Medicine vs Anesthesia CCM for EM trained

[sonofva]

I listed something similar in the em forum. Just want to get some opinions from you guys as to which fellowship an EM trained physician would be a better fit/get the most out of. Which would offer better carry over to someone trying to have a career focusing more on ed resuscitation? IM vs anesthesia ccm? Thanks!

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[Doctor Bob]

If your focus is ED resuscitation, one could argue you don't need a CCM fellowship
But if you want to do one, anesthesia would be better.

 

[sonofva]

If your focus is ED resuscitation, one could argue you don't need a CCM fellowship
But if you want to do one, anesthesia would be better.

Thanks for the input! I plan on doing split practice down the road, i just want to get the most carry over into the ed. Could you clarify as to why anesthesia, if you dont mind?

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[psychbender]

If you ever plan on taking an academic job, where you may want to supervise IM residents in a MICU, do an ABIM-based fellowship. When I was interviewing last year, and spoke with some of the EM applicants, that was a big motivator for some in choosing an IM fellowship over the anesthesiology ones. If you're more of a Surgical/Trauma ICU, Burn ICU, Neuro ICU, Cardiac ICU fan, then maybe the anesthesiology fellowships, which tend to focus more time in these units, would be a better fit. Ultimately, should you put in the effort needed, any route to CCM should teach you what you need to become a competent intensivist.

 

[Doctor Bob]

Thanks for the input! I plan on doing split practice down the road, i just want to get the most carry over into the ed. Could you clarify as to why anesthesia, if you dont mind?

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IM loves going into the weeds looking at the minutae of vasculitides, blood smears, spun urine, etc, etc, etc. Stuff that really isn't relevant in the ED.
Anesthesia is good at the acute resuscitation of hemodynamically unstable patients (usually because someone's cutting on their belly).
But yes, as @psychbender said, it more gets back to what your long term interest is and where you think you'd want do spend your ICU time.

 

[CCM-MD]

I listed something similar in the em forum. Just want to get some opinions from you guys as to which fellowship an EM trained physician would be a better fit/get the most out of. Which would offer better carry over to someone trying to have a career focusing more on ed resuscitation? IM vs anesthesia ccm? Thanks!

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There are several multidisciplinary CCM fellowships, UPMC and SLU come to mind, that I think will serve you well. Many fellowships will train you to become a SICU doctor or a MICU doctor but a multidisciplinary fellowship will give you well rounded training with rotations in a variety of ICU settings. Also, I would argue that many community NeuroICU, SICU, Burn, and Cardiac ICUs are managed by IM trained intensivists.

I think being trained in a multidisciplinary fellowship will be very valuable to an EM doc.

 

[mochief2000]

i personally think you would be better fitted with going to a IM based CC fellowship. My reasons are, 1. all critical care fellowships will teach you how to manage a hemodynamically unstable patients (or they are not that good to begin with) 2. My SICU (anesthesia based) counterparts can't cover the MICU, but our MICU attending can teach in the SICU at my institution.

i have more reasons but thats they fall into the who got the bigger **** category which is all subjective.

 

[Doctor Bob]

2. My SICU (anesthesia based) counterparts can't cover the MICU, but our MICU attending can teach in the SICU at my institution.

This is not the case at most places

 

[mochief2000]

This is not the case at most places

which part? You can cover the MICU? or we cannot cover the SICU?

 

[psychbender]

I've heard of anesthesiologist-intensivists covering MICUs, but not at academic centers that train internists because of the ABIM rule that they can only be trained by ABIM-boarded doctors. I have, though, seen IM-intensivists cover SICUs, as the ACS and ABA have no such rule. Again, if you're a Emergency physician that wants to be able to cover an academic MICU, do an ABIM fellowship. If you are sure you want to stick to community hospitals or more surgical ICUs, then you can go with an ABA program.

 

[pulmoblast]

If your ultimate aim is to do Critical Care only, do IM-CC. Having said that ED-CC, Anes-CC or IM-PCC give you flexibility of practice and an alternate lifestyle.

Doing only CC all the time WILL become a sap on your life once you do it for a few years


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[Doctor Bob]

which part? You can cover the MICU? or we cannot cover the SICU?

Pulm/CC generally does not staff a SICU.
But, really, anesthesia/surg doesn't belong in a MICU either.

It's not to say that they both can't do it.. but they probably shouldn't... in an academic setting. Surgeons and anesthesiologists are the best trained to teach about the operative and perioperative management of patients; IM docs are the best trained to teach about the sick medical patient. Both can care for patients, but they'll each be better teachers in their respective fields.

 

[mochief2000]

It's not to say that they both can't do it.. but they probably shouldn't... in an academic setting. Surgeons and anesthesiologists are the best trained to teach about the operative and perioperative management of patients; IM docs are the best trained to teach about the sick medical patient. Both can care for patients, but they'll each be better teachers in their respective fields.[/QUOTE]

i can agree on that.

 

[physicsnerd42]

I've heard of anesthesiologist-intensivists covering MICUs, but not at academic centers that train internists because of the ABIM rule that they can only be trained by ABIM-boarded doctors. I have, though, seen IM-intensivists cover SICUs, as the ACS and ABA have no such rule. Again, if you're a Emergency physician that wants to be able to cover an academic MICU, do an ABIM fellowship. If you are sure you want to stick to community hospitals or more surgical ICUs, then you can go with an ABA program.

I'm not sure that's true. I'm at Stanford and only had anesthesia-trained intensivists (well, I guess one of them did medicine and crit care fellowship prior to anesthesia) as attendings when I was in the MICU. The MICU attendings are probably 45% anesthesia, 45% medicine and 10% EM background. The SICU attendings are anesthesia, surgery and a couple of medicine. The CVICU is almost entirely anesthesia with a couple of medicine attendings. The resident teams are all combos of anes, EM, IM in the MICU. We have IM, anes, EM and neuro trained critical care fellows.

 

[G-Man82]

I work in academics as an anesthesia-trained intensivist. While my unit is primarily surgical, we admit a lot of medical overflow patients because we just don't have enough medical beds in the hospital. Those medical patients do leave my icu in one way or the other, with some actually leaving alive!


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[jdh71]

I listed something similar in the em forum. Just want to get some opinions from you guys as to which fellowship an EM trained physician would be a better fit/get the most out of. Which would offer better carry over to someone trying to have a career focusing more on ed resuscitation? IM vs anesthesia ccm? Thanks!

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You'll get good at what you do and see after a critical care fellowship which will make you competent to pick up what you need to on the job. I think an IM fellowship would be much more broad based training, this is based on my experience managing SICU patients both in fellowship and now as an attending physician. But these days, and who knows maybe I'll change my mind on this some day, but if you can get away with a shorter fellowship and I think you can coming out of the ED (because a decent amount of IM-CC is getting IM trained folks, which isn't a terribly hyper-acute focused specialty comfortable doing things and managing things that are). I recommend doing the gas fellowship. Then go make money. You'll pick up the rest at your new job.