PICU to anesthesia?

[wellchild]

I'm in the final stages of completing a pediatric critical care fellowship and realizing that my favorite parts of the job are the procedures and physiology--qualities most mimicked in anesthesia--and now I'm considering adding on an anesthesia residency and peds anesthesia fellowship. I'm currently at a large midwest university program with several dual-trained faculty members (peds + PICU + anesthesia + peds anesthesia) who will support me if I choose to pursue this route, but certainly no one seems excited about it.

My reasons for this pursuit are the type of work I enjoy, as well as the flexibility I perceive it will give me later in my career. I love being in the unit, but don't want to be doing a ton of overnight calls into my 60s and I like that I could theoretically get a cushier job doing just anesthesia later in life almost anywhere I'd want to move. My ideal job for the next 10-15 years would be academic, splitting time between the unit and the OR. Additionally, I have a masters in research and would like to continue to publish, though I know this might take a backseat if trying to appease two clinical masters. Additionally, the job market for academic pediatric intensivists is absurdly tight right now and I don't want to take just any job. My sense is that with both I'll be an even more attractive candidate after another 4 years of training and hopefully have more say where I'll be able to land a job.

My questions then for the anonymous horde is:

1. Are my perceptions about what kind of career I could have accurate given your experience?

2. I'd be starting my career in my early 40s with $280-300k in student loans. I won't be poor as a peds intensivist but I'll be even less not-poor as a peds anesthesiologist. Does the time takes to train offset the salary I could expect when I'm done?

3. Have you seen this dual training go well in the end? Part of my hesitation is that I'll finish but still be in the same boat, begging for academic anesthesia/intensivist jobs.

Thanks in advance for any thoughts you all might have.

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[nimbus]

One of my residency classmates did exactly your path and is now an academic peds anesthesia/intensivist. He had a high energy level so he moonlighted as PICU attending during residency to supplement his income. He's a state employee so I know he is very well compensated (>90% MGMA) doing what he loves in academics.

 

[wickedskillz]

Dear God that sounds painful. It would def make you a complete pediatrics boss though

 

[WholeLottaGame7]

We had an anesthesia resident do exactly that: peds, peds ICU, anesthesia, currently doing a peds anesthesia fellowship (somewhere else). Financially it's probably not worth the opportunity cost (unless you take some cush private practice anesthesia job), especially if you want to do academic peds cases. But it does give you flexibility, which is difficult to quantify. Don't know if there are many places that would let you staff both ORs and PICU. I'm sure there are, but it seems like bigger places are moving away from that model. Both my residency and fellowship programs had anesthesia attendings staff the PICU within the last 10-15 years, but were phased out in favor of solely PICU attendings more recently. Granted, they weren't peds ICU fellowship trained, which may change the calculus somewhat.

Regardless, it can definitely be done. Just depends on how badly you want it. Also, you will have to deal with gross adults again for 3 years, and the painfulness of that cannot be understated. It will also change your mindset considerably (probably for the better). I love my PICU colleagues, but sometimes they attack problems very differently than we do in anesthesia.

 

[twoliter]

I'm in the final stages of completing a pediatric critical care fellowship and realizing that my favorite parts of the job are the procedures and physiology--qualities most mimicked in anesthesia--and now I'm considering adding on an anesthesia residency and peds anesthesia fellowship. I'm currently at a large midwest university program with several dual-trained faculty members (peds + PICU + anesthesia + peds anesthesia) who will support me if I choose to pursue this route, but certainly no one seems excited about it.

My reasons for this pursuit are the type of work I enjoy, as well as the flexibility I perceive it will give me later in my career. I love being in the unit, but don't want to be doing a ton of overnight calls into my 60s and I like that I could theoretically get a cushier job doing just anesthesia later in life almost anywhere I'd want to move. My ideal job for the next 10-15 years would be academic, splitting time between the unit and the OR. Additionally, I have a masters in research and would like to continue to publish, though I know this might take a backseat if trying to appease two clinical masters. Additionally, the job market for academic pediatric intensivists is absurdly tight right now and I don't want to take just any job. My sense is that with both I'll be an even more attractive candidate after another 4 years of training and hopefully have more say where I'll be able to land a job.

My questions then for the anonymous horde is:

1. Are my perceptions about what kind of career I could have accurate given your experience?

2. I'd be starting my career in my early 40s with $280-300k in student loans. I won't be poor as a peds intensivist but I'll be even less not-poor as a peds anesthesiologist. Does the time takes to train offset the salary I could expect when I'm done?

3. Have you seen this dual training go well in the end? Part of my hesitation is that I'll finish but still be in the same boat, begging for academic anesthesia/intensivist jobs.

Thanks in advance for any thoughts you all might have.

If I understand ACGME rules correctly, your ICU training may make you eligible to finish anesthesiology residency 6 months shorter. If so, you'd only have 2.5 years or residency plus year of fellowship. Could work in between the two for 6 months if you wanted for $.

 

[WheezyBaby]

@michigangirl

 

[chocomorsel]

Sounds insane. Although I did know one three who did this in residency. Don't thik they did the PICU first though.

 

[BobBarker]

Too much training. Opportunity cost far too high. 11 years of postgraduate training! Just do PICU and help the sick children like you have already spent 6 years training to do.

 

[wellchild]

Thanks all for the replies; actually far more encouraging than I had expected from an online forum.

I'm not overlooking the fact that I'd be reintroduced to diabetic feet, alcoholics, and morbid obesity, and I understand the strict "opportunity cost" sentiment though the same could be said for finishing residency and going into general peds. I have colleagues who finished their three years of peds and went into private practice starting at $200k/year, which is great gen peds money. I just know I wouldn't have been happy doing well child checks, and now I have the sense that I'm not sure I'm cut out for a daily schedule of 8-10 hours of rounding and dictating. As evidenced by going into peds initially it's not about the money, but I do want to pay off my loans eventually.

I feel like SDN tends to skew private practice, but can anyone comment on how this might affect my research goals? I have the sense I'll be abandoning those if I do both clinical fields.

 

[Homeostasis1]

I practice both pediatric critical care and anesthesiology. I love what I do, but I no longer encourage dual training. There are a few major children's hospitals (Hopkins, CHOP, LA Children's come to mind) that integrate their departments of anesthesia and critical care and make practicing both realistic. Other places mean you're splitting your time and you're not exactly "home" anywhere. The fact that PICU salaries are ballpark only 60% or lower of the anesthesia salary and that PICU work is grueling and sad mean that most dally trained people end up practicing solely anesthesia. That said, I love what I do and wouldn't change it. DM me if you'd like to talk more.

Good luck, either way.


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[shepardsun]

Interested in this as well, but just finishing up my peds residency and about to start anesthesia, with the thought of doing a combined PICU/peds anesthesia fellowship after. Structured my path with the knowledge that if I got sick and tired of the post-graduate training I'd probably be in a better financial/flexibility position as a general anesthesiologist than a PICU attending, but the closer I get to starting three years of adults the more I realize how much I truly do love the peds population. My program has put the kibosh on me moonlighting as a general pediatrician during my anesthesia residency, so I would make sure that you clarify with programs that it's going to be important to you to keep up your intensivist skills (and my program is treating me as a PGY-2, so be prepared to make 2/3rds as much as even your fellow salary right now).

 

[wellchild]

Thanks, @shepardsun, this is good to know. If I were starting from scratch, I think other than the few combined programs the back-to-back residencies make the most sense. No matter how you slice it though, the process is long.

I anticipated the drop in "stature" from BE intensivist to PGY-2, but not the drop in salary. Is this pretty common? Not a deciding factor, but this just feels like insult to injury.

 

[urge]

I would advise against all types of dual training. It just doesn't work very well in the end.

Your path is unusual but you will end up in the same situation as Anes/Critical Care or Anes/Pain.

To all of you on the same boat I say pick one and forget the other. Like previously mentioned you will not be "home" anywhere and nobody will take you seriously as an "expert" if you keep doing both.

The real question for the OP is "what do you want to do?" Anesthesia or Critical Care?

 

[wellchild]

I appreciate the comment, but disagree that "ending up" picking one or the other is a bad thing. Perhaps I should have clarified, but I'm not sure straight PICU is the best fit for me. I don't enjoy the hours of rounding, don't like the hours of dictating, and the academic job market is tighter than it's been in many years. I love it, but don't ever want to spend 30+ weeks a year in a unit again after fellowship.

I'm aware that no one escapes documentation headaches and no new grad gets the job they've dreamed about right out of fellowship. But dual training makes me a more attractive PICU attending at many major academic centers, and training in anesthesia allows me to get out of the unit before I hit that major burnout point that I've seen every intensivist go through.

I'll also disagree with your "expert" comment. I understand your intent, but the dual-trained intensivists I work with are some of the most respected in the PICU.

Your points are valid, but perhaps I'm farther down this road than I let on. If I wanted more money, I'd do a cardiac year. If I wanted to be an expert, I'd apply for more grants. What I want is options. Maybe not as many these next ten years, but certainly later in my career.


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[deleted162650]

FWIW I'm aware of 1 private practice group that staffs a Children's hospital where the Anes department runs the PICU and those guys split their time between the unit and OR.

 

[sevoflurane]

We guys in our group that do Anesthesia 75% of the time and Pain 25%.
One guy does Pain, Hearts and Peds. Very respected, good dude.

 

[michigangirl]

If anyone wants to talk more about this, please DM me. Too many nuances to give a "yay" or "nay" like you're getting from many here. I did all of it-- and still do all of it in addition to research. But it doesn't mean I recommend combined training to everyone. In fact, most people I steer to choose either PICU or peds anesthesia, but there's a group of people for whom it's absolutely the right choice for a variety of reasons. I'm always happy to set up a phone call to talk more as well.

Sorry I'm late to the party!

 

[nimbus]

Referencing the gorilla thread, if you want to provide anesthesia and postoperative care for open heart surgery on a baby orangutan, PICU to anesthesia is the route to take. Vet school and veterinary anesthesia would also be helpful.