Critical care practice models

[Self]

My Google-fu is simply failing me for this one. Wondering if you guys can point me towards a resource that details different Pulm-CC practice models. Do they split time between pulm consults and ICU attendings, how much, private practice and academic differences, etc. Anyone know of a good place for this info?

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[jdh71]

My Google-fu is simply failing me for this one. Wondering if you guys can point me towards a resource that details different Pulm-CC practice models. Do they split time between pulm consults and ICU attendings, how much, private practice and academic differences, etc. Anyone know of a good place for this info?

There are literally many many ways to do this.

What are you looking for specifically?

 

[Self]

Looking for a model that gives ample time for both pulmonary work and ICU-specific work, to keep skills sharp for both. Since they are two very different fields in practice I'd imagine it would be something like trying to find two jobs with complementary schedules. It seems challenging, but it also seems pulm/crit would have figured it out by now, if it exists.

 

[chocomorsel]

Looking for a model that gives ample time for both pulmonary work and ICU-specific work, to keep skills sharp for both. Since they are two very different fields in practice I'd imagine it would be something like trying to find two jobs with complementary schedules. It seems challenging, but it also seems pulm/crit would have figured it out by now, if it exists.

I see so many postings for this type of job. Way more than straight CCM. Can’t imagine how this could be a problem for you.

 

[Self]

Ok great. Where can I find these postings?

Never said this was a problem. I'm just trying to do some research.

Looking for details on how a practice like this is run. Immediately there are 3 jobs that any one person can do: ICU intensivist, pulmonary inpatient consults, pulmonary outpatient clinic. Can add a bonus 4th if you do something like post-ICU follow-ups. Inpatient consults generating outpatient followups is a pretty traditional model for any consultant. But how does the ICU attending time fit into that? Do you operate at an opportunity-loss if you do more ICU and don't generate enough of those office visits? What's an example schedule? 1 week and 1 weekend in the ICU, 1 week in the office, 2 weeks on consults? Something different?

What makes the most sense?

 

[Hamhock]

Ok great. Where can I find these postings?

Never said this was a problem. I'm just trying to do some research.

Looking for details on how a practice like this is run. Immediately there are 3 jobs that any one person can do: ICU intensivist, pulmonary inpatient consults, pulmonary outpatient clinic. Can add a bonus 4th if you do something like post-ICU follow-ups. Inpatient consults generating outpatient followups is a pretty traditional model for any consultant. But how does the ICU attending time fit into that? Do you operate at an opportunity-loss if you do more ICU and don't generate enough of those office visits? What's an example schedule? 1 week and 1 weekend in the ICU, 1 week in the office, 2 weeks on consults? Something different?

What makes the most sense?

Self - you are proposing some obvious questions in an interesting way. I am having trouble understanding your angle. Are you trained in CCM in the US?

Clearly there is a move from the traditional Pulm-CCM model (hence my skepticism of your first post) to a straight intensivist model.

Are you looking for opinion or opportunities?

If you want opinion: I believe CCM should be a multi-disciplinary-based fellowship/specialty and that trying to fit outpatient pulmonary clinic into an intensivist's training and ongoing accumulation of knowledge/skill is about as useful as trying to mix it into a trauma surgeon's profession.

If you want an opportunity/job: Join the crowd.

I apologize for my ornery response, but your vague and obtuse posts, I will blame.

If you are genuinely confused, let me know. I will apologize and try again.

HH

 

[chessknt]

These jobs exist in private practice and employed models in abundance. The majority want 60/40 outpt/inpt and the work can be rough because unlike straight ccm it typically isn't shift based and requires overnight call and working icu/clinic the same day. As a result the ICUs are typically lower acuity. Some have higher acuity ICUs with clinic separate but then you only get 5-8 days off a month max instead of 15 like a straight ccm.

 

[jdh71]

Ok great. Where can I find these postings?

Never said this was a problem. I'm just trying to do some research.

Looking for details on how a practice like this is run. Immediately there are 3 jobs that any one person can do: ICU intensivist, pulmonary inpatient consults, pulmonary outpatient clinic. Can add a bonus 4th if you do something like post-ICU follow-ups. Inpatient consults generating outpatient followups is a pretty traditional model for any consultant. But how does the ICU attending time fit into that? Do you operate at an opportunity-loss if you do more ICU and don't generate enough of those office visits? What's an example schedule? 1 week and 1 weekend in the ICU, 1 week in the office, 2 weeks on consults? Something different?

What makes the most sense?

I strongly disagree there is some big move away from PCCM staffing ICUs across the country - you may see this in some markets. The pure CC folks tend to fill in gaps and holes where needed in a traditional PCCM staffed MICU.

There are many many many ways to schedule the time in the ICU and time in clinic in PCCM. The most common right now is a week in the ICU during the day, probably Mon-Sunday. And two weeks in the clinic. One week "off". Nights are covered either with a night shift doc for the week or with a rotating night call of docs in the clinic. Consults in the hospital are usually covered by the ICU doc, which works actually really well because anything that severe or urgent from a pulmonary perspective will be going or should be going to the ICU anyway. Some practices will have a half clinic/half consult week, where you'll see AM clinic patients and PM hospital consults (but this is generally lower RVU generating that simply seeing a full day of clinic MOST of the time). You will likely follow any consult you see in the hospital into your clinic. Don't worry about out patient referrals, you'll have plenty and they will come from the community, mostly bread and butter.