Id/cc

[emt30119]

I've heard that there are some docs who are both Infectious Disease and Critical Care specialized. I am considering this combo, but would like to pick the brains of those who have gone before me. Can anyone pass along(either here or via PM) the names and location/institution where some of these ID/CC docs may be so I can do some networking. Thanks

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[Bostonredsox]

It is not a combo fellowship. You do a 2 year ID fellowship. Than you apply to 2 year CC programs and you essentially get a waiver for one of the 2 years. Which is flat out ridiculous as there isnt the slightest spec of CC mangement during the 2 ID years. Anyway, they are both good fields and it shouldnt be hard for you to get this accomplished. Just email PD's at 2 year CC programs, I believer there are around 30-35, asking if they accept people into 1 year slots as you wil have completed and ID fellowship.

 

[dotcb]

I may be mistaken, but I think you can do 2 years of ID and 1 year of CCM and get boarded in both.

 

[Bostonredsox]

Correct, which as I said, is ridiculous. There is no CC training during the 2 ID years which logically allow for removal of one year of the CC fellowship. It makes since only after cardio. None if the other IM fellowships do any significant, if any at all, CC training during fellowship. However, That iis as they say, the way of the world. I'm just bitter

 

[DIce3]

Renal, cardiology, gastroenterology, and ID fellows round in the ICU on a daily basis exactly like straight 2 year pulmonary fellows. I am really not sure that straight pulmonary fellows really do any more "ICU medicine" than the other four specialties. ID is consulted on more ICU patients than pulmonary in some ICUs.

 

[Hernandez]

Renal, cardiology, gastroenterology, and ID fellows round in the ICU on a daily basis exactly like straight 2 year pulmonary fellows. I am really not sure that straight pulmonary fellows really do any more "ICU medicine" than the other four specialties. ID is consulted on more ICU patients than pulmonary in some ICUs.

I don't even know where to start.....

 

[Bostonredsox]

I don't even know where to start.....

Lol....'rounding in the ICU'......as if that at all counts as managing ICU patients and practicing critical care medicine.

Nephro: "yup, they sure need dialysis. lets dialyse them, rest of management per CC team"

GI: "yup, that sure is a bleed, lets scope them. Lesion cauterized, rest of management per CC team"

Cardio actually runs CCU's in some places for the STEMI pts so I'll give them a nod. Thats it. The rest are laughable.

 

[redy]

Renal, cardiology, gastroenterology, and ID fellows round in the ICU on a daily basis exactly like straight 2 year pulmonary fellows. I am really not sure that straight pulmonary fellows really do any more "ICU medicine" than the other four specialties. ID is consulted on more ICU patients than pulmonary in some ICUs.

Firstly pulmonary/CC fellows rotate through ICU as the ICU fellow during all 3 years. Secondly vent management being a major critical part of ICU is obviously more of a pulmonary domain. Now I do not deny that Abx is any less critical issue but for the most part initially at least ID is not needed. And in our ICU the attendings rarely call ID consults, obviously more comfortable with Abx than say an ID person would be with vents. Fluid management is another major issue where Renal may help but again not something requiring a renal fellowship. You can argue though that being say an ID/CC or renal/CC you will just call pulm for vent management, which btw is done by our CCU team.

 

[Hernandez]

Firstly pulmonary/CC fellows rotate through ICU as the ICU fellow .

Even those very few pure pulm fellowships require many months of ICU rotations.

 

[DIce3]

I am sure that there are huge regional differences. I am not attempting to be argumentative but I respectively disagree.

Where I trained, GI fellows spent a heck of alot of time in the ICU taking care of pre and post liver transplants. They also spent alot of time with bleeders.. fluid management, coag, transfusion, pressors, etc.

Where I trained the renal fellows more or less lived in the ICU taking care of fluid, electrolyte, CVVHDF, pressors, acid-base, and helped the hepatologists on transplant. There was even a special renal ICU that they totally ran.

Where I trained, the cardiology fellows ran their own ICU and all parts of it for the most part.

Where I trained the ID fellows were pretty hands on in the ICU but not as much as the other three.

 

[Hernandez]

I am sure that there are huge regional differences. I am not attempting to be argumentative but I respectively disagree.

Where I trained, GI fellows spent a heck of alot of time in the ICU taking care of pre and post liver transplants. They also spent alot of time with bleeders.. fluid management, coag, transfusion, pressors, etc.

Where I trained the renal fellows more or less lived in the ICU taking care of fluid, electrolyte, CVVHDF, pressors, acid-base, and helped the hepatologists on transplant. There was even a special renal ICU that they totally ran.

Where I trained, the cardiology fellows ran their own ICU and all parts of it for the most part.

Where I trained the ID fellows were pretty hands on in the ICU but not as much as the other three.

Where you may have trained that may have been the case, but it isn't standard by any means. And considering some the anecdote, you must have been at either a very large or a very very subspecialty driven hospital. I'm not at a tiny hospital by any means and none of that is the case here.

And there is a HUGE difference between being hands on and actually being primary on a pt in the ICU, I have NEVER seen GI, do any procedures in an ICU, outside of a scope, hell, I placed the last blakemore tube while GI was out using up to date for instructions on using it.

renal, does renal still do they're own dialysis catheters anywhere?

ID, hell, I've never even seen they do a procedure. None the less, none of the other specialties mandate ICU rotations as part of they're training, except maybe CCU, but I'm sure many CCUs are like mine, pt comes in with 3rd degree heart block, we can't take that because they have too many medical issues, to MICU they go, and we get consulted for CC management on the rest of their CCU pts.

But back to your original point, about pure pulmonary fellows, there sent that many, last time I checked there was 6, and one closed and rolled over into our pulm-CC fellowship. Compared to 125 pulm-CC fellowships.

 

[dotcb]

Where did you train?

I am sure that there are huge regional differences. I am not attempting to be argumentative but I respectively disagree.

Where I trained, GI fellows spent a heck of alot of time in the ICU taking care of pre and post liver transplants. They also spent alot of time with bleeders.. fluid management, coag, transfusion, pressors, etc.

Where I trained the renal fellows more or less lived in the ICU taking care of fluid, electrolyte, CVVHDF, pressors, acid-base, and helped the hepatologists on transplant. There was even a special renal ICU that they totally ran.

Where I trained, the cardiology fellows ran their own ICU and all parts of it for the most part.

Where I trained the ID fellows were pretty hands on in the ICU but not as much as the other three.

 

[Bostonredsox]

Where you may have trained that may have been the case, but it isn't standard by any means. And considering some the anecdote, you must have been at either a very large or a very very subspecialty driven hospital. I'm not at a tiny hospital by any means and none of that is the case here.

And there is a HUGE difference between being hands on and actually being primary on a pt in the ICU, I have NEVER seen GI, do any procedures in an ICU, outside of a scope, hell, I placed the last blakemore tube while GI was out using up to date for instructions on using it.

renal, does renal still do they're own dialysis catheters anywhere?

ID, hell, I've never even seen they do a procedure. None the less, none of the other specialties mandate ICU rotations as part of they're training, except maybe CCU, but I'm sure many CCUs are like mine, pt comes in with 3rd degree heart block, we can't take that because they have too many medical issues, to MICU they go, and we get consulted for CC management on the rest of their CCU pts.

But back to your original point, about pure pulmonary fellows, there sent that many, last time I checked there was 6, and one closed and rolled over into our pulm-CC fellowship. Compared to 125 pulm-CC fellowships.

Lol, when I first came here, maybe 4 months into intern year, the CV surgeons NP dropped a lung putting in a subclavian on one of their fem-pops boarding with us. So I phoned CTSurg who had gone home a bit earlier letting him know pt had PTX on the vent and I was gonna go put a chest tube in, he goes 'no sir, call "NP", she is an actual part of the team whereas I have not worked with you before nor seen what you are capable or not capable of in my patient".. Said ok your pt your show. About 10 min later I saw her watching a youtube video for how to put in a chest tube with the seldinger kit. About 30 min after that I strolled by to see the attending taking off his coat/gloves and getting ready to put in the tube. Smiled as I walked by. She is no longer here and the MICU resident-CT surg dynamic has changed mightily since then off topic but makes me laugh.

Anyway, with Hernandez, the GI guys and nepro guys may be managing the HD and the bleeders and such and such. But chances are that pt is tubed, has a CVC or a cordis and an a-line if on a pressor. I would wager all of that was done by the MICU fellow not the GI or nephro fellow. And cardio guys run the cardiac CCU's which are mostly stable post PTCA STEMIs and heart blocks that needed pacers, who most often had their emergent pacer put in in the ED. The brunt work for initiation and maintance of the critical care in those patients were undoubteldy done by the MICU fellow. Once the pts have been stabilized and are atleast 'on lifesupport' to use the lamens terms, is generally when the other specialities get involved. I have yet to see GI come scope a hypotensive crashing pt without first insisting we intubate them/get access to give them volume/pressors.

 

[redy]

How come you were able to place a chest tube 4 months into your internship?

 

[Bostonredsox]

How come you were able to place a chest tube 4 months into your internship?

because I had already placed the five required to be signed off. My first 4 months of residency were MICU (elec), cardio, Gen surg, MICU. I had a large amount of procedures done very early into internship.

 

[VentdependenT]

Where did you train?

you will never ever get that answer. maybe it trained in the 70's or 80's