CCM pros and cons

[mar8d]

Hello all - need a little advice...

After 3 yrs of practicing EM as an attending, I'm planning on applying for a CCM fellowship. Every now and then I talk myself out of it -- do I really want to go back to training for 2 years? Some of the cons that I see is that my pay won't increase that much compared to not doing the fellowship, perhaps my lifestyle won't improve (or could even worsen(?) with 7 on 7 off 12 hr shifts) , and dealing with the end of life issues can be emotionally, ethically, and mentally difficult.

The pros keep me going (for now) - challenging cases, more continuity of care (vs the emergency dept), greater depth of knowledge, and then there's the flip side of end of life issues -- helping families through some of the toughest decisions of their lives.

As I start to talk myself out of the fellowship, I've been considering just going back and doing an anesthesia residency instead. Only one extra year of training, better lifestyle (?), cool procedures, still lots of critical care, and better pay (upwards to 400K vs 300K for CCM). I know money isn't everything, but when I think about my family and putting them through another few years of training and uprooting us for my career, I want it to be worth it for our future.

What are your thoughts? Any EM/CCM docs out there - what do you think about your lifestyle in CCM vs the ED? Any thoughts from my anesthesia colleagues?

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[jdh71]

@Hamhock
@Doctor Bob
@dotcb
@ORL10
@deuist

 

[Doctor Bob]

After 3 yrs of practicing EM as an attending, I'm planning on applying for a CCM fellowship. Every now and then I talk myself out of it -- do I really want to go back to training for 2 years? Some of the cons that I see is that my pay won't increase that much compared to not doing the fellowship, perhaps my lifestyle won't improve (or could even worsen(?) with 7 on 7 off 12 hr shifts) , and dealing with the end of life issues can be emotionally, ethically, and mentally difficult.

I can't speak to the post-fellowship lifestyle. But yes, the decision to re-enter training after a few years of attending life... well, that was a tough one. I knew with each year that passed that I was less and less likely to bite the bullet and take the income hit, demotion of station, and free-time reduction.

For me it became a question of what did I want to get out of the training. As CC gave me the option for a different practice style and location it was an easier choice. At this point I could never do something like ultrasound or simulation because although it would make me more knowledgeable, when I finished I'd go back to the same (clinical) job.

Ultimately, the drop in salary (at this stage) wasn't dramatic... but I'm coming from the military so it's a lot less of a pay differential than a civilian job. So I decided to do the fellowship before I became too much of a slug and lost all momentum.

 

[ORL10]

I did EM, followed by CCM fellowship (in-training). I loved EM, but I enjoy knowing advanced management and physiology, and seeing my patients through critical illness. Much of what the ICU focuses on is nuanced, and detail oriented which is not always realistic in the ED. I think many ED physicians think CC is procedures, and resus which it is not.

Making end of life decisions with families can be painful, but is a reality and doesn't bother me so much. Also I feel I am able to give a good overall view of what to expect, versus consultants who tend to focus on "their problems" which may or may not be fixable.

As for pay it's similar to slightly more than EM (depending on where you work). Hourly its similar but it is possible to work 7/12's in a week which is virtually impossible in the ED. Most jobs range from 125-200K for 7/12 hour shifts per work (based on graduating fellows salary and offers I have had). Community is obviously more.

I'm not an anesthesiologist, but I'm in a HEAVY anesthesia based ICU and many of my colleagues are graduating and going into private practice to do anesthesia alone (no CCM). Their schedule seems flexible, they do cool procedures are technically savvy and have excellent knowledge of pharmacology.

Overall, do CCM because you are interested in the subset of patients with critical illness who need coordination in many moving parts working together as a team to move patients through. Also the bells and whistles of the ICU tend to be fun (vents, CVVH, EVD's/hummingbirds, echo, ecmo, vad's, pac etc…) It sounds like you need to do some serious soul searching before making an decisions at this point, feel free to PM.

 

[europeman]

Hey.... Message me privately and I can connect you to some of my er colleagues currently in the surgical critical care fellowship at shock trauma in Baltimore. They would have great insight for you.

Don't do anesthesia. The increase pay compAred to ER is a bit of a myth. My wife is an attending anesthesiologist. Plus with health care reform and such..... If anything the demand for ICU docs and er docs will rise as anesthesia falls (crna's etc).

I look forward to hearing from you

 

[Stank811]

I am anesthesiologist that has done a CC fellowship. I would not persue anesthesiology for a better lifestyle. Anesthesiology is no more flexible than ER or CC...all essentailly can be done without clinic and scheduled in shifts. In my region the pay is better being an anesthesiologist compared to CCM or ER but would never recommend chasing a career for money because the difference is not large enough to warrant you doing something you do not like. After your additional training if you still wanted to be an ER physician I would do a CC fellowship bc it would allow you to practice both...would be harder with anesthesiology. If you are looking to get out of the ER do whatever makes you wake up in the morning and not hate your job. I personally would recommend anesthesiology to anyone...and the whole CRNA thing in my opinion is blown out of proportion. States have been opting out of physician supervision for over a decade and there has not been a significant change in independent CRNA practice. More hospitals have been incorporting midlevel anesthesia providers to a more team based model instead of physician only practices which is being driven by need and economics.