Is it possible to have a life in critical care

[Uberman]

I am in the midst of the IM residency interviews and want or wanted to do a critical care fellowship after residency. I recently was talking with an intensivist and he basically said that it was impossible to have a life as an intensivist. I know that many intensivists also have pulm clinic and are really busy but is it possible to just do shift work in the ICU, similar to a hospitalist. Any insight would be great. Thanks

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[howelljolly]

I also recently talked to an intensivist who said something along the line that the job market in the ICU is terrible. I didnt think that was the case, so I didnt think much of it... but maybe theres something to his statement.

 

[souljah1]

I think it largely depends on whether you are talking about academics or private practice.

In academics, it is quite possible to function solely in the intensive care unit when you have service obligations. We have board certified pulm/cc attendings that ONLY attend in the ICU when they are on service. The rest of the time they pursue their academic careers (healthy policy, epi, clinical trials, basic science, administration). Some of them also attend on our procedure service. Others attend in the unit, on pulm consults, and have clinic. That sort of pulm/cc doctor is decreasing at our program.

Community or private ICU medicine is an entirely different reality and lifestyle. The Leapfrog group's recommendations that all ICU's be staffed by intensivists should push many community hospitals to "close" their ICUs, which in return should provide more opportunities for people mainly interested in critical care. The reality of community ICU medicine is that you are often also the pulm consult and have to go see patients on the floor. I've been told that intensivist jobs are moving to a shift-work based system similar to the ED. Because you don't have the capability to dabble in teaching, research, etc - just being in the ICU week after week might grow tiring.

I think that you can solely do critical care medicine if you want to. I think that there'll be more opportunities to do so in the future.

 

[howelljolly]

I think it largely depends on whether you are talking about academics or private practice.

In academics, it is quite possible to function solely in the intensive care unit when you have service obligations. We have board certified pulm/cc attendings that ONLY attend in the ICU when they are on service. The rest of the time they pursue their academic careers (healthy policy, epi, clinical trials, basic science, administration). Some of them also attend on our procedure service. Others attend in the unit, on pulm consults, and have clinic. That sort of pulm/cc doctor is decreasing at our program.

Community or private ICU medicine is an entirely different reality and lifestyle. The Leapfrog group's recommendations that all ICU's be staffed by intensivists should push many community hospitals to "close" their ICUs, which in return should provide more opportunities for people mainly interested in critical care. The reality of community ICU medicine is that you are often also the pulm consult and have to go see patients on the floor. I've been told that intensivist jobs are moving to a shift-work based system similar to the ED. Because you don't have the capability to dabble in teaching, research, etc - just being in the ICU week after week might grow tiring.

I think that you can solely do critical care medicine if you want to. I think that there'll be more opportunities to do so in the future.

True, not being able to participate in research and teaching can make things more mundane... but do you think you can really get tired of the ICU?

 

[souljah1]

True, not being able to participate in research and teaching can make things more mundane... but do you think you can really get tired of the ICU?

Not tired of, but tired in...

 

[howelljolly]

Not tired of, but tired in...

oops... gotcha.

 

[Tigerz_Fan]

I am in the midst of the IM residency interviews and want or wanted to do a critical care fellowship after residency. I recently was talking with an intensivist and he basically said that it was impossible to have a life as an intensivist. I know that many intensivists also have pulm clinic and are really busy but is it possible to just do shift work in the ICU, similar to a hospitalist. Any insight would be great. Thanks

The hours you will work largely depend on the acuity of the patient that you will be managing. Basically, the sicker, the more hours.

I have several friends in the community setting that are intensivists, and a couple as pulm/CCM. The pulm clinic makes the day very busy. The latest rumor that I heard was that there are 50 pts for every pulm doc. Crazy busy. A couple I know only work in the ICU for this reason. An example of their day. Come to work at 8am, lunch 12-1pm, inpatient pulm consult 1-4, PFT 4-5pm. Call 1:4 (at home), and usually only go in once a week for an admission. This is an 20 bed multi-displinary unit in a level II trauma center. Not so bad.

I was recently searching the job market, and yes, there are shift-work positions out there.

Don't get discouraged, it's a great field!

 

[Tigerz_Fan]

I also recently talked to an intensivist who said something along the line that the job market in the ICU is terrible. I didnt think that was the case, so I didnt think much of it... but maybe theres something to his statement.

Terrible job market? Kidding right?

I attended the CareerMD job fair in November with a friend. They give you these stupid name badges to wear with your respective field. His was CCM. We had to leave because he was being swarmed by recruiters.

Food for thought.....

 

[error404]

Terrible job market? Kidding right?

I attended the CareerMD job fair in November with a friend. They give you these stupid name badges to wear with your respective field. His was CCM. We had to leave because he was being swarmed by recruiters.

Food for thought.....

I think it must depend on the area of the country you live in. My husband is a double-boarded trauma/CC doc, and the market has been very competitive where we are.

But he was able to land a nice job with wonderful control of his hours, so I would say... yes, its very possible to have a nice life in CC. At least, he does.

 

[doc20]

what are the salaries range since some members are in the field?

 

[Tigerz_Fan]

IM/CCM not pulm/CCM anywher from 185K-250K or so depending on location.

 

[Impromptu]

I've seen some schedules that are 1 week on 1 week off, so you can have 1/2 of a life.

Pediatric Critical Care is a tighter field. There are many adult hospitals with ICUs, but children's hospitals that are big enough to require pediatric critical care docs are fewer in number. You'd have to work in a big city, and you'd be more likely to be chained to that particular job.

 

[cptcaver]

Well, I am currently in a pulmonary only fellowship, but we get 6 months of critical care in 2 years. I am feeling your pain. I, too, wanted to go on and do a critical care fellowship, but not anymore. It is entirely too much work and there is NO life as it is, much less doing another year. As far as practicing, I think it depends on where you want to practice and what your personality is. I trained in a little community hospital in residency and would love to do pulmonary/CC at a hospital that size and with the set up they have. Easy to have a life that way. I am currently at an academic institution and they have it set up nice, too, but when you are in the MICU, it's miserable. Well, depending on your personality. Some attendings have no problem going home and leaving it to the fellow and resident. Others will stay til the cows come home. Anyway, I see your point and I think you have to find a practice that will fit your lifestyle. You can find shift work as an intensivist, but you will have to work over night some. I personally don't want that. I am going to try to do some CC and some pulm clinic and some pulm hospital consults, but in the next few years, I may just try to be a procedure only service and do lines, taps, bronchs, brain death exams, swans for organ harvesting, etc.

 

[howelljolly]

Interesting post - thanks for that.

If you do strictly pulm, Im wondering, what sorts of consults would you be doing, and what types of private patients would you generally carry - especially if you want a life outside the hospital?

To illustrate where Im going with this... one of my cardiology attendings stuck with non-interventional, and has REALLY good lifestyle. He's at work around 40 hours per week. He spends his days reading echos and official EKG reads. He carries a few private patients...but.... his consults (and he gets a few every day) are very often for totally bogus chest pain. I dont know if he gets the patients because the internists know that he needs to pay the mortgage, or what.

But.. . If you are in a small hospital that doesnt see a whole lot of restrictive lung disease, pulmonary HTN, or lung cancer... do you get a lot of legit recurrent pneumonias... or do you run around evaluating SOB all day?

 

[SocialistMD]

is it possible to just do shift work in the ICU, similar to a hospitalist.

Yes. There are at least 4 community hospitals here that are staffed by intensivists who do nothing but critical care. They do shiftwork (at one hospital with a group of 3, it is 2 weeks of days (one short [out by 3], one long [out by 6]) and a week of nights with weekend coverage provided by part-time intensivists; at another there is only one intensivist there and he works 6a-6p M-F, etc...).

 

[DrJosephKim]

You can also work in various community hospital ICUs as a hospitalist. Therefore, if you don't want to go through fellowship, that's another option.

 

[Tigerz_Fan]

Actually,

I have seen several job postings for hospitalists to work strictly in the ICU.....

I think I may still have the emails. PM me if interested!

 

[spumoni620]

Hey Tigerz,

Confused...If one can theoretically work in the ICU as a hospitalist, then what would be the benefit of doing a fellowship?? Thanks for helping the naive/unenlightened...

 

[Tigerz_Fan]

Hey Tigerz,

Confused...If one can theoretically work in the ICU as a hospitalist, then what would be the benefit of doing a fellowship?? Thanks for helping the naive/unenlightened...

I came very close to taking a job like this.

Most of those units are low-medium acuity. My reasoning for the fellowship was this:

I want the training to handle the high acuity patients. I also want to work in a multi-disciplinary unit, and I haven't seen a trauma patient in 6 years. My fellowship trains in two hospitals, one of which has a 50 bed multi-disciplinary unit. So that means I will take care of trauma, neuro, CTS, cardiac, neurosurg, etc.

And I want to do my own chest tubes and perc trachs

 

[souljah1]

Most of the hospitalist jobs around here that are for ICU level jobs pay fairly well, but come with the feeling of being a glorified resident. There are still pulm/crit care attendings during the day that assist with vent management, bronchoscopy, etc. - and the hospitalist is there to carry out the plan. Obviously, they're more experienced than most housestaff and are quite good at what they do (selection bias) - but if you poll most of them it isn't what they wish to do for a career. If you are interested in critical care, it is probably a better idea to do a fellowship.

 

[G-Man82]

I'm a 4th year student going into Anesthesiology. What's the market like for CCM through that residency? I haven't yet had my ICU elective (4th year just started), but I hear the unit is similar to what anesthesiologists do in the OR anyway.

 

[Pilot Doc]

I'm a 4th year student going into Anesthesiology. What's the market like for CCM through that residency? I haven't yet had my ICU elective (4th year just started), but I hear the unit is similar to what anesthesiologists do in the OR anyway.

Depends on what you mean by Anes CCM market - if you want to work in a Surgical only ICU, the market is somewhat limited to big academic centers and my impression that the market is OK but not great.

If you simply want to work as an intensivist (which currently pays much less than OR anesthesia), there are lots of jobs available

ICU medicine is similar to OR anesthesia, but there are important differences. Primarly, you are dealing with patients primarily on a days to weeks timescale in the ICU compared to minutes to hours in the OR. The skillsets overlap, but the concerns and issues are very different.

And my take on the original question ... the big issue with CCM is that the movement nationally is toward 24-7 intensivist coverage. While you can limit the number of hours you work each week, it's much harder to limit when those hours are. 75%(!) of the hours in a 24-7 schedule are nights, weekends and holidays. You will spend your whole career working when your friends and family are at home. I couldn't handle that.

 

[Uberman]

Thanks for the insight everyone! I just found out that my first month as an intern is in the ICU and I'm psyched!

 

[howelljolly]

Thanks for the insight everyone! I just found out that my first month as an intern is in the ICU and I'm psyched!

Gosh, if my first month as an intern was in the ICU, Id be scared out of my wits.

Good luck.

 

[G-Man82]

Depends on what you mean by Anes CCM market - if you want to work in a Surgical only ICU, the market is somewhat limited to big academic centers and my impression that the market is OK but not great.

If you simply want to work as an intensivist (which currently pays much less than OR anesthesia), there are lots of jobs available

ICU medicine is similar to OR anesthesia, but there are important differences. Primarly, you are dealing with patients primarily on a days to weeks timescale in the ICU compared to minutes to hours in the OR. The skillsets overlap, but the concerns and issues are very different.

And my take on the original question ... the big issue with CCM is that the movement nationally is toward 24-7 intensivist coverage. While you can limit the number of hours you work each week, it's much harder to limit when those hours are. 75%(!) of the hours in a 24-7 schedule are nights, weekends and holidays. You will spend your whole career working when your friends and family are at home. I couldn't handle that.

Thanks for the answer. Yes, I am beginning to see your point. The hours for ICU are awful, and the attendings do show up at 3 am to admit a patient some times. Even holidays; was on call Jul 3rd night, and the attendings came in ... late. I'm doing my MICU rotation (Medicine sub-I) at a private hospital, so I'm getting that perspective. It's a bit disorganized in the sense that all the consultants write orders on the patient too and the resident's role is very limited. But so far, I am definitely enjoying it more than floor-work. I dunno, the Anesthesiology intensivists at my university actually alternate time in the OR with being "on-service" in the unit (CTICU at my school), which seems like an ideal mix to me. However, I don't think that's how its done in private hospitals. Anyway, I guess I've still got my residency to decide. I think I'll still keep it on my list, though, unless residency burns me out that I give up all hope on a fellowship.

 

[fery]

I am in the midst of the IM residency interviews and want or wanted to do a critical care fellowship after residency. I recently was talking with an intensivist and he basically said that it was impossible to have a life as an intensivist. I know that many intensivists also have pulm clinic and are really busy but is it possible to just do shift work in the ICU, similar to a hospitalist. Any insight would be great. Thanks

working is hard in icu but you have chance for seeing life

 

[draks]

The hours you will work largely depend on the acuity of the patient that you will be managing. Basically, the sicker, the more hours.

I have several friends in the community setting that are intensivists, and a couple as pulm/CCM. The pulm clinic makes the day very busy. The latest rumor that I heard was that there are 50 pts for every pulm doc. Crazy busy. A couple I know only work in the ICU for this reason. An example of their day. Come to work at 8am, lunch 12-1pm, inpatient pulm consult 1-4, PFT 4-5pm. Call 1:4 (at home), and usually only go in once a week for an admission. This is an 20 bed multi-displinary unit in a level II trauma center. Not so bad.

I was recently searching the job market, and yes, there are shift-work positions out there.

Don't get discouraged, it's a great field!

Hi , I am currently working as a Hospitalist in a big city- start salary around 160-170. I found recently that start salary in PCCM at my hospital is 180-200(might be negotiable). So, my question is- is it worth doing PCCM fellowship for next 3 yrs and get a resident salary. Also, if someone can compare traditional prim care to PCCM- as many of my aquaintances are doing prim care- making big money. I want to do PCCM- but am reconsidering it based on long term prospects

 

[howelljolly]

Hi , I am currently working as a Hospitalist in a big city- start salary around 160-170. I found recently that start salary in PCCM at my hospital is 180-200(might be negotiable). So, my question is- is it worth doing PCCM fellowship for next 3 yrs and get a resident salary. Also, if someone can compare traditional prim care to PCCM- as many of my aquaintances are doing prim care- making big money. I want to do PCCM- but am reconsidering it based on long term prospects

Somebody isnt listening to meeeeeeee.

If you want to make attending money, theres not reason to do a PCCM fellowship.

If you want to be a pulmonologist or intensivist, then it is nescessary to do a PCCM fellowship.

Pulm is by definition not primary care. CCM is by definition not primary care. The part where CCM is similar to primary care is that it covers all organ systems.

What do you mean by "worth"?

A PCCM fellowship is worth it if you want to be a pulmonologist or intensivist. Why would you want to be one? Because of the job description. Not because of the pay - theres no extra pay.

Is it worth it? If you want to be a pulmonologist or intensivist, its worth every dime you lose in the pay cut. If you just want money, no pay cut is worth anything.