Best route to CCM (for me)

[Jabbed]

I'm very interested in pursuing CCM but I'm more than a little undecided about the ways of getting there. Looking for some advice:

-Pulm/CCM: the most traditional route, but I really don't have much interest in working outside of an acute care setting, so I feel that it would constrain my options.
-IM/CCM: similar concerns as with the pulm route, with the added concern of finding a CCM only group, which I've been told can be difficult.
-EM/CCM: lots of appeal for me as I think that the high points of both practices really help compensate for their respective low points (ie too many low acuity patients in the ED vs dealing with tubes all day in the ICU). I also really like the idea that I will conceivably be able to manage the same patients in both settings. Cons: 25% rule for IM fellowships has me worried, and there really isn't much of a backup for when I'm old and burnt out. Also, I imagine that it might be difficult to find dual positions within the same hospital, although it seems like the transition to true shift work might mitigate that.
-IM/EM/CCM: if god granted me immortality, I would do it. @Doctor Bob
-gas/CCM: something that I'm becoming increasingly interested in as dual practice seems to complement one another especially well. In contrast to the other routes, I've also seen several gas guys covering SICU as well. Concerns: CRNAs

Incidentally, can someone briefly elaborate on why anesthesia only requires a one year fellowship in comparison to other residencies?

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[deleted547339]

I'm very interested in pursuing CCM but I'm more than a little undecided about the ways of getting there. Looking for some advice:

-Pulm/CCM: the most traditional route, but I really don't have much interest in working outside of an acute care setting, so I feel that it would constrain my options.
-IM/CCM: similar concerns as with the pulm route, with the added concern of finding a CCM only group, which I've been told can be difficult.
-EM/CCM: lots of appeal for me as I think that the high points of both practices really help compensate for their respective low points (ie too many low acuity patients in the ED vs dealing with tubes all day in the ICU). I also really like the idea that I will conceivably be able to manage the same patients in both settings. Cons: 25% rule for IM fellowships has me worried, and there really isn't much of a backup for when I'm old and burnt out. Also, I imagine that it might be difficult to find dual positions within the same hospital, although it seems like the transition to true shift work might mitigate that.
-IM/EM/CCM: if god granted me immortality, I would do it. @Doctor Bob
-gas/CCM: something that I'm becoming increasingly interested in as dual practice seems to complement one another especially well. In contrast to the other routes, I've also seen several gas guys covering SICU as well. Concerns: CRNAs

Incidentally, can someone briefly elaborate on why anesthesia only requires a one year fellowship in comparison to other residencies?

Anesthesia does a 4y residency as opposed to 3 in IM or EM.

There's also a surgical critical care route.

I'm going EM -> CCM. I think it's going to be harder for me than my IM colleagues with similar applications if I want an IM CCM fellowship, as a lot of CCM programs don't take EM or only take a handful. That being said, we can go through anesthesia.

They all bring different strengths and weaknesses to the table. If I had all the time (and patience a in the work), I could see why EM/IM/CC would be appealing. Part of me wishes I went IM->PCCM only because both EM and CCM have high burn out rates, but I know I would have been miserable in IM.

Good luck.

 

[dotcb]

Pick the base specialty you'd most enjoy practicing if you later chose to not do (or do a different) fellowship.

Things change during residency. You'll enjoy things you didn't expect to and find out you don't enjoy things you thought you would. Don't think too long term about your base specialty (as the means to a fellowship) - do the one you enjoy the most.

 

[psychbender]

Also to add to the negatives of Anes/CCM, very few private groups cover both, or are really interested in your CCM training. If you want a split practice, then you're more likely to find it in academics. Now, there are a couple on SDN that are private and do both (Seinfeld over on the Anesthesiology forum), so it's not entirely unheard of, but it is rare.

I'm an anesthesiologist with a little over two years left in the Army, so I started sending out feelers for jobs back home, and none of the groups care one whit if I have CCM training. The two academic programs in my state would really like it, but the pay is ****. Regardless, I still plan on pursuing fellowship once I get out, as I picked anesthesiology specifically because I enjoyed it as a route to the ICU, then getting a job doing primarily anesthesiology and covering the unit prn on my off time (most of the anesthesiology groups I've contacted still do 12 weeks of vacation, and one weekend day a month of call, so should be plenty of time available to stay current on CCM).