty represented in the NRMP match and to fill spots, IMGs find this an easier place to get a job. The relative number of spots in neutropenic's list is relatively small...almost comparing apples to oranges here.


As to KGUNNER's assessment, I can't really speak to that other than from my first person perspective choosing to do a combined pulmonary/CCM track is not really an issue of intimidation with other ICUs, not wanting to do in house call or fear of burn-out in the ICU...We all have to do the same amount of ICU time as the non pulm folks and a significant fraction of this is done within nonmedical ICUs. The rigor between programs is highly variable regardless of the ties to pulmonary or another discipline....most people who interview find marked heterogeneity between programs and yes, after doing 3 years of in-house call, the prospects of doing more may not be in line with one's desire for training (nor does it necessarily make you any less prepared or qualified to perform the job). I found pulmonary/CCM programs with lots of in-house call and some with mostly home call...very variable...

Also, a large proportion who do pulmonary actually find pulmonology "intellectually challenging" and satisfying The IM/Pulmonary background is well suited for critical care, combining intense understanding of diagnostics and physiology with evolving techniques and protocols to manage the sickest of patients. Critical care, though a buzzword, is the result of a convergence of medical philosophies in physiologic support arising from medical crisis management of the 1920s-40s with the polio epidemics, the advent of mechanical ventilator and antibiotics and surgical philosophies of anesthesia and resuscitation garned from the earliest traumatologists. Given that legacy, it espouses many disciplines.


Cheers.

 

[KGUNNER1]

That's a fairly uneducated and relatively "factopenic" reply and the use of "intellectually challenging pursuits", lest it be tongue in cheek, is probably not really accurate. Now, replace that with more...."monetarily satisfying pursuits" or "ego inflating pursuits" and you might be on the money. Then again, maybe neutropenic is an expert on the socioeconomicocultural aspects of fellowship admission trends, namely pulmonary and critical care medicine....but I highly doubt that.

IM is the largest specialty represented in the NRMP match and to fill spots, IMGs find this an easier place to get a job. The relative number of spots in neutropenic's list is relatively small...almost comparing apples to oranges here.


As to KGUNNER's assessment, I can't really speak to that other than from my first person perspective choosing to do a combined pulmonary/CCM track is not really an issue of intimidation with other ICUs, not wanting to do in house call or fear of burn-out in the ICU...We all have to do the same amount of ICU time as the non pulm folks and a significant fraction of this is done within nonmedical ICUs. The rigor between programs is highly variable regardless of the ties to pulmonary or another discipline....most people who interview find marked heterogeneity between programs and yes, after doing 3 years of in-house call, the prospects of doing more may not be in line with one's desire for training (nor does it necessarily make you any less prepared or qualified to perform the job). I found pulmonary/CCM programs with lots of in-house call and some with mostly home call...very variable...

Also, a large proportion who do pulmonary actually find pulmonology "intellectually challenging" and satisfying The IM/Pulmonary background is well suited for critical care, combining intense understanding of diagnostics and physiology with evolving techniques and protocols to manage the sickest of patients. Critical care, though a buzzword, is the result of a convergence of medical philosophies in physiologic support arising from medical crisis management of the 1920s-40s with the polio epidemics, the advent of mechanical ventilator and antibiotics and surgical philosophies of anesthesia and resuscitation garned from the earliest traumatologists. Given that legacy, it espouses many disciplines.


Cheers.

I agree with Eidolon, it is very hard to generalize this when there is such a diversity in trainin options. Pitt is unique, though, and has a very different fellowship than other programs. Unless you really look into it, you probably wouldn't appreciate the differences. In my previous post, I not giving absolute reasons, but just a few of the more common ones that I heard from IM grads that went other places.

What one is right for you? You need to ask yourself what you want out of a program. You need to put some time and effort in making this decision since it is a very sizable investment (time and money). You'll never get a second chance at going back and doing it over.

Why does Pitt have a large amount of IMG's? I'm not sure other than what we've noticed in the past and what I posted earlier. Also I'm sure that a vast majority of US IM grads have had a very traditional ICU experience dominated by Pulm/CCM and thus that track has been emphasized and further emulated.

It's quite amusing when I attend SCCM meetings and hear my colleagues with different backgrounds (all in fun) state that a true intensivist is a Pulmonologist/Anesthesiologist/Surgeon

kg

 

[neutropenic]

[sarcasm]They prefer more intellectually challenging pursuits like dermatology, ophthalmology, orthopaedics, and the like.[/sarcasm]

 

[dmaes]

Hey All,

On the topic of CC medicine I have a couple perhaps dumb questions. 1) If you are IM trained are you limited to only IM critical care fellowships or can you apply to anesth and surg CC? Looking at the IM based CC only programs it seems like the second year seems generally to be a research one. Are there 1 yr IM CC fellowships?

Thanks!

 

[ITE]

I am IM resident and went through fellowship application this year. I had offers and interviews from good places such as UMich, Stanford and OHSU. I found UPMC by far the best academically and I accepted their offer. The best attendings (Fink, kellum, kochaneck, Pinskey, Angus, Grinvek,...) who rule in the field are there and they are editors of the best CCM journals, write the best textbook in thefield and....
However the work load is very high since there is no resident in the ICU. Of course in general UPitt does not have the name of some others like Stanford and Pittsburgh as a city is an average size (but nice) city and that's why they are not as competitive as their academic level. I've heard very good things about Hopkins too.

 

[dbiddy808]

What about BID and Mass General? I never hear much about their critical care programs.

 

[bulgethetwine]

Is this true? I find it hard to believe that the so called "best" CCM program is filled with IMG's.

Good to see the racists here on the board.

Also, the work hours listed for the UK/Ireland are only guidelines -- and they are very laxly enforced. So, the result of going over your weekly hour limit is overtime pay. Exactly the way it should be.

Do your due diligence before you open your mouth, jackass.

 

[tupac_don]

As elaborated previously and echoed below.

Many US superstars don't go into IM. They prefer more intellectually challenging pursuits like dermatology, ophthalmology, orthopaedics, and the like.

Those that do tend to try to go to a few programs which I'll label MGH et al. And many of these go into GI or cards.

Which doesn't leave that many US superstars for P/CC. My $0.02.

The well balanced medical student that exists today in the US cares about the finer things in life: time for a family, time to have babies, a nice glass of red wine, boating to Martha's Vineyard, making more money with less call...the adcoms have to reap what they sowed.

Superstars???? Maybe academically, but you aint a superstar if your aspiration is to be a dermatologist. I mean seriously, all of dermatology can be summed up in one word Steroids IV STAT!!!

 

[deleted21609]

I think residency programs get less money from fed gov for IMG than AMG. It's about money, not quality!

The extended training abroad is also about the money. It's much cheaper to have the work done by relatively low paid docs 'in training' for 10 years than to pay a fellow's salary for 2-3 years then an attending's salary for 8. It's not as if you stop learning at the end of residency and fellowship, you just start getting paid more fairly.

 

[deleted21609]

Good to see the racists here on the board.

Also, the work hours listed for the UK/Ireland are only guidelines -- and they are very laxly enforced. So, the result of going over your weekly hour limit is overtime pay. Exactly the way it should be.

Do your due diligence before you open your mouth, jackass.

IMG isn't a racial group.

 

[bulgethetwine]

IMG isn't a racial group.

Fair point. IMG refers to a group of diverse racial groups.

As for the point about pay, it is an entirely differnet scale. Whereas in North America you have a *much* lower salary level for trainees (residents/fellows) vs. attendings, the salary scale is much more traditional elsewhere in terms of you can expect to start at a much better salary (interns make $80K in the U.K./Ireland by the time you figure overtime) and then can count on gradual increases year over year, but you will generally never earn as much in the UK/Ireland as a consultant as you would as an attending in North America (generally... cardiologist still get rich in the UK/Ireland, for instance).

 

[leorl]

that's why a good proportion of NAers are starting to stay for an intern year . As long as we can (before a working time directive gets enforced, which probably will never happen), we can stay and earn overtime, up to 80K or so and recoup some of the money we've poured into the system, tax free. And have some money in the bank before starting internship/residency in the US. Puts you back a couple years, but eh, not a bother.

 

[bulgethetwine]

that's why a good proportion of NAers are starting to stay for an intern year . As long as we can (before a working time directive gets enforced, which probably will never happen), we can stay and earn overtime, up to 80K or so and recoup some of the money we've poured into the system, tax free. And have some money in the bank before starting internship/residency in the US. Puts you back a couple years, but eh, not a bother.

Hmmm. I'm not sure it is going to be tax free.

And another thing -- it's not actually fiscally smart. Although an argument could be made that you are reducing your debt load up front (earning 80K instead of 40K) it actually doesn't make financial sense because you are essentially reducing the number of high earning years from the back end of your career for every year you put off residency.

Either way you're going to have 3 or 4 or whatever years where you earn 40-50K (residency). All the rest of your years are either post-residency with commensurate salary, or else the 80K of which you speak of in intern year. Follow?

In truth, staying for intern year is probably a break-even proposition in the long-run (lower principal up front vs. an additional high-earning year post residency). Stay any longer than a year, however, and it eats at your net worth.

But of course there are other good reasons to stay that transcend financials, and certainly some have a reason beyond simple med school debt to earn a little extra up front. So I suppose it is different for every specific situation.

 

[GuP]

Comments on UF CC program?

 

[waterski232002]

I don't know much about it either... but am interested as well. Years, rotations, requirements. Any EM residents out there who have completed the program?

 

[drdev]

Hello,

I have a query for everyone involved in Critical Care. I will complete my pulmonary fellowship in 2012. Got 2 critical care offers- UPMC-Pittsburg and Rhode ISland- Miriam hospital.

PLease advise as people tell me there is high drop ou rate from UPMC

Thanks

 

[Bostonredsox]

thoughts on the 2 year Wake CC program? Also, anyoen know if UNC offers a 2 year CC track within their pulm/cc program?

 

[gloriacollins]

Pitt, Michigan ,Wash U,UTMB are some i remember...

 

[Bostonredsox]

Do you guys know of any website that sort of lists the 2year CC programs besides Freida? I have been told that some 3 year pulm/cc divisions in major academic centers will also take 2 year straight cc fellows, more or less to keep their ICUs staffed, but they don't readily advertise the 2 year program. This as opposed to places like Pitt and Uroch that have dedicated 2 year programs with their own NRMP #. Sort of hoping there are more of these programs with 2 year tracts within their 3 year division as the # of 2 year programs is much lower than I would like it to be given I am already somewhat geographically limited 2/2 family.

 

[jdh71]

Do you guys know of any website that sort of lists the 2year CC programs besides Freida? I have been told that some 3 year pulm/cc divisions in major academic centers will also take 2 year straight cc fellows, more or less to keep their ICUs staffed, but they don't readily advertise the 2 year program. This as opposed to places like Pitt and Uroch that have dedicated 2 year programs with their own NRMP #. Sort of hoping there are more of these programs with 2 year tracts within their 3 year division as the # of 2 year programs is much lower than I would like it to be given I am already somewhat geographically limited 2/2 family.

Use your email and ask.

The major limiting variable here will be money. If they can't pay you, even if they could use you, they're not going to take you.

Pitt has so much money it doesn't even know what to do with it all.

Look for places that have a lot of research money into the unit and send the program coordinator (listed on FREIDA) for Pulm/CC an email asking if they ever take just straight CC fellows.

 

[Bostonredsox]

will do, thanks man.

 

[draks]

Hi Can anyone tell me how is the CC program at SLU- St John Mercy and how do you compare it to pitts . Thanks

 

[draks]

Hi Can anyone tell me how is the CC program at SLU- St John Mercy and how do you compare it to pitts . Thanks

Also, does it matter a lot that you have transplant exposure in your CC fellwoship

 

[jdh71]

Hi Can anyone tell me how is the CC program at SLU- St John Mercy and how do you compare it to pitts . Thanks

I'm assuming you're asking about the medicine CC program there.

The gossip on SLU's program is that it is very good - muiltidisciplinary in nature, so you'll spend time with the surgeons, anesthetists, and medical intensivists.

I don't think you need to see transplant unless you plan on seeing it again int he future, however, transplant patients tend to be sicker than snot when they get sick, and it can be "weird sick", so I think having exposure to these patients in to your advantage in training.

Pitt is the tits. Bottom line. The program most of the other programs wish they could be, but it is also a lot of transplant and a lot of fellow-only kind of work. It's a tough gig. Pitt will be better, but SLU is good.

 

[draks]

Thanks for the reply. Appreciate it. R u currently in CC ? Indeed I was asking about Medicine CC fellowship. About jobs in Academics, does it maytter if you do ur training in SLU versus somewhere else. Also, does SLU have good standing in CC compared to other good programs. Thanks

 

[jdh71]

Thanks for the reply. Appreciate it. R u currently in CC ? Indeed I was asking about Medicine CC fellowship. About jobs in Academics, does it maytter if you do ur training in SLU versus somewhere else. Also, does SLU have good standing in CC compared to other good programs. Thanks

I'm doing pulm/crit. I only know SLU by reputation and gossip (which is good). Doing critical care just about anywhere that does it will be fine for almost any academic job. As far as their standing, I think based on what I've heard they are well respected, they aren't Pitt, or Vandy, or UWash, or UCSF - but, you know . . . solid.

Let me put it this way, I do not think you are doing yourself a disservice by training there, not in the least. If you're asking about Pitt vs SLU, you should go to Pitt if you have the chance, IMHO, but SLU is a good program.

 

[Doctor4Life1769]

I assume this only accounts for med/ccm and not anes/ccm?

I'm contemplating doing 2 fellowships. Peds and CCM. who knows.