Flexibility of Pulm/CC

[Bonesaw45]

So I'm a 3rd year picking my 4th year rotations and trying to focus in on a specialty and I think that critical care is really appealing in terms of the severity of disease and the spectrum of pathology versus some of the other specialties which seem to focus more than my liking. However I do not want to spend all of my time in a unit, I also want to spend some time on the floors. The recent cardiology rotation I was on had attendings rotating bi weekly, in the unit and on the floors/clinic. This would be ideal for me personally, but I wonder does this happen with MICU attendings at academic or community institutions?

Also another concern is the schedule. My future wife would like to pursue her own career in clinical psychology and I would really like to have a work/life balance that would allow me to be a part of my children's life. I understand that a lot of that is prioritizing them, but I also understand that there is a commitment to the job if I'm going to do something like ICU. What kind of hours are you normally covering for? My thought was that it was shift work but no one ever told me how long the shifts were and how the weekends were handled. Thanks for any help, I just need a general idea or some personal experience, I never asked a resident/attending because I'm afraid that asking how long you work equates to a lack of interest and that is not the impression I want to give.

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[AquaFortis]

I would also be interested in what others have to say about this. I'm interested in Pulm/CC as well, but I have to wonder what the work/life balance is and how brutal call is in a community setting. Are most places (not academia) shift work? Or no?

 

[jdh71]

I would also be interested in what others have to say about this. I'm interested in Pulm/CC as well, but I have to wonder what the work/life balance is and how brutal call is in a community setting. Are most places (not academia) shift work? Or no?

Depends on how the practice is set up.

One of the nicer set ups I've heard about had 12 docs. Where one doc covered the MICU for an entire week out of tweleve, covered in-patient consult for an entire week out of the tweleve, and the rest of the time was pulm clinic. While covering the unit, you were the guy 24/7 for that week.

Another practice set up, everyone in the group took an ICU call night and whatever they admitted while on call they followed in the ICU until death or d/c, so after clinic or before that day, you'd have to go round on the patients you admitted while on call.

It all depends. Shift work is beocming very popular in the ICU though.

 

[Jadeite]

I don't recommend picking a specialty based on perceived lifestyle. You can do anything part-time if you are willing to be paid less, but you should pick something you actually like because you'll be doing it for a long time and really regret spending 3+ years doing something you hate.

Critical Care is hard, especially in training but if it's what you like you should do it. Similarly you should not pick it because it has shifts and can be convenient, you have to like it.

 

[PMPMD]

I don't recommend picking a specialty based on perceived lifestyle. You can do anything part-time if you are willing to be paid less, but you should pick something you actually like because you'll be doing it for a long time and really regret spending 3+ years doing something you hate.

Critical Care is hard, especially in training but if it's what you like you should do it. Similarly you should not pick it because it has shifts and can be convenient, you have to like it.

 

[Bonesaw45]

While I guess I can appreciate the input thats not really the issue I have. Just the vent a little bit thats not really what I was asking for, and I hate how people throw that up in a post like this resulting in very little help. I have already considered crit care as a specialty for many components that appeal to me, that I don't feel I need to list here.

The question about the lifestyle is because, like most experiences you get in medical school, I have very little exposure to the community hospital side and to how many hours non academic attendings work. Additionally I feel like asking how much you work is frowned upon in medicine because it means your not interested, or if you ask on this board somebody tries to give you the same thing about not picking specialties based on hours.

Honestly if I have multiple specialties I am equally interested in but if it came down to it I would pick the one with the best combination of interest/time off/money, not because I don't deserve to be a doctor or because I don't want to do right by my patients but because I want to have a life outside of medicine that interests me as well.

So if anyone has input like jdh on what they have seen in the workforce thanks. If you are going to tell me something that has nothing to do with my question and is just your opinion save your time rather than telling me that something in hard with no reason why.

 

[proman]

If it helps, the hospital where I did my internship was staffed with 4 full time private intensivists (all medicine, none practiced pulmonary). There were 2 separate pulmonologists who only covered the ICU as a favor. The intensivists had a rotating schedule, 12 hours a shift, in house day and night. Those guys were like brick walls, I remember keeping a patient in a step down unit on a non rebreather for 24 hours. They only accepted her when the PaCO2 hit 100.

 

[Hernandez]

So if anyone has input like jdh on what they have seen in the workforce thanks. If you are going to tell me something that has nothing to do with my question and is just your opinion save your time rather than telling me that something in hard with no reason why.

you've already been told what you need to know. you cn go from a part time pulm doc, to s shift work intensivist, to full blown 24/7 pulm/cc doc with no help. we cant tell you more as you can make what you want out of any specialty,

 

[IdontTakeCall]

Do most 3 year Pulm/CC fellowships offer 2 year CC-only spots as a separate track within their department or am I stuck gunning for a spot at one of the dismally low 12-15 2 year IM->CC fellowship spots?

 

[Hernandez]

Do most 3 year Pulm/CC fellowships offer 2 year CC-only spots as a separate track within their department or am I stuck gunning for a spot at one of the dismally low 12-15 2 year IM->CC fellowship spots?

A 3 year combined program can make it a 2 year pulm only or cc only program but why would they if they don't have too?

 

[IdontTakeCall]

A 3 year combined program can make it a 2 year pulm only or cc only program but why would they if they don't have too?

I have no interest in pulmonology, just wantto be cc boarded after EM or IM whichever I match too next week. So I wanted to know if I were to match IM, can I apply to 3 year pulm/cc programs in the event that they have a 2 year cc only track or am I going to have to apply to the 12-15 dedicated 2 year cc programs around the country the same as if I match EM and go cc?

 

[IdontTakeCall]

A 3 year combined program can make it a 2 year pulm only or cc only program but why would they if they don't have too?

I have no interest in pulmonology, just wantto be cc boarded after EM or IM whichever I match too next week. So I wanted to know if I were to match IM, can I apply to 3 year pulm/cc programs in the event that they have a 2 year cc only track or am I going to have to apply to the 12-15 dedicated 2 year cc programs around the country the same as if I match EM and go cc?

 

[jdh71]

Do most 3 year Pulm/CC fellowships offer 2 year CC-only spots as a separate track within their department or am I stuck gunning for a spot at one of the dismally low 12-15 2 year IM->CC fellowship spots?

A 3 year combined program can make it a 2 year pulm only or cc only program but why would they if they don't have too?

I'm pretty sure that its pretty much separate always. The curriculum, rotation, and funding for salary are set up for pulm/cc . . . it's only those Divisions at big academic places that can rarely finagle a CC spot, unless they've already got a CC only program in place.

And I don't think you're "stuck gunning" because those spots require FMGs and EM to even fill.

 

[jdh71]

I have no interest in pulmonology, just wantto be cc boarded after EM or IM whichever I match too next week. So I wanted to know if I were to match IM, can I apply to 3 year pulm/cc programs in the event that they have a 2 year cc only track or am I going to have to apply to the 12-15 dedicated 2 year cc programs around the country the same as if I match EM and go cc?

You'll have to apply to the CC only programs. But there's a lot of good programs for that . . . UCSF, Stanford, NIH, Mayo, Hennepin County, SLU, Dartmouth, Wake, OHSU, Pitt (the ****ing tits for CC), Baylor, University of Washington . . . you'll find a spot at one of them

 

[IdontTakeCall]

You'll have to apply to the CC only programs. But there's a lot of good programs for that . . . UCSF, Stanford, NIH, Mayo, Hennepin County, SLU, Dartmouth, Wake, OHSU, Pitt (the ****ing tits for CC), Baylor, University of Washington . . . you'll find a spot at one of them

I hope so, there's a lot less spots for them than pulm/cc

 

[jdh71]

I hope so, there's a lot less spots for them than pulm/cc

they are pretty easy to get

 

[Neuro or Derm]

I was once told that people prefer to go into PCC because when they don't feel like doing critical care, there's always pulm clinic. I'm definitely interested in Critical care, but so far I have not been that excited by pulmonary. (although I'll give myself a chance to experience it better in residency). I'm not much of a medicine clinic person, but I don't want to feel like there's nothing left for me when I'm too old to be running an ICU. are there any other CC-linked choices or am I pretty much stuck doing clinic no matter which fellowship I choose? I have always liked ID and Critical care - can I find that fellowship in ERAS/NRMP or would I have to talk to the PD of the critical care fellowship and ask for it to be added on?

 

[jdh71]

I was once told that people prefer to go into PCC because when they don't feel like doing critical care, there's always pulm clinic. I'm definitely interested in Critical care, but so far I have not been that excited by pulmonary. (although I'll give myself a chance to experience it better in residency). I'm not much of a medicine clinic person, but I don't want to feel like there's nothing left for me when I'm too old to be running an ICU. are there any other CC-linked choices or am I pretty much stuck doing clinic no matter which fellowship I choose? I have always liked ID and Critical care - can I find that fellowship in ERAS/NRMP or would I have to talk to the PD of the critical care fellowship and ask for it to be added on?

It's a fairly common phenomenon to find pulmonary uninteresting as a medical student. The more pulm you do as a physician, the more you appreciate it, and that been the experience of most who go into pulm/cc in my experience. Sub-specialty clinic is much, much better than general medicine clinic. But either way, it's not for everyone. For me, if I wouldn't have liked pulm, I wouldn't have done the pulm/cc route.

 

[Hernandez]

It's a fairly common phenomenon to find pulmonary uninteresting as a medical student. The more pulm you do as a physician, the more you appreciate it, and that been the experience of most who go into pulm/cc in my experience. Sub-specialty clinic is much, much better than general medicine clinic. But either way, it's not for everyone. For me, if I wouldn't have liked pulm, I wouldn't have done the pulm/cc route.

seconded. i was ambivalent about pulm as a student, now i like it as much as cc.

 

[G-Man82]

I'm definitely interested in Critical care, but so far I have not been that excited by pulmonary. (although I'll give myself a chance to experience it better in residency). I'm not much of a medicine clinic person, but I don't want to feel like there's nothing left for me when I'm too old to be running an ICU. are there any other CC-linked choices ...

Well, as a student I was in a similar boat - I liked critical care, but despised the idea of pulmonary clinic, or clinic in general. Are you definitely choosing IM as your residency? If so, then your choices are as above. Other CC specialties (other than surgery) include Anesthesiology and now EM. In either case, what you would be falling back on is your foundation specialty - Anesthesia or EM when not in the ICU. It's 1 year fellowship after anesthesiology and 2 years after EM if you go the ABIM boarding route. Just something else to consider.

 

[Neuro or Derm]

Well, as a student I was in a similar boat - I liked critical care, but despised the idea of pulmonary clinic, or clinic in general. Are you definitely choosing IM as your residency? If so, then your choices are as above. Other CC specialties (other than surgery) include Anesthesiology and now EM. In either case, what you would be falling back on is your foundation specialty - Anesthesia or EM when not in the ICU. It's 1 year fellowship after anesthesiology and 2 years after EM if you go the ABIM boarding route. Just something else to consider.

Yea I'm definitely doing IM. I am hoping that wherever I get into residency next week will give me a solid enough opportunity to experience pulm and give it a second chance or allow me flexibility to pair CC with another sub-specialty that I like.

 

[G-Man82]

Yea I'm definitely doing IM. I am hoping that wherever I get into residency next week will give me a solid enough opportunity to experience pulm and give it a second chance or allow me flexibility to pair CC with another sub-specialty that I like.

From the medicine standpoint, I've heard of people who pair CCM, which is then a 1 year fellowship, with cardiology, renal, or ID. In one of our affiliated hospitals here where I'm doing my medicine internship, our CCU is headed by a cardiologist who is dual-boarded in cardiology and CCM. I think renal and ID are both 2 year fellowships, so tacking on an extra year of CCM will not cost you any more time than doing a Pulm/CCM combined fellowship.

 

[jdh71]

From the medicine standpoint, I've heard of people who pair CCM, which is then a 1 year fellowship, with cardiology, renal, or ID. In one of our affiliated hospitals here where I'm doing my medicine internship, our CCU is headed by a cardiologist who is dual-boarded in cardiology and CCM. I think renal and ID are both 2 year fellowships, so tacking on an extra year of CCM will not cost you any more time than doing a Pulm/CCM combined fellowship.

This is a good point. You can add an extra year of critical care if you've already done two years of ID or Renal.

 

[IdontTakeCall]

Well, as a student I was in a similar boat - I liked critical care, but despised the idea of pulmonary clinic, or clinic in general. Are you definitely choosing IM as your residency? If so, then your choices are as above. Other CC specialties (other than surgery) include Anesthesiology and now EM. In either case, what you would be falling back on is your foundation specialty - Anesthesia or EM when not in the ICU. It's 1 year fellowship after anesthesiology and 2 years after EM if you go the ABIM boarding route. Just something else to consider.

thats my plan. 3 years EM then 2 years ABIM cc or 1 year anesthesia cc if im lucky , then split time as the attending intensivist and in the ED. If i match IM instead on monday, it will be 3 IM then 2 CC probably followed by full time CC. Possibly could moonlight some hospitalist shifts but unlikely. I dont personally hate pulm clinic, I dislike it as much as any clinic whether it be endocrine, ID or cards in the office. I just dont like outpatient medicine. I greatly prefer to be in the hospital which is why I dont particularly want to do an extra year of pulm/cc if I can get into the unit with just 2 or even one of straight cc.

 

[Neuro or Derm]

From the medicine standpoint, I've heard of people who pair CCM, which is then a 1 year fellowship, with cardiology, renal, or ID. In one of our affiliated hospitals here where I'm doing my medicine internship, our CCU is headed by a cardiologist who is dual-boarded in cardiology and CCM. I think renal and ID are both 2 year fellowships, so tacking on an extra year of CCM will not cost you any more time than doing a Pulm/CCM combined fellowship.

Thanks. Even though the total length of training is the same, would that mean I have less CC exposure compared to the Pulm/CC route, or is the latter practically 2years of pulm and 1year of CC anyways?

 

[Hernandez]

Thanks. Even though the total length of training is the same, would that mean I have less CC exposure compared to the Pulm/CC route, or is the latter practically 2years of pulm and 1year of CC anyways?

pulm-cc mandates ~9 months of CC, 6 months of micu, a month of sicu, and 2 months of ICU. most places do more, I'll have 12 months or more when im done.

straight CC has ~12 months in their 2 year program, I've not the 1 year-post other subspecialty requirements, you can find those here

 

[Neuro or Derm]

pulm-cc mandates ~9 months of CC, 6 months of micu, a month of sicu, and 2 months of ICU. most places do more, I'll have 12 months or more when im done.

straight CC has ~12 months in their 2 year program, I've not the 1 year-post other subspecialty requirements, you can find those here

Thanks!

 

[jdh71]

thats my plan. 3 years EM then 2 years ABIM cc or 1 year anesthesia cc if im lucky , then split time as the attending intensivist and in the ED. If i match IM instead on monday, it will be 3 IM then 2 CC probably followed by full time CC. Possibly could moonlight some hospitalist shifts but unlikely. I dont personally hate pulm clinic, I dislike it as much as any clinic whether it be endocrine, ID or cards in the office. I just dont like outpatient medicine. I greatly prefer to be in the hospital which is why I dont particularly want to do an extra year of pulm/cc if I can get into the unit with just 2 or even one of straight cc.

Just remember the ABIM pathway out of EM will be the only way to be board certified.

 

[Xerxes1729]

An EM guy doing a two-year CCM fellowship through anesthesia told me that the IM department at his institution was going to let him do MICU rotations and sign off on some documentation that would make him eligible for the ABIM board certification even though his position was funded by the anesthesia program. I have no idea if that will actually work out, but if it can be made to work, then that would open up a lot more potential slots for EM people wanting to be board-certified.

 

[jdh71]

An EM guy doing a two-year CCM fellowship through anesthesia told me that the IM department at his institution was going to let him do MICU rotations and sign off on some documentation that would make him eligible for the ABIM board certification even though his position was funded by the anesthesia program. I have no idea if that will actually work out, but if it can be made to work, then that would open up a lot more potential slots for EM people wanting to be board-certified.

This be sweet. I mean seriously, the whole notion of letting warm bodies into your fellowship programs because not enough of your own people will fill the spots and then denying those same warm bodies the right to the board certification is a douchebag move for sure.

 

[IdontTakeCall]

This be sweet. I mean seriously, the whole notion of letting warm bodies into your fellowship programs because not enough of your own people will fill the spots and then denying those same warm bodies the right to the board certification is a douchebag move for sure.

Thats beacuse the ABS is full of d-bags who want us to fill their spots and then not certify us. In fact the ABS put forth a motion to deny all recent EM grads who completed surgical CC fellowships the right to be grandfathered in to take the boards after the ABIM/ABEM made their agreement. F'n surgeons...

 

[IdontTakeCall]

An EM guy doing a two-year CCM fellowship through anesthesia told me that the IM department at his institution was going to let him do MICU rotations and sign off on some documentation that would make him eligible for the ABIM board certification even though his position was funded by the anesthesia program. I have no idea if that will actually work out, but if it can be made to work, then that would open up a lot more potential slots for EM people wanting to be board-certified.

This would really help alot seeing as I have been told several tertiary care academic centers have been denying EM trained CC docs an attending spot with their european boards, apparently they feel europeans are dumb. or they hate EM. maybe both

 

[Dwindlin]

Thats beacuse the ABS is full of d-bags who want us to fill their spots and then not certify us. In fact the ABS put forth a motion to deny all recent EM grads who completed surgical CC fellowships the right to be grandfathered in to take the boards after the ABIM/ABEM made their agreement. F'n surgeons...

I was actually told that at the last big CCM conference (in San Diego me thinks) that the ABS had said that they are willing to come to the table on a EM > SCCM board pathway.

 

[jdh71]

I was actually told that at the last big CCM conference (in San Diego me thinks) that the ABS had said that they are willing to come to the table on a EM > SCCM board pathway.

money talks, bull**** walks

 

[dbiddy808]

If you guys are thinking of doing 3 years Emergency Medicine and then one year of anesthesia, you are not doing yourself or your patients a favor. You need more training!

I did both internal medicine and anesthesia residencies and I have worked with attendings who have done medicine + CCM, medicine + pulmonary/CCM, surgery + CCM, surgery + CCM/trauma, anesthesia + CCM and anesthesia + CCM/cardiac. I have also worked with fellows from all the above scenarios. I have not worked with any ER + CCM people, but I have worked with enough ER guys to have a good idea about their abilities and limitations.... I'd say that with the exception of one or two people, all the attendings and fellows who did just one year of fellowship were sub-par. It is just not enough time. If you are going to have a career in medicine, you cannot be too prepared. One more year of training is a drop in the bucket...

In addition, why put yourself in a situation where you might face problems with getting board certified or credentialed? It is different if you are already an ER doc and you want to do something different because your path has already been set, but why put yourself in that situation from the get-go? It doesn't make sense?

 

[IdontTakeCall]

If you guys are thinking of doing 3 years Emergency Medicine and then one year of anesthesia, you are not doing yourself or your patients a favor. You need more training!

I did both internal medicine and anesthesia residencies and I have worked with attendings who have done medicine + CCM, medicine + pulmonary/CCM, surgery + CCM, surgery + CCM/trauma, anesthesia + CCM and anesthesia + CCM/cardiac. I have also worked with fellows from all the above scenarios. I have not worked with any ER + CCM people, but I have worked with enough ER guys to have a good idea about their abilities and limitations.... I'd say that with the exception of one or two people, all the attendings and fellows who did just one year of fellowship were sub-par. It is just not enough time. If you are going to have a career in medicine, you cannot be too prepared. One more year of training is a drop in the bucket...

In addition, why put yourself in a situation where you might face problems with getting board certified or credentialed? It is different if you are already an ER doc and you want to do something different because your path has already been set, but why put yourself in that situation from the get-go? It doesn't make sense?

Because I want to be an EM attending, not a medicine attending. If I wanted to be an anesthesiologist and then work in the ICU, I'd have done that. If I wanted to be a surgeon, and then work in the ICU, I'd have done that. I want to be and ER doc, and I want to work in the ICU. That is the rationale for my decision. And why do you think it would be any different for a surgeon who albeit does a 5 year residency in surgery, but spends the same amount of time or possibly less on ICU rotations as an EM resident does in 3 years, to do a one year CCM fellowship but not for an EM to do one year? If the ABA is willing to give spots to EM docs in their one year programs and these fellows can get jobs as attending intensivists at major university based tertiary care ICUs, I know of 2 personally, than clearly they are qualified.

 

[jdh71]

Because I want to be an EM attending, not a medicine attending. If I wanted to be an anesthesiologist and then work in the ICU, I'd have done that. If I wanted to be a surgeon, and then work in the ICU, I'd have done that. I want to be and ER doc, and I want to work in the ICU. That is the rationale for my decision. And why do you think it would be any different for a surgeon who albeit does a 5 year residency in surgery, but spends the same amount of time or possibly less on ICU rotations as an EM resident does in 3 years, to do a one year CCM fellowship but not for an EM to do one year? If the ABA is willing to give spots to EM docs in their one year programs and these fellows can get jobs as attending intensivists at major university based tertiary care ICUs, I know of 2 personally, than clearly they are qualified.

Bro, surgery residency by itself on a day to day basis is largely critical care. Anesthesia residency by itself on a day to day basis is largely critical care.

Anyone (I recognize exceptions to the rule, it's a generalization) can be trained to be an intensivist, some get more critical care time in residency than others. In EM you do a good amount of stablization and initial management of the critically ill, but this is different than long term management. I don't think you should be surprised that the EM guys who do the extra year are a little better at it initially. It's a learning curve and I'm sure a few years out most docs working in critical care basically catch up to each other relatively speaking - there is nuance and there are outliers.

 

[IdontTakeCall]

Bro, surgery residency by itself on a day to day basis is largely critical care. Anesthesia residency by itself on a day to day basis is largely critical care.

Anyone (I recognize exceptions to the rule, it's a generalization) can be trained to be an intensivist, some get more critical care time in residency than others. In EM you do a good amount of stablization and initial management of the critically ill, but this is different than long term management. I don't think you should be surprised that the EM guys who do the extra year are a little better at it initially. It's a learning curve and I'm sure a few years out most docs working in critical care basically catch up to each other relatively speaking - tI don'here is nuance and there are outliers.[/QUOTE

I dont disagree with you that surgery and anesthesia get lots of cc time and are more than qualified. I was just saying that em's have been filling one year anesthesia cc spots and have been allowed to work as intensivists at major hospitals for quite some time so there must be bigwigs in charge who feel their training is adequate.

 

[Hernandez]

so there must be bigwigs in charge who feel their training is adequate.

thats not a metric I'd give a damn bout if you asked me. bigwigs are rarely docs these days, and only care about not having law suits/bad press and increasing their bottom line. im not saying ER isn't capable as they are, just don't fall into the trap that non-clinical administration have a clue....

 

[jdh71]

I dont disagree with you that surgery and anesthesia get lots of cc time and are more than qualified. I was just saying that em's have been filling one year anesthesia cc spots and have been allowed to work as intensivists at major hospitals for quite some time so there must be bigwigs in charge who feel their training is adequate.

Maybe. It just doesn't seem strange to me that someone might remark that an EM guy who only did a one year fellowship may not be as good right out fo training. And that's because of the critical care that gas and surg have to do on a daily basis.

 

[IdontTakeCall]

thats not a metric I'd give a damn bout if you asked me. bigwigs are rarely docs these days, and only care about not having law suits/bad press and increasing their bottom line. im not saying ER isn't capable as they are, just don't fall into the trap that non-clinical administration have a clue....

They may not have a clue but they often have a large say as to who gets hired and who gets privileges at their hospitals, that's what I was getting at.

 

[Hamhock]

Bro, surgery residency by itself on a day to day basis is largely critical care. Anesthesia residency by itself on a day to day basis is largely critical care.
.

I think you could say that anesthesia has a lot of critical care on a daily basis (except pain, regional, pre-op, etc), but to say that surgery is daily critical care is nonsense. Yes, there are some months of a surgical residency that involve critical care, but nothing close to anesthesia and certainly not "day to day".

HH

 

[jdh71]

I think you could say that anesthesia has a lot of critical care on a daily basis (except pain, regional, pre-op, etc), but to say that surgery is daily critical care is nonsense. Yes, there are some months of a surgical residency that involve critical care, but nothing close to anesthesia and certainly not "day to day".

HH

Where I train every team has a couple patients in the unit on a daily basis, and everyone is tossed into the trauma call schedule if not on vacation. Perhaps some places are more chill or have closed SICUs. I'm not really interested in quibbling too much but over the course of 5 years surgeons get a lot more critical care than EM or IM for sure.

 

[Winged Scapula]

I think you could say that anesthesia has a lot of critical care on a daily basis (except pain, regional, pre-op, etc), but to say that surgery is daily critical care is nonsense. Yes, there are some months of a surgical residency that involve critical care, but nothing close to anesthesia and certainly not "day to day".

HH

As JDH notes, I think it highly depends on where you are training.

We had an open SICU and took trauma call every night we were in house on call. That meant that regardless of what rotation we were on, we always had some patients for whom we (GS) were the primary providers in the ICU. Rotations such as CT, Surg Onc, Trauma, Pediatric Surgery, Transplant and HPB, and Vascular required a lot of ICU care. Only the MIS service and usually Colorectal had few to none ICU patients (although the latter was often consulted in the MICU for Gi Bleeds, dead gut). The SICU was run mostly by surgeons, with 1-2 anesthesiologists, rotating as CC attending for the day. The PICU/NICU was run by pediatric surgeons and Peds Intensivists.

In addition, at our hospitals NONE of the surgical subspecialties (ie, Ortho, ENT, Plastics, Uro) managed their ICU patients; all of the call and day to day management was done by GS with the subspecialists as Consultants. They were allowed to manage them but fortunately, they recognized that the couldn't.

Sounds like you are training at a place where GS doesn't do a lot of CC outside of devoted months. That would have been unusual at my program (which the community general surgeons would often refer to as our "CC residency").