Options for IM/CCM without Pulmonary?

[deleted547339]

Sometimes I hate my er colleagues ( figure of speech).
Like: she had a saddle pe was a little hypotensive so we gave tpa...
Now she's hypotensive( maxed on levo and vasopressin through a peripheral line) and we can't get a cvp line, just put her in the Icu.
I felt like bitch slapping some one.
But I just put a femoral line in the patient in the er in front of all of them and took her in.
I lost a lot of respect for them that day.
But In reality
Ed gets bombarded with crap left and right and ends up making stupid mistakes. I feel sorry for them sometimes.

What problem do you have with lysing a saddle embolus with hypotension???

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[tartesos]

What problem do you have with lysing a saddle embolus with hypotension???

None. I have a problem with not putting a central line on the patient maxed on pressors through a peripheral line because she had tpa.
That's just plain crazy.

 

[deleted547339]

None. I have a problem with not putting a central line on the patient maxed on pressors through a peripheral line because she had tpa.
That's just plain crazy.

Gotchya. Misunderstood.

 

[timbuktu]

i found out this week that our med center only lets PulmCC guys staff the MICUs during days; CC or general med people can only work nights in the unit (CTICU is staffed by surgeons and the CVICU is staffed by Cards).

is that typical? Is foregoing the Pulm side of things going to pigeonhole me into ****ty shifts at major centers?

 

[jdh71]

i found out this week that our med center only lets PulmCC guys staff the MICUs during days; CC or general med people can only work nights in the unit (CTICU is staffed by surgeons and the CVICU is staffed by Cards).

is that typical? Is foregoing the Pulm side of things going to pigeonhole me into ****ty shifts at major centers?

It could. Know what you are getting into.

 

[tartesos]

i found out this week that our med center only lets PulmCC guys staff the MICUs during days; CC or general med people can only work nights in the unit (CTICU is staffed by surgeons and the CVICU is staffed by Cards).

is that typical? Is foregoing the Pulm side of things going to pigeonhole me into ****ty shifts at major centers?

There's a lot of mixed feelings about this... In my opinion Doing Ccm only is exciting and awesome and it pays very well and at one point I didn't see myself doing anything else... but one cannot do this for ever without burning out, so a back up plan is needed , a way out to ease off later on...
With Ccm only You could go into academics, or to a va( maybe?), primary care?, or if you have another combined training ( renal, id, cards) into that.
And not to say that some places will not look at you without the Pulm side so it will limit you geographical to big cities/programs.
Do your homework so you can make an educated decision, it's only your whole life on the line here.
No pressure!!

 

[Hernandez]

There's a lot of mixed feelings about this... In my opinion Doing Ccm only is exciting and awesome and it pays very well and at one point I didn't see myself doing anything else... but one cannot do this for ever without burning out, so a back up plan is needed , a way out to ease off later on...
With Ccm only You could go into academics, or to a va( maybe?), primary care?, or if you have another combined training ( renal, id, cards) into that.
And not to say that some places will not look at you without the Pulm side so it will limit you geographical to big cities/programs.
Do your homework so you can make an educated decision, it's only your whole life on the line here.
No pressure!!

There are plenty of CCM only jobs but as someone who went into pulm-cc without liking pulm.....there is a high probability of burning out and Pulm makes a nice alternative when you want out of the ICU.

 

[jdh71]

I personally love the mix. Single organ disease is nice from a physician standpoint and allows you to turf A LOT of nonsense back to the PCP.

And when I'm kind of sick of clinic I am usually scheduled to be back in the unit and when I'm kind of sick of the unit I can head back to the clinic.

I don't know. I think if you have the option, do it. But lots of places looking for critical care only. Including my own.

Shameless plug: if you're interested in a gig out in the mountain west send me a PM! Lol.

 

[tartesos]

There are plenty of CCM only jobs but as someone who went into pulm-cc without liking pulm.....there is a high probability of burning out and Pulm makes a nice alternative when you want out of the ICU.

I agree with you on the plenty of jobs out there, but not as much as Pulm/Ccm and it will limit you geographically to be Ccm trained only.
That's another point.

 

[bashwell]

Apologies as I hope this isn't a dumb question, but if you do cc only, then can't you minimize burnout by working less shifts and/or shorter shifts? Instead of 7 x 12h shifts, maybe 5 x 10h shifts (assuming you can work out something with a group or hospital)?

 

[sluggs]

IM/CCM here. Lots of good and bad jobs for us out there; variable shifts; urban and rural (not tiny rural but medium and smaller cities/suburbs); high pay and low pay; locums and permanent. Almost all are week on/off with variable rotating night duties. The single driving decision maker should be whether you like "pure" critical care better, or whether you find general pulm medicine (or its specialties like sleep, transplant, CF, interventional) to be a passion.
The pulm folks will jump on this, but I do believe that you get a more diverse crit care education at some pure CCM programs (more SICU, CTICU, Neuro), but that is just my personal experience.
JUMP Pulm FOLKS! JUMP!
AS I get older, though, kinda wish I had that extra year of lungs!

 

[Hernandez]

JUMP Pulm FOLKS! JUMP!

Eh, CC is CC no matter the unit. 2/3rds chest thumping, 1/6 coffee 1/12 sarcasm. 1/24th shenanigans and 1/48th trying to remember to place all the orders in the EMR.

And NICU is boring.

 

[Hamhock]

Post deleted to remove personal info

HH

 

[jdh71]

IM/CCM here. Lots of good and bad jobs for us out there; variable shifts; urban and rural (not tiny rural but medium and smaller cities/suburbs); high pay and low pay; locums and permanent. Almost all are week on/off with variable rotating night duties. The single driving decision maker should be whether you like "pure" critical care better, or whether you find general pulm medicine (or its specialties like sleep, transplant, CF, interventional) to be a passion.
The pulm folks will jump on this, but I do believe that you get a more diverse crit care education at some pure CCM programs (more SICU, CTICU, Neuro), but that is just my personal experience.
JUMP Pulm FOLKS! JUMP!
AS I get older, though, kinda wish I had that extra year of lungs!

First couple years out and I definitely wish I'd have had a little more time with bad heads but that about it - you see one and you really know how to manage going forward with a tweek here or a tweek there, and a lot is really determined by how aggressive the neuro surgeon on call is (or won't do) and how much I can talk a family out of doing.

I find very little nuance to SICU; now Trauma though is a bit of a different beast, but that still is mostly timing of things, rather than the actual critical care part.

CTICU can be very nuanced but everywhere I've been has largely anecdotally driven management by whatever voodoo the surgeon thinks works or has worked for him in the past so the nuance disappears into a cloud of stubborn, boxed in thinking, with the surgeons spending way too long banging a square peg at a round hole before they ask for an opinion (usually a week), and then usually ignoring the opinion. I think it would be hard to find a unit where the surgeon gets out of your way, but maybe if they really trust you . . .

And you do get more diverse formal critical care training in the CCM only fellowships. I'm just not convinced folks don't equalize out after one to two years depending on what they actually DO for their critical care practice.