can EM/CC teach in CC in IM residency?

[Crabbygas]

It’s not my job to give the patient 4 units of blood. It’s my job to put the 9 French catheter and order the blood/FFP/plts. The unit secretary get the blood from the blood bank and the nurse runs it in through the level 1 blood administrator.[/QUOTE]

Spoken like an internest. The surgeon would order 2 units of blood and try to find the bleeder. The anesthesiologist would hang 1 unit, give what was needed and stop once the bleeding was fixed.

---

Members don't see this ad.

 

[Nephro critical care]

How many of the listed procedures did you complete in residency vs. fellowship?

Mostly in fellowship. The only procedure I could do independently in residency was central lines IJ and femoral and I even lost that skill to some extent in 4 years of hospitalist medicine. I spent my first year of fellowship almost exclusively focusing on procedures.
But that’s OK because as a nocturnist for 4 years admitting 10-17 and cross covering 100+ patients on a busy service I became extremely good at figuring out what’s was really going on with a patient. It takes me about 15-20 minutes to do a chart biopsy and ask the patient pertinent questions and with the help of a CT scanner and lab I can figure out almost anything that’s going on with a patient.
I am a little bit sad that my critical care fellowship was MICU based and I didn’t spend that much time in CTICU/tx ICU. So while I’m a decent MICU intensivist I am not that good at the post surgical stuff and that’s why I plan to do a year in anesthesia CC if someone lets me.

 

[psychbender]

@Nephro critical care have you looked at the current Anes-CC fellowship vacancies on the SF Match site? I'm sure if you start sending emails down that list, you'll find someone who would be happy paying a boarded intensivist for $65k in exchange for providing a year of additional training.

Sent from my SM-G930V using SDN mobile

 

[psychbender]

Also, I just remembered seeing that Hopkins just rolled out a Cardiac surgical ICU fellowship, that is intend to follow a regular anes-CCM fellowship. I didn't know why they thought anyone would go for itb at the time, but now that you being it up, that might also suit you. Since it's not an ACGME fellowship, they'd probably pay you more than a regular fellow.

Sent from my SM-G930V using SDN mobile

 

[CCM-MD]

It’s not my job to give the patient 4 units of blood. It’s my job to put the 9 French catheter and order the blood/FFP/plts. The unit secretary get the blood from the blood bank and the nurse runs it in through the level 1 blood administrator.

Spoken like an internest. The surgeon would order 2 units of blood and try to find the bleeder. The anesthesiologist would hang 1 unit, give what was needed and stop once the bleeding was fixed.[/QUOTE]

Nah the anesthesiologist would play on his iPad while the CRNA did his job.

 

[deleted547339]

The answer is this: you can work anywhere that a hospital will credential you. There is no rule saying an EM or anesthesia trained graduate is unable to supervise IM residents.

There are two misinterpreted rules: 1) EM fellows can’t supervise medicine residents until they have completed the prerequisite 6 months of IM training. 2) Non-internists cannot be core residency faculty. This says nothing of teaching faculty, giving lectures, etc.

This is different from the fact that some academic micus don’t want non-internists (or even non-pulm/ccm) or non ABEM/ABIM trained EM grads.

 

[deleted547339]

I wouldn't make this into anesthesia vs medicine based critical care programs, it will degenerate quickly. There's really crappy and really good programs on both sides. Multidisciplinary training is important. But don't get fooled by programs promising well rounded training but you're just hanging out on the side... example: neuro ICU month where there's neuro ICU fellows doing all the fun stuff. It's easier to match into anesthesia programs - there's always some going empty.

It will be hard to get hired as MICU faculty without internal medicine or internal medicine based critical care medicine training but not impossible.

Correction: nothing fun ever happens in the neuro icu.

 

[CCM-MD]

Correction: nothing fun ever happens in the neuro icu.

There can be a lot of perc trachs. Which can be fun...

 

[Nephro critical care]

@Nephro critical care have you looked at the current Anes-CC fellowship vacancies on the SF Match site? I'm sure if you start sending emails down that list, you'll find someone who would be happy paying a boarded intensivist for $65k in exchange for providing a year of additional training.

Sent from my SM-G930V using SDN mobile

Thank you. I really appreciate that. I will contact these programs.

 

[CCM-MD]

Thank you. I really appreciate that. I will contact these programs.

Probably not worth a 300k investment.

 

[Nephro critical care]

Probably not worth a 300k investment.

Maybe. But I have never been into medicine/CC for the money. It’s because I want to be the most complete CC physician of all time. Maybe it will help me get into an academic setting. I will try to moonlight a few nights in my fellowship to make a little extra.

 

[NewYorkDoctors]

Norwalk Hospital has a 2 year pulmonary program and one of their faculty members is an EM/CC physician.

 

[CCM-MD]

Norwalk Hospital has a 2 year pulmonary program and one of their faculty members is an EM/CC physician.

Not according to their website.

 

[Nephro critical care]

The answer is this: you can work anywhere that a hospital will credential you. There is no rule saying an EM or anesthesia trained graduate is unable to supervise IM residents.

There are two misinterpreted rules: 1) EM fellows can’t supervise medicine residents until they have completed the prerequisite 6 months of IM training. 2) Non-internists cannot be core residency faculty. This says nothing of teaching faculty, giving lectures, etc.

This is different from the fact that some academic micus don’t want non-internists (or even non-pulm/ccm) or non ABEM/ABIM trained EM grads.

I remain unconvinced that a non IM boarded CC physician will be able to manage patients in the MICU. I don’t believe the CC fellowship and boards will give you the broad depths of knowledge to be able to manage a complex medical patient. You need the IM board as backup for all that IM knowledge. Would you be able to diagnose a case of eosinophilia PNA now with ARDS ? Hemoptysis with Wegeners the clue being RBC and proteinuria on UA. A complex toxicity to chemo ? I am not familiar with the EM boards but my general impression about ED docs is that they do initial resuscitation and triage and goal is to be done with the patient in 2 hrs or less.
Yes there are some situations such as a trauma pt who requires massive transfusion or a post liver tx with bleeding which I am sure you will manage as well or better than a IM/CC guy.

 

[deleted547339]

I remain unconvinced that a non IM boarded CC physician will be able to manage patients in the MICU. I don’t believe the CC fellowship and boards will give you the broad depths of knowledge to be able to manage a complex medical patient. You need the IM board as backup for all that IM knowledge. Would you be able to diagnose a case of eosinophilia PNA now with ARDS ? Hemoptysis with Wegeners the clue being RBC and proteinuria on UA. A complex toxicity to chemo ? I am not familiar with the EM boards but my general impression about ED docs is that they do initial resuscitation and triage and goal is to be done with the patient in 2 hrs or less.
Yes there are some situations such as a trauma pt who requires massive transfusion or a post liver tx with bleeding which I am sure you will manage as well or better than a IM/CC guy.

I get it. You think all of the EM docs are mouth breathers and couldn’t possibly run a MICU. You’re just wrong. Yes, I have diagnosed eosinophilic PNA and pulmonary/renal syndromes. Believe it or not, there’s actually a fellowship for that...

I’m not going to try to convince you, and that’s fine, but I can tell you that the highest ever in-service at my (well-respected) CCM program was obtained by an EM trainee.

 

[Nephro critical care]

I get it. You think all of the EM docs are mouth breathers and couldn’t possibly run a MICU. You’re just wrong. Yes, I have diagnosed eosinophilic PNA and pulmonary/renal syndromes. Believe it or not, there’s actually a fellowship for that...

I’m not going to try to convince you, and that’s fine, but I can tell you that the highest ever in-service at my (well-respected) CCM program was obtained by an EM trainee.

I will grant that my experience with ED physicians is a bit biased because I haven’t worked with an EM/CC physician and the ED docs in my hospital couldn’t be trusted to put a IJ central line.

 

[Nephro critical care]

Crabbygas fix your post. Internist is spelled wrong it’s not internest. Also if you are quoting someone it should appear in blue.

 

[SpacemanSpifff]

I will grant that my experience with ED physicians is a bit biased because I haven’t worked with an EM/CC physician and the ED docs in my hospital couldn’t be trusted to put a IJ central line.

Then you work at a hospital with an incredibly weak emergency department. That's certainly not the standard across the country.

 

[NewYorkDoctors]

Not according to their website.

Give them a call for the definitive answer.

 

[deleted547339]

I will grant that my experience with ED physicians is a bit biased because I haven’t worked with an EM/CC physician and the ED docs in my hospital couldn’t be trusted to put a IJ central line.

So then you are making entirely uninformed statements. To say that you are unconvinced that an EP can provide high quality care in a MICU is absurd if you literally know no EM/CCM docs.

There is a reason that places such as UPMC, Michigan, WashU, Stanford, Brigham, Mt. Sinai, Maryland, etc train EPs to be intensivists. I assure you these places wouldn’t want to put their stamp of approval on people they don’t think can do the job.

 

[CCM-MD]

Give them a call for the definitive answer.

I'm not going to be calling them. But if you happen to speak to them, have them update the website. It will be encouraging for aspiring EM/CC physicians.

 

[Nephro critical care]

So then you are making entirely uninformed statements. To say that you are unconvinced that an EP can provide high quality care in a MICU is absurd if you literally know no EM/CCM docs.

There is a reason that places such as UPMC, Michigan, WashU, Stanford, Brigham, Mt. Sinai, Maryland, etc train EPs to be intensivists. I assure you these places wouldn’t want to put their stamp of approval on people they don’t think can do the job.

These places want cheap labor and if they can get a board certified ED doc to be their scut monkey for peanuts for 2 years they will take them. Most PP are Pulm/CC and EM/CC will always find it hard to be a part of that pack.

 

[CCM-MD]

These places want cheap labor and if they can get a board certified ED doc to be their scut monkey for peanuts for 2 years they will take them. Most PP are Pulm/CC and EM/CC will always find it hard to be a part of that pack.

You're wrong (this and about a lot of other things that you write on here). But you seem pretty ignorant so you're never going to realize that.

No CCM trained physician is having a hard time "joining the pack". Theres PLENTY of jobs. Market remains hot for intensivists. Trend is towards hospital run ICU groups. I live in a large midwest city where a majority of the CCM gigs are separate from pulmonary. Combined pulm/cc gigs are more common at smaller hospitals.

 

[deleted547339]

These places want cheap labor and if they can get a board certified ED doc to be their scut monkey for peanuts for 2 years they will take them. Most PP are Pulm/CC and EM/CC will always find it hard to be a part of that pack.

Why do you insist on commenting on things when you’re clearly wrong?

You have already said that you don’t know any EM/CCM docs and yet somehow you are competent to evaluate our competency practicing critical care -now you feel competent to comment on our job prospects?

This thread was asking if EM/CCM can supervise IM residents. You have done nothing but give assumptions that are clearly based on little to no data. You should stop.

 

[Nephro critical care]

Why do you insist on commenting on things when you’re clearly wrong?

You have already said that you don’t know any EM/CCM docs and yet somehow you are competent to evaluate our competency practicing critical care -now you feel competent to comment on our job prospects?

This thread was asking if EM/CCM can supervise IM residents. You have done nothing but give assumptions that are clearly based on little to no data. You should stop.

I don’t know any EM/CC docs but know plenty of EM docs and feel they are idiots as far as inpatient care is concerned. I am recertifying for my IM boards and realize how much studying for ABIM boards broadens my knowledge of critical care and understanding of complex pathology. An EM boarded guy will never have the option of giving the IM boards.

 

[deleted547339]

I don’t know any EM/CC docs but know plenty of EM docs and feel they are idiots as far as inpatient care is concerned. I am recertifying for my IM boards and realize how much studying for ABIM boards broadens my knowledge of critical care and understanding of complex pathology. An EM boarded guy will never have the option of giving the IM boards.
Critical care shouldn’t be done by a monkey that is adept at repairing a laceration or relocating a shoulder. It’s complex pathology and family meetings / palliative discussions best handled by guys specializing in inpatient care.

I’m done.

 

[CCM-MD]

I don’t know any EM/CC docs but know plenty of EM docs and feel they are idiots as far as inpatient care is concerned. I am recertifying for my IM boards and realize how much studying for ABIM boards broadens my knowledge of critical care and understanding of complex pathology. An EM boarded guy will never have the option of giving the IM boards.
Critical care shouldn’t be done by a monkey that is adept at repairing a laceration or relocating a shoulder. It’s complex pathology and family meetings / palliative discussions best handled by guys specializing in inpatient care.

You just called all ER doctors monkeys.

 

[Petypet]

I don’t know any EM/CC docs but know plenty of EM docs and feel they are idiots as far as inpatient care is concerned. I am recertifying for my IM boards and realize how much studying for ABIM boards broadens my knowledge of critical care and understanding of complex pathology. An EM boarded guy will never have the option of giving the IM boards.
Critical care shouldn’t be done by a monkey that is adept at repairing a laceration or relocating a shoulder. It’s complex pathology and family meetings / palliative discussions best handled by guys specializing in inpatient care.

This is laughable.
Because the 6-8 months IM does in ambulatory setting really makes them superior intensivists.
Because the 6+ months of ICU I do doing residency makes me inferior to the IM residents that do at most 3-4.
Because doing rotations in geriatrics, nephrology, endocrin, rhem, neurology, ID makes them much more adept to making decisions in the ICU.
I'll go back to eating my banana.

 

[CCM-MD]

This is laughable.
Because the 6-8 months IM does in ambulatory setting really makes them superior intensivists.
Because the 6+ months of ICU I do doing residency makes me inferior to the IM residents that do at most 3-4.
Because doing rotations in geriatrics, nephrology, endocrin, rhem, neurology, ID makes them much more adept to making decisions in the ICU.
I'll go back to eating my banana.

As much as I disagree with the poster you quoted. If you don't think subspecialty rotations in neurology, cardiology, pulmonary, ID, and nephrology makes you a better ICU physician, you are mistaken.

 

[SpacemanSpifff]

I don’t know any EM/CC docs but know plenty of EM docs and feel they are idiots as far as inpatient care is concerned. I am recertifying for my IM boards and realize how much studying for ABIM boards broadens my knowledge of critical care and understanding of complex pathology. An EM boarded guy will never have the option of giving the IM boards.
Critical care shouldn’t be done by a monkey that is adept at repairing a laceration or relocating a shoulder. It’s complex pathology and family meetings / palliative discussions best handled by guys specializing in inpatient care.

You know plenty of EM docs that apparently can't properly place central lines... Not surprised they may not be the brightest bunch. The time of EM as a catch-all field for the intellectually subpar has past. In my program, any one of my fellow residents could have matched at top tier IM programs. Some of these residents will be matching into CCM fellowships and subsequently become ICU attendings in the years to come. Sorry you don't think we're up to the task but, fortunately, your opinions are immaterial.

 

[Nephro critical care]

You know plenty of EM docs that apparently can't properly place central lines... Not surprised they may not be the brightest bunch. The time of EM as a catch-all field for the intellectually subpar has past. In my program, any one of my fellow residents could have matched at top tier IM programs. Some of these residents will be matching into CCM fellowships and subsequently become ICU attendings in the years to come. Sorry you don't think we're up to the task but, fortunately, your opinions are immaterial.

I quit as well from this thread. Pax.

 

[CCM-MD]

My opinions aren’t immaterial. I am the nocturnist/intensivist who has bailed countless ED docs from missed diagnosis /delayed treatment lawsuits. I was born nice and always try to cover other people’s misses but there are others CC docs / hospitalists who will point fingers at ED docs in front of families and administration about missed diagnosis/delayed treatment.

Quoted your original post. I wanted everyone to know you were "born nice".

 

[Nephro critical care]

Quoted your original post. I wanted everyone to know you were "born nice".

That’s true. I was born nice. I hope you were too.

 

[Siggy]

As much as I disagree with the poster you quoted. If you don't think subspecialty rotations in neurology, cardiology, pulmonary, ID, and nephrology makes you a better ICU physician, you are mistaken.

You mean those specialties round on the patients in the unit?

In the mean time, I'm just going to sit back and wait for my next patient that's on a vent who is undersedated and over ventilated since apparently the ED docs at my hospital can't put in a tidal volume other than 500 and won't start anything for sedation besides propofol.

 

[cbrons]

Sorry, but I think you are missing the point here. You are almost dead in the water without a nurse to help you, so you depend on her speed, and that becomes your speed of thinking and doing things. Can you draw up, dilute, titrate, and administer your own drugs? And I am not talking about a code situation. I am talking about what happens before, about what one does rapidly to avoid getting there. You cannot compare yourself with somebody who's used to do things solo, if needed, no offense. You might be great in a team, you might be great at putting in a central line (especially when all is needed is a large bore peripheral IV), your long-term and even short-term medical thinking may be outstanding, but you are not the best at hands-on patient care, because you really don't do enough of it. Your speed is your team's speed, and what kind of speed is that when you guys almost never practice as a team? One can't really supervise things one hasn't done solo, and I see it all the time when around ICU "teams".

You are doctors, while we are doctors and nurses and pharmacists and respiratory techs etc. We do whatever we need to do. Patient is bucking, or overbreathing the vent? Fixed in a minute. (And I am not talking about just pushing a stick of rocuronium, but deciding in ten seconds why the patient is doing it and what's the best way to treat it.) Patient is uncomfortable? Fixed in a blink, again. (Your patients are either oversedated and/or in pain, rarely where they should be, according to your own science, because the show is run by your nurses and protocols, not true individualized patient care. How come a lot of ICU patients remember having pain while in the ICU, and nobody feels ashamed about this level of "care"?) Patient is unstable? Fixed. We don't care about bruising egos; we care about saving patients. Your speed is usually not an anesthesiologist's speed, and same goes for some surgeons at bedside. It's always faster to just do stuff, than give orders to nurses and explain. The whole ICU is set up almost like a regular floor; except for a code situation, one cannot get things done without a nurse and an order (do you guys have your own Pyxis access?), or having the pharmacy bless them (while even the first year anesthesia resident has an entire cart at his fingertips), cannot change vent settings without hurting the poor RT's ego, must keep the nurses happy etc. It's all about egos and bureaucracy. It's the difference between snail mail and email.

So, yeah, I'd rather crash in an OR or PACU with some badass (not just any) anesthesiologists around.

I’ve never seen an attending or fellow care 1 iota about the RT getting mad at them touching the ventilator. Never seen an RT get mad about that though either.

 

[AdmiralChz]

I’ve never seen an attending or fellow care 1 iota about the RT getting mad at them touching the ventilator. Never seen an RT get mad about that though either.

In both residency and fellowship the RTs absolutely lose it if someone touches the vent without telling them. Maybe it’s a SICU thing, but I’ve been written up multiple times.

 

[Situasian]

Oh, they definitely get mad if you change the vent settings without telling them. Once they get to know you they are ok with it as long as you let them know. It's just good communication.

 

[Siggy]

Oh, they definitely get mad if you change the vent settings without telling them. Once they get to know you they are ok with it as long as you let them know. It's just good communication.

They get more mad when you cosign the order to the hospitalist attending (who doesn't have vent privileges) than the critical care attendings. This, of course, is dependent on them trusting that you have at least a mild knowledge of how to manage a vent.

 

[cbrons]

Ours dont get mad as long as you tell them what you changed