Peds Cardio/ PICU 5 year combined fellowship?

[greatmichigandoctor]

Hi folks,

I am currently 2nd year peds resident, going into 3rd year and will be applying fellowship soon.

I am interested to apply for combined 5 year PICU/ peds cardio fellowship. Anyone who has applied, please elaborate how it works? Does 5 year positions go out of match or we have to apply via ERAS? do we have to apply to 2 different specialities or only one?
Which should I apply first? PICU or peds cardio?
Also if someone can tell which programs offer 5 year combine fellowship positions?

I am also interested to know if there is any salary difference between working only as PICU attending and working in CVICU as combined PICU/peds cardio attending?

Is it worth to do 5 years combined fellowship or doing 1 year advanced fellowship in CVICU after 3 years of PICU enough to get good position in academc settings?

Thanks

---

Members don't see this ad.

 

[SurfingDoctor]

Hi folks,

I am currently 2nd year peds resident, going into 3rd year and will be applying fellowship soon.

I am interested to apply for combined 5 year PICU/ peds cardio fellowship. Anyone who has applied, please elaborate how it works? Does 5 year positions go out of match or we have to apply via ERAS? do we have to apply to 2 different specialities or only one?
Which should I apply first? PICU or peds cardio?
Also if someone can tell which programs offer 5 year combine fellowship positions?

I am also interested to know if there is any salary difference between working only as PICU attending and working in CVICU as combined PICU/peds cardio attending?

Is it worth to do 5 years combined fellowship or doing 1 year advanced fellowship in CVICU after 3 years of PICU enough to get good position in academc settings?

Thanks

I'm sure there are "combined" programs, but it my experience, it tends to matching into one first, then greasing the wheels so to speak to have your home program dedicate you a spot in the follow up match. The general process is match into a fellowship, then hand shake that you'll get a spot in the same institution, but you still have to go through the match. Both are through ERAS. But the path is always 5 years because you never have to do 2 fellowship scholarly projects. So 3 years in your first fellowship and 2 in the second, no matter what the combination is.

Doing a PICU + Cards fellowship does not typically net you more opportunities then PICU + CVICU fellowship. Both attend in the CVICU. I suppose you could do Echos or something on the side if you did the the former, but that's about it. Our group is made up of Cards who did a 1 year CVICU fellowship, Cards or PICU only who are grandfathered in, PICU who did a 1 year CVICU fellowship and PICU + Cards fellowship. They all basically attend in the CVICU and that's it. No one wants to do clinic. No one wants to have 2 bosses to report to. I have seen some at other institutions do side stuff if they are Cards trained with a CVICU year. Some do Heart Failure/Transplant or like I mentioned, Echos. But that is not typical. They all get paid the same more or less, which is more than the base salary of PICU only. There also tends to be more job opportunities as many places attempt to have CVICUs because the surgeries generate more revenue than any other pediatric subspecialty.

 

[BigRedBeta]

Others may have a little more insight into the "combined" process but the most consistent piece of advice I can give you is to reach out to the programs you're interested in and ask how they like to manage the process. As @SurfingDoctor has mentioned, it's usually match into one and then figure out the second later.

I'll disagree slightly though about opportunities of dual boarded vs 4th year CVICU. Many of the bigger centers, especially those that tend to think the CVICU's home is the Division of Cardiology rather than Critical Care, will show preference towards those who are dual trained. Places like Boston, Northwestern, Cincinnati, CHOP and others have a greater proportion of dual trained people than those who completed a 4th year. So if you think you want your career to land you in those sort of institutions...then being dual boarded will garner you more opportunities.

As it stands in 2018, either dual boarded or 4th year people are very much in demand, as almost every place that does cardiac surgeries is looking for more expertise. Whether that demand will remain in 6 years is not as clear. I would expect that they will still have an easier time than straight PICU people coming out, but perhaps not as many opportunities as they currently have.

Most of the people I've seen go through the dual boarded process have started out in cardiology and then done the final two years in the PICU (but I trained at a place where the CVICU was part of the Heart Center, not the PICU). Because of the varied locations (echo room, cath lab, CVICU, clinic, EP lab, etc) in a cardiology fellowship, it can be hard to create a schedule that actually fits everything in only 2 years, whereas most PICU fellowships get the majority of the clinical time out of the way in the first year anyways, it's not as difficult to meet the requirements.

I suppose if you felt that you were a relatively mediocre cardiology applicant (given the competitiveness of that match) but fairly solid PICU applicant (still a very competent self selecting group), maybe it would be beneficial to match into PICU fellowship first, but that's a big maybe.

The last consideration is which do you think of yourself as more - a future intensivist who likes hearts, or a future cardiologist who likes the ICU? Most people have a sense of where they fall on that continuum, and that can help you figure out which place to start.

 

[greatmichigandoctor]

Thank you very much BigRedBeta and Surfing doctor. Very well elaborated the answers to my questions. I really appreciate it. I think I want to be a future intensivist who like hearts .
I would like to get an idea what is the base salary for most of the PICU/ CVICU attendings? I really love PICU but burnout is a natural process, how do people deal with burnout in later part of lives?

 

[BigRedBeta]

I'm three years out and my offers ranged from 185-210k. The place with lowest base salary had the highest average production bonus and most potential for salary/bonus growth (by a lot since private practice). Higher base salary had lower bonus potential, at least for the first few years every place was roughly equivalent at around $230k for total compensation. Would expect that with the competition for CVICU people that salaries would be higher bases, but since they are almost all academic, there are limits on growth potential.

Burnout is real - most people do more administrative work, slide into roles like sedation service or if they are successful researchers, start to dedicate more time to that. You can also get out of academics entirely and do locum tenens in smaller 4-10 bed PICU's (and those places are always looking for someone permanent to step into their openings).

 

[SurfingDoctor]

Thank you very much BigRedBeta and Surfing doctor. Very well elaborated the answers to my questions. I really appreciate it. I think I want to be a future intensivist who like hearts .
I would like to get an idea what is the base salary for most of the PICU/ CVICU attendings? I really love PICU but burnout is a natural process, how do people deal with burnout in later part of lives?

The pay differential for CVICU versus PICU is about 10 to 15% higher in CVICU. That has been my experience.

Burnout rate is likely the same in both groups. Maybe slightly higher in the CVICU group because their is less autonomy, but I doubt that makes a significant difference. The burnout rate for either is higher than most pediatric subspecialties but I don't know the actual rate. The problem though (at least it my opinion) is not so much burnout, but what to do with the aging intensivist. No one, and I mean no one wants to be taking in house call when they at 60+. Some people have the ability to buy down time, others don't. There's no magic solution to the issue other than be financially as smart as possible and find a way out of call at that age.