CCM Fellow Schedule

[EndTidalCO2]

Hey all, just a simple question.

What's a typical month look like for a FELLOW doing his or her ICU rotations during the fellowship year(s) (depending if you are anesthesia vs pulm vs IM)?

I know that typically 9 months are spent in ICU and 3 are elective. During the ICU months, do fellows have 1 week on and 1 week off similar to attending lifestyle? Or is it insane and doing 12s 6 days a week?

Just curious.

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[ToKingdomCome]

My program is like work 14 days with like 2 days off scattered in between. I don’t think any program is giving you 7 on and 7 off

 

[CCM-MD]

Hey all, just a simple question.

What's a typical month look like for a FELLOW doing his or her ICU rotations during the fellowship year(s) (depending if you are anesthesia vs pulm vs IM)?

I know that typically 9 months are spent in ICU and 3 are elective. During the ICU months, do fellows have 1 week on and 1 week off similar to attending lifestyle? Or is it insane and doing 12s 6 days a week?

Just curious.

Critical care fellows definitely do not have 1 week on/off. Fellows work hard.

 

[Tipsy McStagger]

You'll work a lot. Our ICU blocks were 2 weeks each, often there would be 3-4 stacked on top of each other. During your ICU blocks you work 6/7 days, and they're generally pretty long days. Week on / week off doesn't exist for fellows as far as I know.

 

[EndTidalCO2]

So fellows work 6-7 days a week, for 9 months straight?? How can anyone keep up with this? Lol damn

 

[psychbender]

So fellows work 6-7 days a week, for 9 months straight?? How can anyone keep up with this? Lol damn

Ummmm, yeah?

On our MICU rotations, two fellows would lead two teams. One worked for 12 straight days, then was off two (then on to the next rotation). The other worked M-F, then M-Sun, and on to the next rotation. During the week, one fellow had to remain until 7pm signout, so the two fellows would agree on which would be 'long' which days (long also admitted). The 'short' fellow may leave after rounds and the bulk of the work was done (maybe somewhere 2-5pm).

Trauma/SICU was usually until 3-5pm M-F only. CVICU was 7-5pm, with one night (5p-7a) per two week block (getting the required two days off each block).

 

[EndTidalCO2]

Ummmm, yeah?

On our MICU rotations, two fellows would lead two teams. One worked for 12 straight days, then was off two (then on to the next rotation). The other worked M-F, then M-Sun, and on to the next rotation. During the week, one fellow had to remain until 7pm signout, so the two fellows would agree on which would be 'long' which days (long also admitted). The 'short' fellow may leave after rounds and the bulk of the work was done (maybe somewhere 2-5pm).

Trauma/SICU was usually until 3-5pm M-F only. CVICU was 7-5pm, with one night (5p-7a) per two week block (getting the required two days off each block).

Well, that's brutal but it's CCM for a reason. Thanks for the info. Guess it helps if it's only a year coming from anesthesia.

 

[psychbender]

Well, that's brutal but it's CCM for a reason. Thanks for the info. Guess it helps if it's only a year coming from anesthesia.

Nah, that ain't a brutal schedule. When I was interviewing, I had some PDs send me their fellows' schedules. I looked at some and if the offgoing and oncoming fellows high fived each other instantly transferring knowledge of the patients, they still would exceed 80hrs/week nearly every week on service.

 

[eefen]

Almost done with my last MICU block of fellowship.

Just finished a 75 hour week. 3 weeks down, 1 week to go. Very excited about my day off tomorrow. Lots of blocks like that first year. Slightly less in second year.

 

[EndTidalCO2]

Almost done with my last MICU block of fellowship.

Just finished a 75 hour week. 3 weeks down, 1 week to go. Very excited about my day off tomorrow. Lots of blocks like that first year. Slightly less in second year.

What do you think of the attending lifestyle? Is the burnout real? What's the schedule like after fellowship?

 

[eefen]

Burnout is real.

Attending life for me will be week on week off. Sounds great right now.

For full disclosure, second year in particular has a few more elective and research months. So after next week, for example, I'm moonlighting a bit, working some back up coverage shifts, but mostly will be working from home tying up some research projects. Can't wait. Those are the stretches where I feel more like a human with hobbies and non-medical interests.

 

[Katheudontas parateroumen]

I think in general for anesthesia icu fellowships, there’s like one or two dedicated units where they’ll be the workhorse and the other units will be more so M-F. For us, we have 2 units MICU and transplant for a total of 6 months where we are the grunt force taking calls, seeing 10-15 pts during the day, 30+ at night, writing all the notes etc, 12+ hour days, 6 days per week. The other 6 rotations are mostly
M-F, a weekend day here and there 7-5.

But yeah, no week on week off type of things like attending schedules. I think Mayo is is like 3 days, 3 nights, 3 days off rotation.

 

[psychbender]

I think in general for anesthesia icu fellowships, there’s like one or two dedicated units where they’ll be the workhorse and the other units will be more so M-F. For us, we have 2 units MICU and transplant for a total of 6 months where we are the grunt force taking calls, seeing 10-15 pts during the day, 30+ at night, writing all the notes etc, 12+ hour days, 6 days per week. The other 6 rotations are mostly
M-F, a weekend day here and there 7-5.

But yeah, no week on week off type of things like attending schedules. I think Mayo is is like 3 days, 3 nights, 3 days off rotation.

I think CCF had a similar thing in their SICU (6 months), where fellows worked a stretch of days, had a couple days off, then a three or four night block of nights, several more days off, then back into days.

There were also a handful of programs (MUSC, UAB) that were strictly M-F, 7-5 (or 3?) with no call or weekend expectations (but available as moonlighting). Off course, that was when I was interviewing years ago, things may have changed.

 

[EndTidalCO2]

Burnout is real.

Attending life for me will be week on week off. Sounds great right now.

For full disclosure, second year in particular has a few more elective and research months. So after next week, for example, I'm moonlighting a bit, working some back up coverage shifts, but mostly will be working from home tying up some research projects. Can't wait. Those are the stretches where I feel more like a human with hobbies and non-medical interests.

Are you excited to work 1 week on and 1 week off? People love to talk about how "you need a whole week just to recover" but I personally have had pretty tough stretches working 6-7 days, 12+ hrs a day and then I usually can recover to baseline after 1 day of rest. I think I would enjoy the whole week off.

I think once I'm done with anesthesia residency, CCM would allow me to do 1.5 weeks of OR, 1 week in the unit, and then 1.5 weeks off. Sounds great to me. Vacation each month.

 

[eefen]

Are you excited to work 1 week on and 1 week off? People love to talk about how "you need a whole week just to recover" but I personally have had pretty tough stretches working 6-7 days, 12+ hrs a day and then I usually can recover to baseline after 1 day of rest. I think I would enjoy the whole week off.

I think once I'm done with anesthesia residency, CCM would allow me to do 1.5 weeks of OR, 1 week in the unit, and then 1.5 weeks off. Sounds great to me. Vacation each month.

I think there's a obviously variety of schedules in the world of CCM that can be built. I can definitely see the appeal of shorter stretches, though those usually go hand-in-hand with fewer days off in a row.

Week on/off sounds reasonable right now. I think that's especially true if you find a place where you aren't worked to the bone when you are on. There is something to be said for continuity of care and some things being easier later in the week when you know your patients instead of relearning a service every time you are starting a shorter stretch.

Also, a rough week isn't the end of the world. A rough month (e.g. right now, in fellowship) sucks. But at least after the end of every stretch I'll have a vacation of sorts to look forward to, even if that just means having flexibility to spend extra time with family, etc.

But who knows. All of this is somewhat theoretical right now, but a week on seems long enough to be ready for some time off, and a week off seems long enough to want to get back in the thick of things.

 

[psychbender]

Are you excited to work 1 week on and 1 week off? People love to talk about how "you need a whole week just to recover" but I personally have had pretty tough stretches working 6-7 days, 12+ hrs a day and then I usually can recover to baseline after 1 day of rest. I think I would enjoy the whole week off.

I think once I'm done with anesthesia residency, CCM would allow me to do 1.5 weeks of OR, 1 week in the unit, and then 1.5 weeks off. Sounds great to me. Vacation each month.

Be careful about that thinking. Anes/CCM doesn't blend too well, outside of academics. I am in an anomalous practice, working anesthesia 32wks, ICU 10wks, off 10wks. In academics, I saw a bunch of models, including staff working nearly a full FTE critical care (20-24wks) AND >0.5FTE anesthesia, while being paid barely more than the 1FTE generalists. One I really liked was 2wks OR (M-F, no call), 1wk ICU. one week off, plus a few more weeks (2-6, depending on university program) of vacation/CME time throughout the year.

 

[ToKingdomCome]

I think there's a obviously variety of schedules in the world of CCM that can be built. I can definitely see the appeal of shorter stretches, though those usually go hand-in-hand with fewer days off in a row.

Week on/off sounds reasonable right now. I think that's especially true if you find a place where you aren't worked to the bone when you are on. There is something to be said for continuity of care and some things being easier later in the week when you know your patients instead of relearning a service every time you are starting a shorter stretch.

Also, a rough week isn't the end of the world. A rough month (e.g. right now, in fellowship) sucks. But at least after the end of every stretch I'll have a vacation of sorts to look forward to, even if that just means having flexibility to spend extra time with family, etc.

But who knows. All of this is somewhat theoretical right now, but a week on seems long enough to be ready for some time off, and a week off seems long enough to want to get back in the thick of things.

Where did you for icu fellowship

 

[eefen]

Where did you for icu fellowship

I'm still there for a couple months, but I'll PM you.

 

[grt398]

I would strongly urge people to ask about the schedule for your fellowship b/c it varies quite a bit by program. One year programs are what they are b/c it's just one year. Most 2 year programs will work you pretty hard the first year, i.e. 8-9 months of ICU time like people are talking about above, but the second year can be quite variable, from as little as 3 months of mandatory ICU time to another 9 months of mandatory ICU time, and there's a really big quality of life difference there.

And I would argue there's a point where it's counterproductive to learning to still be grinding away long hours on your 15th ICU block, especially if you were someone who did the maximum ICU months in residency (if coming from IM). The PCCM folks are actually limited by ACGME to 15 months of ICU time max over 3 years and I think that's a better way to go and allows for more time to read/consolidate your knowledge, and give you the opportunity to do other rotations that may be helpful if your program offers it like pulm consults, ICU only nephro consults, ICU only ID consults, cards/heart failure consults, maybe an additional airway rotation in the OR's etc.

 

[Siggy]

My program was 23 months of ICU and 1 month of trauma ICU at an outside hospital.

Fellows rotate a week between 3 weeks of days and 1 week of nights. Technically speaking, there were specific unit assignments, but that depended on which other fellows were on.

1st year fellows worked 66 hours/week averaged over 4 weeks and 2nd year fellows worked 60 hours/week averaged over 4 weeks.

 

[chocomorsel]

Critical care fellows definitely do not have 1 week on/off. Fellows work hard.

I didn't work hard at all. It was lovely. I was too old for that ish.

 

[nycitygas]

I learned alot during my fellowship but damn I worked my ass off. The schedule shown to me during the interview was completely different. Every job I have taken since then has been so much easier in comparison.

I typically worked 3/4 weekends (since I didnt have kids I somehow ended up with more weekends). Out of a 28 day block, I typically worked 22-23 12 hours shifts. Several of the "off days" were really just night-day transition shifts.

It wasn't worth it especially with the mediocre ICU job market. Do a regional or cardiac fellowship.

 

[chocomorsel]

I worked about 40-45 hours a week. It was glorious. I make tons of money since Covid broke but the Anesthesia market is exceptional now with better hours.
OP do a chill fellowship. Be motivated and you will still learn a lot.

 

[ToKingdomCome]

I worked about 40-45 hours a week. It was glorious. I make tons of money since Covid broke but the Anesthesia market is exceptional now with better hours.
OP do a chill fellowship. Be motivated and you will still learn a lot.

Is this a program in Chicago?

 

[chocomorsel]

Is this a program in Chicago?

Hell no. I am too boney for the cold. It’s in the Deep South. I am an anesthesiologist so this is not an IM program.

 

[ToKingdomCome]

Hell no. I am too boney for the cold. It’s in the Deep South. I am an anesthesiologist so this is not an IM program.

Are IM CC fellowships more hours ?

 

[chocomorsel]

Are IM CC fellowships more hours ?

Heck if I know.

 

[Doctor Bob]

Are IM CC fellowships more hours ?

Both are limited by the same ACGME requirements. It will be program dependent as to how close to that limit they want to come.

 

[the argus]

PCCM at large academic center in the north east.

11 months total of critical care over the 3 years (majority is MICU). Blocks go by calendar month, work week is M-F and usually 12 hour days, and then a separate weekend call schedule. Weekend call is ~1/month first year, and then progressively less each year.

When interviewing I remember some programs with much rougher schedules. 2 weekends/month for the first 2 years, q4day 24 hour call for the entire first year, etc.