Critical care medicine before cardiology fellowship

[manchester]

I am wondering about the cons and pros of this approach. How would matching in a prestigious critical care medicine program for 2 years help or not for matching into cardiology?pros and cons? What is the career of a cardiac intensivist like in the long term?

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[residentk3]

I’m not sure anyone knows the answer to this. Cards/CC is newer and recently gaining traction.

Having critical care training certainly wouldn’t hurt your chances of matching Cardiology and would likely only help. As far as long term career prospects, you may have an easier time joining an academic group as most private hospitals would aready have an intensivist group running the ICU. Most private groups have open ICUs and so many patients have both Internal Medicine and PCC consulted to run ICU management and vents.

TLDR: won’t hurt your chances, may help depending on cards fellowship. Will help for academics, won’t matter much for private practice.

 

[CCM-MD]

I am wondering about the cons and pros of this approach. How would matching in a prestigious critical care medicine program for 2 years help or not for matching into cardiology?pros and cons? What is the career of a cardiac intensivist like in the long term?

Probably won’t hurt your chances. Not sure how much it will help. There are limited Cards & CCM combination prospects outside of academics. Hard to do both and probably won’t make sense financially. If you really want to do this, it’s probably smart to do cardiology first followed by CCM so you can save a year of training.

I think the cons of this approach are obviously the length of training. You will be spending at least 5 years on top of 3 years of internal medicine. Lookin at your post history... looks like you did prelim surgery initially and then IM? That’s a lot of years of training. Consider the prospect that you may be too burnt out to pursue cardiology training after doing 2 years of CCM.

I know someone who did CCM after cardiology and based on his experience - I think if you go into a non-academic setting after completing both fellowships, you will be working primarily as a cardiologist and likely won’t be using your CCM training. The converse is less likely but also possible - working primarily as an intensivist and not using your cardiology training as much.

 

[cardsguy2017]

Just my opinon here, but probably won't help much at all. If you don't continue to work on cardiac related "scholarly activity" during CCM fellowship, it may even hurt. As for career prospects, it's not the first I've heard of but I agree with the others and job prospects using both skills will likely be narrow.

 

[IMreshopeful]

To echo what others have said, it can give you connections with the cardiology faculty at that institution and the ability to get connected with research there. You can always spin your future interest as potential cardiac critical care/heart failure as a career interest - the field of cardiac critical care is small but burgeoning and there probably will be a niche for it in the academic world. However simply doing a critical care fellowship without demonstrating a sustained interest in cardiology in some form will be unhelpful in matching a good cardiology program.

 

[SpartanStrong]

Probably won’t hurt your chances. Not sure how much it will help. There are limited Cards & CCM combination prospects outside of academics. Hard to do both and probably won’t make sense financially. If you really want to do this, it’s probably smart to do cardiology first followed by CCM so you can save a year of training.

I think the cons of this approach are obviously the length of training. You will be spending at least 5 years on top of 3 years of internal medicine. Lookin at your post history... looks like you did prelim surgery initially and then IM? That’s a lot of years of training. Consider the prospect that you may be too burnt out to pursue cardiology training after doing 2 years of CCM.

I know someone who did CCM after cardiology and based on his experience - I think if you go into a non-academic setting after completing both fellowships, you will be working primarily as a cardiologist and likely won’t be using your CCM training. The converse is less likely but also possible - working primarily as an intensivist and not using your cardiology training as much.

I'm a 2nd year resident, also looking into going Cardiology -> CCM. Ideally I was thinking of doing cardio clinic with MICU time. Is this feasible, or am I better served just going straight pulm/crit?

 

[CCM-MD]

I'm a 2nd year resident, also looking into going Cardiology -> CCM. Ideally I was thinking of doing cardio clinic with MICU time. Is this feasible, or am I better served just going straight pulm/crit?

It is honestly going to be very challenging to find a way to do that. MIGHT be possible somewhere in academics - highly unlikely tbh.

Forget about it outside of academics. In fact, in many parts of the country it’s becoming harder to find Pulm and CCM combined gigs as more and more large hospitals start to employ intensivists. Typically the larger the hospital and the higher the acuity, the more likely they employ intensivists. In my experience, the smaller hospitals with lower acuity ICUs is where the Pulm/CCM model continues to exist. I have several colleagues who are Pulm/CCM trained and work as employed intensivists at a large community hospital in the Midwest - don’t practice any Pulm currently.

 

[SpartanStrong]

It is honestly going to be very challenging to find a way to do that. MIGHT be possible somewhere in academics - highly unlikely tbh.

Forget about it outside of academics. In fact, in many parts of the country it’s becoming harder to find Pulm and CCM combined gigs as more and more large hospitals start to employ intensivists. Typically the larger the hospital and the higher the acuity, the more likely they employ intensivists. In my experience, the smaller hospitals with lower acuity ICUs is where the Pulm/CCM model continues to exist. I have several colleagues who are Pulm/CCM trained and work as employed intensivists at a large community hospital in the Midwest - don’t practice any Pulm currently.

So if that's the case, unless I'm doing academics or a small suburban hospital..there's no point in me doing pulm either, and I'm best served just going into CCM?

I LOVE my time in the unit, but I also do notice the slow burnout setting in, such that at the end of two weeks, I'm ready for a break, so ideally, some type of clinic time during that works, but now you're saying that practice model doesn't really work anymore?

 

[CCM-MD]

So if that's the case, unless I'm doing academics or a small suburban hospital..there's no point in me doing pulm either, and I'm best served just going into CCM?

I LOVE my time in the unit, but I also do notice the slow burnout setting in, such that at the end of two weeks, I'm ready for a break, so ideally, some type of clinic time during that works, but now you're saying that practice model doesn't really work anymore?

The advantage of doing Pulm is that if/when you burn out of practicing CCM... you can transition to practicing more Pulm. But practically speaking that may be hard to do... if you practice CCM alone for 5-10 years it will be hard to transition to practicing Pulm after that. Typically intensivist gigs are ~14 shifts a month scattered or week on/off. Combined pulm/CCM gigs are either ~1 week in the ICU a month with rest Pulm or some other variation.

Don't get me wrong - there are lots of Pulm/CCM combination jobs out there. But in many parts of the country the trend is towards hospitals employing intensivists that don't simultaneously practice pulm (many of these intensivists are dual pulm/ccm trained).

 

[SpartanStrong]

The advantage of doing Pulm is that if/when you burn out of practicing CCM... you can transition to practicing more Pulm. But practically speaking that may be hard to do... if you practice CCM alone for 5-10 years it will be hard to transition to practicing Pulm after that. Typically intensivist gigs are ~14 shifts a month scattered or week on/off. Combined pulm/CCM gigs are either ~1 week in the ICU a month with rest Pulm or some other variation.

Don't get me wrong - there are lots of Pulm/CCM combination jobs out there. But in many parts of the country the trend is towards hospitals employing intensivists that don't simultaneously practice pulm (many of these intensivists are dual pulm/ccm trained).

But the idea of burning out and practicing cardiology...not so feasible?

My thought process was that given the increasing move towards giant hospital employment, I could potentially work something out such that I get 1-2 weeks in the CCU/MICU, then time off to do clinic.

But it sounds like I'm just a naive resident without much of a grip of how things work in the real world eh?

 

[AceXIII]

But the idea of burning out and practicing cardiology...not so feasible?

My thought process was that given the increasing move towards giant hospital employment, I could potentially work something out such that I get 1-2 weeks in the CCU/MICU, then time off to do clinic.

But it sounds like I'm just a naive resident without much of a grip of how things work in the real world eh?

I'm a resident applying to cardiology at a large academic program. There are currently TWO fellows here who are cardiology/crit care. One of them did critical care first, and the other is doing it after general cardiology fellowship. They are both planning to work primarily in a CCU setting but also are not excluding the option of being a MICU intensivist or general cardiologist. This is not such an uncommon path as many people prefer cardiology over pulmonology. Ultimately, this is a new trend without a clearly defined role, but you will without a doubt be trained uniquely and will have no trouble finding work. It may be difficult to find an "ideal" arrangement (ie CCU and general cards/outpatient mix) but thats just because few people do it, and by no means would it be impossible.

I personally wouldn't listen to people discouraging you from pursuing this, you will have a ton of options and you may even be able to carve out a niche little dream job.

 

[CCM-MD]

Might be able to "carve out a niche" in academics.

Outside of academics: I agree with the above poster that you will be uniquely trained and won't have any trouble finding a job as a cardiologist OR as an intensivist. But you will be so uniquely trained that it will be hard to find a situation unique enough to let you do both in a location you want to live in.

 

[cardsguy2017]

I'm a 2nd year resident, also looking into going Cardiology -> CCM. Ideally I was thinking of doing cardio clinic with MICU time. Is this feasible, or am I better served just going straight pulm/crit?

Not saying its impossible, but finding such a setup may be difficult, you're essentially working 2 jobs that have their own needs and finding jobs that'll mesh will be a challenge. If you're thinking of doing CCU and being the do-it-all person, again it'll be a challenge to find a hospital/group that will accommodate it. How interested are you in cards? Are you willing to go thru 3yrs of cards fellowship and the cardiologist lifestyle (i.e. call)? Have you considered doing just crit and gen med? You could always transition to hospitalist, outpatient, etc.

There are currently TWO fellows here who are cardiology/crit care. One of them did critical care first, and the other is doing it after general cardiology fellowship. They are both planning to work primarily in a CCU setting but also are not excluding the option of being a MICU intensivist or general cardiologist.

Won't disagree with what you said, having options are good and being flexible is good, but they're still fellows, lets see what the end up actually doing with it before judging the merits of this.