FM to CC?

[chocomorsel]

Your experience is by and large the normal across this country, despite some in this thread incessantly arguing against reality.

I don’t know to be honest. I know plenty of CCM jobs that require night shift. I don’t know what is more prevalent.

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[MedicineZ0Z]

You’re a second year resident at best. Your « experience » is MARKEDLY limited.

Not clinical experience. But observations in different settings. It's not unusual for many attendings to be limited in how many settings they've been or just be out of touch with what's happening elsewhere. There's a reason residents are the most informed on this issue.

 

[Lexdiamondz]

Not clinical experience. But observations in different settings. It's not unusual for many attendings to be limited in how many settings they've been or just be out of touch with what's happening elsewhere. There's a reason residents are the most informed on this issue.

Compared to your academic attendings? Arguable

However overall residents are generally the least informed on this issue - some just think they're informed because they spend an unhealthy amount of time on the internet being in their feelings

 

[Lexdiamondz]

I'm not sure who you're talking about, but it can't be me as this is the first SDN post that I've commented on midlevels. Whoever this person is, though, I applaud them. As someone who has sat back and watched the older generation of physicians sell out our profession for a few extra bucks, the midlevel issue certainly hits home. And nothing changes until more people speak up and demand change.

It's especially disheartening to see it come from emergency physicians, where new grads are struggling to find jobs and wages actively get driven down year after year, all whilst "seasoned" physicians go online to crusade for why midlevels are so great and why physicians that aren't them are so dumb and dangerous.

Except this thread has nothing to do with midlevels, and only is tangentially related to a (single) EM physician who happens to be dual-boarded through a relatively new training pathway and thus, more qualified to comment on the issue than any of the residents (myself included) in this thread.

Furthermore, how is promoting scope creep among physicians supposed to help new EM grads in a struggling job market? Explain that logical fallacy to me.

I get wanting to bring light on very important issues, but you shouldn't use one crisis to try and advance your agenda. Otherwise, you're no better (and only marginally safer) than the midlevels you claim to be fighting against. Scope creep is scope creep no mater who is doing it.

Right. But FM docs do have that training. And from what it sounds like, OP has more than most IM docs.

Most FM docs emphatically do not have that training - OP is an outlier by a considerable margin. That's why the pathway doesn't exist.

I agree if they meet the pre-requisites then sure, they should be able to enrol in a fellowship and sit for the boards. That also requires them to have enough support from their own professional organisation to make that pathway an option. EM did it and it took us 20 years and many *still* consider EM-CCM medicine the black sheep of CCM. You have to do the work, and whining on an online forum about physician gatekeeping and building straw man after straw man doesn't do anything but alienate the very physicians you say you're advocating for.

 

[MedicineZ0Z]

Compared to your academic attendings? Arguable

However overall residents are generally the least informed on this issue - some just think they're informed because they spend an unhealthy amount of time on the internet being in their feelings

Yes, the ones who think training them is an excellent idea and have 0 insight to what's actually happening, are indeed the most informed.

 

[Lexdiamondz]

Yes, the ones who think training them is an excellent idea and have 0 insight to what's actually happening, are indeed the most informed.

Pot meet kettle.

The thing is, you aren't wrong. But this ain't the thread for it dude.

Worst part is, your charlatan behaviour dissuaded someone who actually had advice from participating and helping OP.

I'll give you the benefit of the doubt and say your heart is in the right place, but your execution and situational awareness are abysmal.

 

[CCM-MD]

Ah, yes! The trainee that knows more than the attending. A rare breed that is in its natural habitat on SDN. When on my service, this breed extends my teaching rounds by atleast an hour.

This thread has gone to 💩. Sorry OP, I truly wish you the best. Hope you find a way to do what you enjoy.

Not clinical experience. But observations in different settings. It's not unusual for many attendings to be limited in how many settings they've been or just be out of touch with what's happening elsewhere. There's a reason residents are the most informed on this issue.

 

[chocomorsel]

Keep us posted OP! Hilarious @CCM-MD!!!!

 

[CallMeDoctorLov]

I am going to say that while there are dangerous FM CCM docs out there, there are just as equally if not worse midlevels running wild out there who are probably just as clueless or worse and certainly not being adequately supervised.

I mean, OP is an FM grad who is confident that he can intubate and manage vents based on 4 months of ICU at a community hospital. His name might as well be Dunning Kruger M.D.

 

[Nephro critical care]

I do not think FM physicians should be allowed to do CCM fellowship. They may just as well claim to be gastroenterologists if they do few months of GI in 3rd year or claim to be competent at doing lap-chole and appis if their 3rd year is geared towards general surgery.

 

[andrewsmack05]

I mean, OP is an FM grad who is confident that he can intubate and manage vents based on 4 months of ICU at a community hospital. His name might as well be Dunning Kruger M.D.

I did not assert that I was by any ways a "master" at anything. I have been exposed to these skills and I have found that I really enjoy taking care of these patients so I tried hard throughout my residency to gain this experience. All I am asking for a chance to TRAIN FURTHER so that I can become more proficient. I'm not asking for all FM grads to become intensivists. I am asking that if someone meets certain requirements given the amount of inpatient experience that I have had (i.e. trauma, surgery(I know IM doesn't even the previous two), inpatient medicine, and several months of critical care experience. I signed up for a hospitalist position at that hospital you are referring to. Not a critical care position. They saw my procedure list and asked if I would help the intensivists cover their ICU's at night. They wanted me to offload the stress on the CC docs because they did not have any one who would offer to help. So I helped. I am not here to fight the SDN community. All I am asking for is more training because I love to come to work and take care of these type of patients.

 

[andrewsmack05]

Thank you all for your responses, I appreciate it! I really didn't mean for this to turn into an FM vs. CC vs. Mid-level discussion. I just want to find more training to be a better physician so I can take better care of patients who I come into contact with.

 

[CallMeDoctorLov]

Thank you all for your responses, I appreciate it! I really didn't mean for this to turn into an FM vs. CC vs. Mid-level discussion. I just want to find more training to be a better physician so I can take better care of patients who I come into contact with.

There is no “vs” here. None of us venture into the pediatrics forum and pretend that we can we pediatricians because we have seen children before.
Your program has done you a horrible disservice if you think that critical care can be learned in 4 months at a resident level.

And the only people who care about your “70 ventilated patient at a time” job are fiction writers, and malpractice lawyers.

 

[MedicineZ0Z]

I do not think FM physicians should be allowed to do CCM fellowship. They may just as well claim to be gastroenterologists if they do few months of GI in 3rd year or claim to be competent at doing lap-chole and appis if their 3rd year is geared towards general surgery.

The only reason FM docs can't go into IM subspecialties is due to historical politics. There's literally no reason an FM resident (hypothetically) pursuing a GI or renal or ID or whatever fellowship would be any less competent than their IM counterpart. There is a lot of self selection that goes on.

 

[CCM-MD]

The only reason FM docs can't go into IM subspecialties is due to historical politics. There's literally no reason an FM resident (hypothetically) pursuing a GI or renal or ID or whatever fellowship would be any less competent than their IM counterpart. There is a lot of self selection that goes on.

Its funny how you have a massive problem with midlevels but are doing exactly what they do: creating false equivalency and downplaying the value of training. The FM resident that graduates with ACGME required minimum 600 hours dedicated to adult inpatient medicine is not going to be any less competent in an IM subspecialty program than an IM resident. Its all "historical politics". OK. You sound exactly like the midlevels you despise that are using a similar narrative to push for independent practice rights.

 

[MedicineZ0Z]

Its funny how you have a massive problem with midlevels but are doing exactly what they do: creating false equivalency and downplaying the value of training. The FM resident that graduates with ACGME required minimum 600 hours dedicated to adult inpatient medicine is not going to be any less competent in an IM subspecialty program than an IM resident. Its all "historical politics". OK. You sound exactly like the midlevels you despise that are using a similar narrative to push for independent practice rights.

View attachment 329889

That's why I said self selection? Of course the weaker inpatient FM programs don't even prepare you for basic hospital medicine let alone more. The self selection part is where the person goes to a stronger inpatient program that is light years above requirements. Hence, the applicant to a subspecialty program would be on par with others. It's not saying that any random grad from anywhere is on par.

You can't forget that there are a lot of weaker IM programs too. Lots of community hospitals out there where a lot of complex cases (obviously) get shipped to the academic center. The residents mainly just do bread and butter.

 

[CCM-MD]

That's why I said self selection? Of course the weaker inpatient FM programs don't even prepare you for basic hospital medicine. The self selection part is where the person goes to a stronger inpatient program that is light years above requirements. Hence, the applicant to a subspecialty program would be on par with others. It's not saying that any random grad from anywhere is on par.

You can't forget that there are a lot of weaker IM programs too. Lots of community hospitals out there where a lot of complex cases (obviously) get shipped to the academic center. The residents mainly just do bread and butter.

 

[chessknt]

Your experience is by and large the normal across this country, despite some in this thread incessantly arguing against reality.

Remind us--how extensive is your experience to generalize to the entire country? I personally have worked in 4 midwestern states and 2 western states in 10 different hospitals and never seen that. I imagine places hiring locums are probably not a good example of a stable/good working environment.

 

[VA Hopeful Dr]

There is no “vs” here. None of us venture into the pediatrics forum and pretend that we can we pediatricians because we have seen children before.
Your program has done you a horrible disservice if you think that critical care can be learned in 4 months at a resident level.

And the only people who care about your “70 ventilated patient at a time” job are fiction writers, and malpractice lawyers.

That seems unnecessarily harsh.

People bounce around to forums that aren't their specialty all the time. A few months ago an EP came into the FM forum asking for advice about leaving the ED and what sort of outpatient stuff he would be qualified (or could become qualified) for.

This particular thread seemed to be going very well at first - good responses, and OP that seemed very appreciative and open to even negative feedback.

It's a shame that's not the case anymore.

 

[SpacemanSpifff]

Thank you all for your responses, I appreciate it! I really didn't mean for this to turn into an FM vs. CC vs. Mid-level discussion. I just want to find more training to be a better physician so I can take better care of patients who I come into contact with.

I think this attitude is the right way to approach your situation, good on you. While you might not be able to apply to fellowship, if you are continuing to work in a critical care setting, just keep looking for ways to improve and learn. That's all any of us can do.

 

[Katheudontas parateroumen]

Certainly there is specialty bias here. But when it comes to physicians, I do believe we should be able to get into some sub specialties. Like why can every specialty go into sleep medicine, hospice palliative care, pain, hyperbaric, transfusion medicine, etc but we cant go into nephro, ID, cards, etc? If one doesn’t come from a IM background, then as some fellowships do, tack on a year or 2 to the fellowship. CCM already does that for all the tracks they currently allow. EM does 2, pure IM does 2, meanwhile anesthesia and I think some surgery do just 1 year. Is it inconceivable that an FM person can go into a 3 year CCM fellowship instead? That makes sense to me. Can an anesthesiologist do a 3 year nephro fellowship instead? Honest question.

 

[CCM-MD]

Certainly there is specialty bias here. But when it comes to physicians, I do believe we should be able to get into some sub specialties. Like why can every specialty go into sleep medicine, hospice palliative care, pain, hyperbaric, transfusion medicine, etc but we cant go into nephro, ID, cards, etc? If one doesn’t come from a IM background, then as some fellowships do, tack on a year or 2 to the fellowship. CCM already does that for all the tracks they currently allow. EM does 2, pure IM does 2, meanwhile anesthesia and I think some surgery do just 1 year. Is it inconceivable that an FM person can go into a 3 year CCM fellowship instead? That makes sense to me. Can an anesthesiologist do a 3 year nephro fellowship instead? Honest question.

Do you think it’s reasonable for an FM/IM doc to do a 2 year fellowship is CT anesthesia instead of the 1 year anesthesiologists do and become an specialist in CT anesthesia?

 

[Katheudontas parateroumen]

Do you think it’s reasonable for an FM/IM doc to do a 2 year fellowship is CT anesthesia instead of the 1 year anesthesiologists do and become an specialist in CT anesthesia?

Point well taken. But I do believe 2-2.5 of anesthesia would be enough for other specialties to jump on. as other combined residencies do such a thing like the combined 5 yr IM/Anes , Ped/Anes, EM/Anes. I also don’t think it’s unreasonable for a pediatric ccm do a 2yr peds anesthesia fellowship. I’m sure these might be unpopular opinions. I guess what I’m saying mostly applies to some other sub specialties such that people are, IMO, needlessly excluded. Like CCM isn’t allowed to take TEE echo boards, do a clinical US fellowship, etc.

 

[MedicineZ0Z]

Do you think it’s reasonable for an FM/IM doc to do a 2 year fellowship is CT anesthesia instead of the 1 year anesthesiologists do and become an specialist in CT anesthesia?

CT anesthesia isn't the same as CC. Cmon man, bit of common sense. It's about the overlap. Much of CC is an extension of inpatient medicine. CT anesthesia is a different realm with little overlap.
How about you address this. We can talk about an outpatient heavy IM subspecialty like Endo. I'd argue FM does a lot more outpatient endo (and endo in general) than IM does. So why can't they apply to endo fellowships if it has nothing to do with historical politics/board societies?

 

[CCM-MD]

CT anesthesia isn't the same as CC. Cmon man, bit of common sense. It's about the overlap. Much of CC is an extension of inpatient medicine. CT anesthesia is a different realm with little overlap.
How about you address this. We can talk about an outpatient heavy IM subspecialty like Endo. I'd argue FM does a lot more outpatient endo (and endo in general) than IM does. So why can't they apply to endo fellowships if it has nothing to do with historical politics/board societies?

Oh my god, how dare you? What you said is so offensive. Midlevels are practicing CT anesthesia essentially independently. I know places where the attending anesthesiologist walks in for a few minutes and the CRNA is handling the rest of the case. I am just a resident in a totally different specialty but I have first hand knowledge of how CT anesthesia is practiced in 33 states and have personally witnessed this. And you are telling me that a fully trained FM doc can't do a 2 year fellowship program and practice as a specialist in the same specialty? I am so offended!

Above is a mockery of an argument you make consistently on various parts of this website. Hope this demonstrates to you how ridiculous it sounds. No disrespect intended towards anesthesiology. I can see where you are coming from regarding endocrine but the bottom line is: I am not the arbitrator of specialty training pathways in this country. At the end of the day, the line has to be drawn somewhere. If you have a problem with it, do something more about it than argue anonymously online.

 

[Splenda88]

No, you get the maximum of half a year of FM residency validated toward IM. You can get an additional 6 months of FM training validated if you did IM rotations with a program that had an IM residency and did it with their department identical to an IM resident (ie, supervised by IM PD and for the same hours IM residents do it). From IM to FM you can get a year or a little more validated

These rules are harsh... Do they really think an FM attending would function at the level of a PGY1 IM?

 

[Splenda88]

I am going to say that while there are dangerous FM CCM docs out there, there are just as equally if not worse midlevels running wild out there who are probably just as clueless or worse and certainly not being adequately supervised.
I worked w midlevels in my last travel assignment. It’s great in the daytime because I am there and we run over all the patients and they present to me etc.
But at night the NPs worked under their own licenses even though I was supposed to “supervise” and sometimes did crazy stuff. They were supposed to call me with big issues and one of them did mostly and the other had a big ego, loved to hear himself talk and was always coming up w plans at night that didn’t help in the daytime. In fact they set the patient back many times. And the good one half the time didn’t listen and did his own thing even after being instructed on what to do at night.
I prefer working alone, then next working alongside the midlevel and not “supervising” from home.

You are just a liability sponge...

 

[MedicineZ0Z]

Oh my god, how dare you? What you said is so offensive. Midlevels are practicing CT anesthesia essentially independently. I know places where the attending anesthesiologist walks in for a few minutes and the CRNA is handling the rest of the case. I am just a resident in a totally different specialty but I have first hand knowledge of how CT anesthesia is practiced in 33 states and have personally witnessed this. And you are telling me that a fully trained FM doc can't do a 2 year fellowship program and practice as a specialist in the same specialty? I am so offended!

Above is a mockery of an argument you make consistently on various parts of this website. Hope this demonstrates to you how ridiculous it sounds. No disrespect intended towards anesthesiology. I can see where you are coming from regarding endocrine but the bottom line is: I am not the arbitrator of specialty training pathways in this country. At the end of the day, the line has to be drawn somewhere. If you have a problem with it, do something more about it than argue anonymously online.

Didn't address any of the points made. Disregarding the fact that there's overlap between some things and not others, and this isn't black and white.

 

[Splenda88]

This is the reality of medicine. This profession is taking a nosedive.

 

[Splenda88]

The only reason FM docs can't go into IM subspecialties is due to historical politics. There's literally no reason an FM resident (hypothetically) pursuing a GI or renal or ID or whatever fellowship would be any less competent than their IM counterpart. There is a lot of self selection that goes on.

I do not agree...

 

[Katheudontas parateroumen]

View attachment 329959

This is the reality of medicine. This profession is taking a nosedive.

Wtf that’s disgusting

 

[MedicineZ0Z]

View attachment 329959

This is the reality of medicine. This profession is taking a nosedive.

As demonstrated in this thread by above posters.

I do not agree...

It's the self selection factor. Not saying any random FM grad would be as competent. But one who is heavily pursuing X field would be as competent as a typical grad in IM pursuing that field. Self interest and drive are important factors in competence.

 

[Nephro critical care]

CT anesthesia isn't the same as CC. Cmon man, bit of common sense. It's about the overlap. Much of CC is an extension of inpatient medicine. CT anesthesia is a different realm with little overlap.
How about you address this. We can talk about an outpatient heavy IM subspecialty like Endo. I'd argue FM does a lot more outpatient endo (and endo in general) than IM does. So why can't they apply to endo fellowships if it has nothing to do with historical politics/board societies?

I think that is a good point. I believe FM / IM physicians should also be offered a 2 year fellowship in dermatology which would lead to board certification.

 

[VA Hopeful Dr]

I think that is a good point. I believe FM / IM physicians should also be offered a 2 year fellowship in dermatology which would lead to board certification.

Those exist (or at least used to). One of my derm attendings in med school did a peds residency and then a derm fellowship and now practices full time dermatology: Annette Lynn, M.D. | Carolinas Dermatology Group

Seems just a back-door into the most competitive specialty in medicine to me.

 

[CCM-MD]

Those exist (or at least used to). One of my derm attendings in med school did a peds residency and then a derm fellowship and now practices full time dermatology: Annette Lynn, M.D. | Carolinas Dermatology Group

Seems just a back-door into the most competitive specialty in medicine to me.

https://www.castleconnolly.com/top-doctors/annette-w-lynn-dermatology-91cc008694

Says she did a derm residency according to above.

 

[InternistDO]

CT anesthesia isn't the same as CC. Cmon man, bit of common sense. It's about the overlap. Much of CC is an extension of inpatient medicine. CT anesthesia is a different realm with little overlap.
How about you address this. We can talk about an outpatient heavy IM subspecialty like Endo. I'd argue FM does a lot more outpatient endo (and endo in general) than IM does. So why can't they apply to endo fellowships if it has nothing to do with historical politics/board societies?

Ignoring the d**k measuring about IM and FM that always happens during these conversations, it doesn't really seem logical to have FM be a gateway to specialties. It is definitionally a generalist specialty meant to create primary care physicians and to a lesser extent hospitalists and obstetricians. IM is not a particularly competitive specialty once you leave the university and established community programs, so it's not like people who dreamed of being endocrinologists are being forced into FM. Again, this isn't a value judgement about the training or capability of FM, just that subspecializing doesn't really line up with the stated goals of the specialty.

I do see the value of the +1 fellowships that are done in Canada to give extra training to FM physicians in EM or OB (or sure, crit care) for rural/underserved practice, but I don't think that's the same as true subspecialization.

 

[AlbinoHawk DO]

These rules are harsh... Do they really think an FM attending would function at the level of a PGY1 IM?

I would suspect it has to do with protecting IM as independent from FM, but there's a good question to be had for "at what level is an FM attending compared to residents in IM?" Perhaps you could argue that it depends on the number of inpatient rotations or subspecialty rotations done

 

[Splenda88]

I would suspect it has to do with protecting IM as independent from FM, but there's a good question to be had for "at what level is an FM attending compared to residents in IM?" Perhaps you could argue that it depends on the number of inpatient rotations or subspecialty rotations done

There is a big overlap between the 2 specialties... I would expect FM attending to function as a PGY 2(end) regardless of how many inpatient rotations they had ... Hospital in suburbia hire FM as hospitalists.

 

[AlbinoHawk DO]

There is a big overlap between the 2 specialties... I would expect FM attending to function as a PGY 2(end) regardless of how many inpatient rotations they had ... Hospital in suburbia hire FM as hospitalists.

I know they get hired as hospitalists, but having worked with both, IM is definitely better trained as they have more inpatient, specialty months and ICU coverage. You can't be good at inpatient medicine by doing outpatient medicine. However, the opposite is more likely to be true as you get patients that have been managed on the outside. I would say your average graduating FM is probably closer to someone that finished a strong IM intern year, and considering FM requests only 6 months inpatient in the entire residency, I think it fits.

 

[Splenda88]

I know they get hired as hospitalists, but having worked with both, IM is definitely better trained as they have more inpatient, specialty months and ICU coverage. You can't be good at inpatient medicine by doing outpatient medicine. However, the opposite is more likely to be true as you get patients that have been managed on the outside. I would say your average graduating FM is probably closer to someone that finished a strong IM intern year, and considering FM requests only 6 months inpatient in the entire residency, I think it fits.

I think agree with you. So at least starting as a PGY2 should be the starting point. I don't expect that FM residents where I am who only do 1-month of ICU as opposed to IM residents who do 6 months to be great in managing really sick patients on the floor.

What have you noticed after working with both? I worked with FM interns in the ICU but it was their first few months of residency and I was PGY2/PGY3, and I did not not notice anything egregious...

 

[betamale]

I see a lot of ICU registrar openings in Australia. I think they are training programs. Maybe consider applying to them

https://www.health.qld.gov.au/__data/assets/pdf_file/0019/714502/intensive-care-role.pdf

Critical Care Registrar Jobs (with Salaries) | Indeed.com Australia

Critical Care Registrar jobs now available. Registrar, Fellow, Care Worker and more on Indeed.com

au.indeed.com

GV Health : eRecruit

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gvhealth.mercury.com.au

 

[AlbinoHawk DO]

I think agree with you. So at least starting as a PGY2 should be the starting point. I don't expect that FM residents where I am who only do 1-month of ICU as opposed to IM residents who do 6 months to be great in managing really sick patients on the floor.

What have you noticed after working with both? I worked with FM interns in the ICU but it was their first few months of residency and I was PGY2/PGY3, and I did not not notice anything egregious...

Big picture both IM/FM function well. I think it has a lot to do with how you tackle subtleties of each case. Neither is killing patients outright, but you can just carry a patient along or just easily say "vanc/zosyn" if an infection walks in. There's also much less experience managing ventilators. At my institution, it's an open ICU, but FM doesn't do dedicated ICU rotations at all.

 

[MedicineZ0Z]

I think agree with you. So at least starting as a PGY2 should be the starting point. I don't expect that FM residents where I am who only do 1-month of ICU as opposed to IM residents who do 6 months to be great in managing really sick patients on the floor.

What have you noticed after working with both? I worked with FM interns in the ICU but it was their first few months of residency and I was PGY2/PGY3, and I did not not notice anything egregious...

There's far too much variability from program to program to make conclusions on it.

There are a lot of relatively weak IM community programs too where a lot (obviously not all) of ICU cases are bipap, DKA and low dose pressors. Those are all things we manage daily during our floor months + extensive call schedule. There are IM programs where the residents do all the procedures in the hospital and others where IR does everything. And lots of IM hospitalist groups don't run codes.

There are also very weak FM programs too. Some places only take care of the simplest patients. Others do every single thing.

 

[AMEHigh]

I do not think FM physicians should be allowed to do CCM fellowship. They may just as well claim to be gastroenterologists if they do few months of GI in 3rd year or claim to be competent at doing lap-chole and appis if their 3rd year is geared towards general surgery.

Since this thread is tangents, funny thing you mention this because I’m FM and I was just reading a message board for FM docs. There were posts about all the procedures that FM can do, especially if you’re well-trained in a rural area. FM docs area trained to do endoscopy and colonoscopy in certain places.

Anyway, this one FM doc did say a GI hepatologist did take him under his wing because he had extensive training in endoscopy and colonoscopy during his FM training. So he now works exclusively with a GI group doing just that. He said he also does a lot of primary care for the liver transplant patients.

None of the people I know that do a lot of things that other specialties do call themselves that specialist. FM docs that do OB and csections dont call themselves obgyn. They get the appropriate training during residency and possibly fellowship to be competent in those skills as a FM doctor.

OP I wish you the best. I hope you can find the training and position that you want because it sounds like you have some experience that lends yourself well to continuing growth to learn in CC and provide competent care to patients.

 

[VA Hopeful Dr]

https://www.castleconnolly.com/top-doctors/annette-w-lynn-dermatology-91cc008694

View attachment 329979

Says she did a derm residency according to above.

So it seems.

Very weird as her written bio says she completed a peds residency but this says she was only there for what looks like 1 year. It also makes no mention of the seem residency.

Very weird.

 

[Katheudontas parateroumen]

Since this thread is tangents, funny thing you mention this because I’m FM and I was just reading a message board for FM docs. There were posts about all the procedures that FM can do, especially if you’re well-trained in a rural area. FM docs area trained to do endoscopy and colonoscopy in certain places.

Anyway, this one FM doc did say a GI hepatologist did take him under his wing because he had extensive training in endoscopy and colonoscopy during his FM training. So he now works exclusively with a GI group doing just that. He said he also does a lot of primary care for the liver transplant patients.

None of the people I know that do a lot of things that other specialties do call themselves that specialist. FM docs that do OB and csections dont call themselves obgyn. They get the appropriate training during residency and possibly fellowship to be competent in those skills as a FM doctor.

OP I wish you the best. I hope you can find the training and position that you want because it sounds like you have some experience that lends yourself well to continuing growth to learn in CC and provide competent care to patients.

I think this herein lies the difference between APP and physicians. Physicians can be trained in a multitude of things but rarely do they ever call themselves equivalent sub specialists like these APP do. They never call themselves “oh I’m a nurse” they say “I do the exact same thing as xyz!” As stated, an FM doc has training in many places to deliver, csection, flex sig, etc but they call themselves FM docs. Physicians understand where they come from and don’t generally don’t have an inferiority complex.

 

[YCAGA]

This was briefly touched on before some classic SDN s*** flinging started, but how do you all feel about the numerous IM/FM trained doctors that are more or less acting as an “intensivist-lite” at critical access hospitals? I have seen literally hundreds of locums and FT job postings that have in the requirements: open ICU, must be comfortable managing ICU patients, intubation, central/art lines, vent management required.

Not saying doing those procedures = being a true CCM doctor, but it seems like FM/IM are already practicing aspects of critical care medicine in the community. Should it be this way? Probs not but it is a reality and cheap hospital admin isn’t going to stop requiring it anytime soon, so why not let FM doctors with equivalent ICU and inpatient time an EM/IM do a CC fellowship?

There are multiple threads about IM residents getting <10 intubations, central/art, etc by PGY3. Counter argument is that they probably wouldn’t be competitive for critical care fellowship since they most likely didn’t do extra ICU time. But, it does open up the argument that a motivated FM resident at an unopposed program could easily surpass an IM resident in both critical care procedures and ICU time. No way any FM resident is going to match IM in terms of inpatient months (30+ months I think?), but that is true for EM too, which already struggles to get 6 months of ICU experience before CC fellowship.

I will defer to actual critical care doctors on what they think is most important coming into a CC fellowship…procedural experience? ICU experience? Non-ICU inpatient experience?

I’m not remotely qualified to say what is most important and how much time/experience in each is needed, but I can say that an unopposed FM resident could get similar procedures and ICU time to an IM/EM resident.

 

[MedicineZ0Z]

This was briefly touched on before some classic SDN s*** flinging started, but how do you all feel about the numerous IM/FM trained doctors that are more or less acting as an “intensivist-lite” at critical access hospitals? I have seen literally hundreds of locums and FT job postings that have in the requirements: open ICU, must be comfortable managing ICU patients, intubation, central/art lines, vent management required.

Not saying doing those procedures = being a true CCM doctor, but it seems like FM/IM are already practicing aspects of critical care medicine in the community. Should it be this way? Probs not but it is a reality and cheap hospital admin isn’t going to stop requiring it anytime soon, so why not let FM doctors with equivalent ICU and inpatient time an EM/IM do a CC fellowship?

There are multiple threads about IM residents getting <10 intubations, central/art, etc by PGY3. Counter argument is that they probably wouldn’t be competitive for critical care fellowship since they most likely didn’t do extra ICU time. But, it does open up the argument that a motivated FM resident at an unopposed program could easily surpass an IM resident in both critical care procedures and ICU time. No way any FM resident is going to match IM in terms of inpatient months (30+ months I think?), but that is true for EM too, which already struggles to get 6 months of ICU experience before CC fellowship.

I will defer to actual critical care doctors on what they think is most important coming into a CC fellowship…procedural experience? ICU experience? Non-ICU inpatient experience?

I’m not remotely qualified to say what is most important and how much time/experience in each is needed, but I can say that an unopposed FM resident could get similar procedures and ICU time to an IM/EM resident.

We have alumni doing those jobs. They like it a lot and have had 0 issues.

 

[YCAGA]

We have alumni doing those jobs. They like it a lot and have had 0 issues.

Alumni from FM/IM residency or a cc fellowship?

 

[CCM-MD]

This was briefly touched on before some classic SDN s*** flinging started, but how do you all feel about the numerous IM/FM trained doctors that are more or less acting as an “intensivist-lite” at critical access hospitals? I have seen literally hundreds of locums and FT job postings that have in the requirements: open ICU, must be comfortable managing ICU patients, intubation, central/art lines, vent management required.

Not saying doing those procedures = being a true CCM doctor, but it seems like FM/IM are already practicing aspects of critical care medicine in the community. Should it be this way? Probs not but it is a reality and cheap hospital admin isn’t going to stop requiring it anytime soon, so why not let FM doctors with equivalent ICU and inpatient time an EM/IM do a CC fellowship?

There are multiple threads about IM residents getting <10 intubations, central/art, etc by PGY3. Counter argument is that they probably wouldn’t be competitive for critical care fellowship since they most likely didn’t do extra ICU time. But, it does open up the argument that a motivated FM resident at an unopposed program could easily surpass an IM resident in both critical care procedures and ICU time. No way any FM resident is going to match IM in terms of inpatient months (30+ months I think?), but that is true for EM too, which already struggles to get 6 months of ICU experience before CC fellowship.

I will defer to actual critical care doctors on what they think is most important coming into a CC fellowship…procedural experience? ICU experience? Non-ICU inpatient experience?

I’m not remotely qualified to say what is most important and how much time/experience in each is needed, but I can say that an unopposed FM resident could get similar procedures and ICU time to an IM/EM resident.

Your argument doesn’t make sense. As long as hospital admin doesn’t want to pay for an intensivist, hospitals that staff these places with non-intensivists will continue to do so. Whether or not there is a pathway for FM docs to become intensivists doesn’t change this.