Community versus academic MICUs

[Levo]

Long-time lurker first-time poster. I'm a fourth year medical student currently applying to IM residencies with an interest in pulm/cc. The only exposure I've ever had to critical care was at my home institution's university hospital. I was curious how a university hospital MICU compares to a MICU at a big community hospital. Are kinds of cases you see very different? Are there a lot fewer crazy-sick crashing patients at the community MICU? Or is a MICU going to have similar kinds of patients regardless of whether it's at an academic center or a large community hospital? Thanks!

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[Nephro critical care]

The major difference at a university ICU is that you are more likely to have more transplant / pretransplant cases so more of the immunocompromised variety. Will also see more ECMO , ventricular assist devices in cardiac ICU and complex neuro trauma / subarachnoid hemorrhage. Academic ICUs are more likely to do more procedures, community ICU are likely to get by with less procedures as there are more people in academic ICUS wanting to get certified and less people available and have time/energy to do procedures in community ICUs. You are going to get more subspecialty backup in academic centers.
I think the clinical acuity is not different though. I work in 10-12 bed community ICU and we get some very sick patient's who can take up your whole day. An intensivist in a busy community ICU will likely be better clinically than in a university ICU because they spend more time " in the trenches " so as to speak.