Closed units in private practice

[Jabbed]

Medical student keenly interested in CCM, although my exposure on rotations has made it clear to me that I would not be able to spend my career in an open unit. Assuming that I don't stay in academics, how viable is it to find a job in the community with a closed (or at least "mixed") unit?

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[tartesos]

Medical student keenly interested in CCM, although my exposure on rotations has made it clear to me that I would not be able to spend my career in an open unit. Assuming that I don't stay in academics, how viable is it to find a job in the community with a closed (or at least "mixed") unit?

Very likely, hospitals love it, if they can find the coverage.
For private practice he larger the group the more likely it is to be feasible, as you need to cover it 24/7( even with np on board) and it's hard to do that with a small group, or you can choose to be hospital employed.



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[deleted171991]

Medical student keenly interested in CCM, although my exposure on rotations has made it clear to me that I would not be able to spend my career in an open unit. Assuming that I don't stay in academics, how viable is it to find a job in the community with a closed (or at least "mixed") unit?

If it's a MICU, it will probably be closed. If it's a SICU, it will probably be open.

 

[sluggs]

I have worked in a community hospital with a closed ICU; it was a very high acuity place and it worked well. Things you need: hospital/admin support; hospital willing to foot bill for night coverage; medical staff that understands value of closing ICU. I am at a community program that is "hybrid" (read: "free for all") and it is tough. Over 30 beds of real ICU patients is very conducive to 2 day/1 night intensivist CLOSED. Easier said than done, though.

 

[AdmiralChz]

If it's a MICU, it will probably be closed. If it's a SICU, it will probably be open.

A reasonable generalization. Some surgeons really struggle with giving up significant control of their patients in the perioperative (especially postoperative) period. Surgery in general enjoys a more comprehensive relationship with their patients going from pre/intra/post surgery (a really huge generalization, and only talking about inpatient care for the most part but bear with me for a minute). Medicine consultants may not enjoy as long-lasting a relationship, especially if the inpatient and outpatient teams are different.

Honestly it's hard to blame them when they are on the hook medico legally if complications arise. Some of the more savvy surgeons are more than happy to leave the critical care to others and stick to relevant surgical issues, but certainly there are many on the other side who are hyper-critical of their patients.

 

[jdh71]

Completely closed can bite you in the ass with horse**** nonsense though too.

Where I work is hybrid. If it's on a vent it's an automatic consult to us unless it's the trauma guys who are admitting the patient and they are all critical care trained. This includes post op patients. We have a good working relationship with our general surgeons so we don't run into much trouble there. And it's probably better for the patients just given the skills sets both parties are bring to the table. Our surgeons want to be in the OR not dealing with the "stupid" insulin drip or vent. Anything medicine or FP parks in the unit is an automatic consult. The medicine guys disappear happy to pick back up on the other side. FP has a residency and follows along. With that said if all the patient needs is an insulin drip for some straight forward out of control DM2 without DKA or maybe a dilt or nicardipine infusion for fib or high BP and the floor nurses won't titrate they can put their patients in the unit but with our approval. We are also an automatic consult on any sick heads. The neuro surgeons can admit elective cases but can't be primary on disasters. The same with the cardiologists. Our CV surgeons do all their own work rarely asking for an opinion. We have 42 General ICU beds and 12 in the CV. The medical intensivists provide 24/7 coverage. Two guys on during the day and one at night. Our trauma service provides 24/7 coverage as well.

It works really well. And seems to have worked out the kinks between a "free for all" and a completely closed unit.

 

[mochief2000]

@jdh71 how many nights do you do in this hybrid schedule??

 

[jdh71]

@jdh71 how many nights do you do in this hybrid schedule??

Probably a total of 30-35 nights in a year. And it probably won't ever more more than that because contractually we get extra for any nights above 35 in a contract year. The "suits" aren't fans of paying me more than they have to!!

But we break it into four and three night blocks. M-Th and F-Su. It gets kind of spread out too. I had no nights this month at all.

We also have a couple of pure intensivists who do weeks on and weeks off. These folks spend a third of those weeks on covering at night.