I'd rather give up all my floor months, just to stay in the ICU

[sunny123]

I have even volunteered to take call with the seniors to gain additional experience for when I become a senior. Just scared about second year you know?

Now that I know this is what I want, what should I do to maximize my chances of getting a fellowship? I haven't found too many cases that could be published, but my eyes are always on the lookout. I am also going to try to do some away electives.

FYI, I am at a hospital that is under a university program, but my hospital doesn't have the pulm/critical care program. I would have to go downtown for that.

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[Bostonredsox]

I actually did this. new AOA program that didn't have a true framework setup. Not enough quality seniors to staff the MICU 24/7. Too many seniors for the floor teams. most people were willing to do just about anything to avoid extra MICU time. Guess who traded nearly all of his floor months for MICU months that were labeled as "acute care medicine" months, thus satisfying the AOA requirement......By next june/graduation time I will have done 8 floor months, 3 night floor months and 9 MICU months. hollaaaaaa

 

[sunny123]

9 months of MICU?? That is badass..... My program director said the max I could do is 6... bu I could get around it by doing pulmonary electives.

 

[ihearttriangles]

To take this one step further...does anyone know why CC isn't its own residency? People are always debating which residency prepares you best for a CC felowship but why not just make it its own residency? Maybe 3 parts medicine and 1 part each of EM/anesthesia/surgery?

 

[sunny123]

Would've loved for a critical care residency

 

[jdh71]

ACGME caps the months of critical care time (I assume to prevent the overuse of residents in the ICU)

So be careful about trading too may floor months, because you need so many in order to finish IM (I'm assuming OP is IM) - you could find yourself doing some "super-senior" type of stuff and missing your window for fellowship immediately following residency, having to start a year later.

 

[jdh71]

To take this one step further...does anyone know why CC isn't its own residency? People are always debating which residency prepares you best for a CC felowship but why not just make it its own residency? Maybe 3 parts medicine and 1 part each of EM/anesthesia/surgery?

Would've loved for a critical care residency

You're a better more well rounded clinician for the general residency time, no matter which pathway you come from. It's important to understand how medicine works outside of the ICU which is a very different animal. You are a better ICU physician for having a base outside of the unit before stepping into it.

 

[Bostonredsox]

ACGME caps the months of critical care time (I assume to prevent the overuse of residents in the ICU)

So be careful about trading too may floor months, because you need so many in order to finish IM (I'm assuming OP is IM) - you could find yourself doing some "super-senior" type of stuff and missing your window for fellowship immediately following residency, having to start a year later.

/nod. ACGME has strict rules. AOA only requires 12 months general medicine and ICU has no cap. Make sure you check with your governing body's rules.

 

[sunny123]

ACGME caps the months of critical care time (I assume to prevent the overuse of residents in the ICU)

So be careful about trading too may floor months, because you need so many in order to finish IM (I'm assuming OP is IM) - you could find yourself doing some "super-senior" type of stuff and missing your window for fellowship immediately following residency, having to start a year later.

Yep, in IM. And I don't plan on violating the rules.... Just wanted to express how I actually enjoy showing up to the icu everyday.

 

[jdh71]

Yep, in IM. And I don't plan on violating the rules.... Just wanted to express how I actually enjoy showing up to the icu everyday.

Just be careful with CCU time then too, because I think these months count as half critical care time and can add up if you're not paying attention.

But as long as you get the 6 months floors as an intern and 6 months floors as a supervising resident, and don't tap into those ICU months with too much cards time, you can do a good number of months. You can also get creative depending on how the services run at your shop - sometimes the pulmonary service will get to do a lot of critical care on the side as consultants, also the ED can also be a place to get some solid CC time depending on your shop. We didn't have a EM residency when I did IM, so the EPs downstairs loved being able to show us their side of the critical care spectrum in the ED and I got a good number of procedures including most of my intubations in residency in the ED (just don't be "too good" to see a vag bleeder at 2am)

 

[BigRedBeta]

The best subspecialists start out as great generalists.

While the floors or clinics may be miserable, there's still lots to be learned. Perhaps this is more true in peds, but if nothing else, remember that your IM boards will not be ICU exclusive, and there's only so much time to learn the secondary points in fields that typically are not sending a lot of patients to the ICU but will still generate points on your certification exam.

Maybe it's because I'm a PICU fellow and it's a different experience than seen in the adult world, but I think there's great value in being able to go toe to toe with your consultants in their areas of expertise in terms of pathophys. Our job should be to consider the entire patient and make sure that the therapies from multiple specialists make sense in sum. One of my mentors said that critical care physicians are generalists on steroids and that's something that sticks with me every day. If you don't know how those groups think, it'll make your job harder in the future.