Straight CCM for IM at any disadvantage?

[chessknt]

I am ultimately planning on practicing in a community setting and while pulm is somewhat interesting I would likely not want to practice it in an outpatient setting which makes me feel like it is a waste to do a third year to specialize in something I am not that interested in. Furthermore I feel like pulm/ccm programs are more MICU-centric whereas straight CCM gives better preparation for SICU/CTICU populations since they tend to be more multi-disciplinary.

My question is if skipping out on pulm and doing straight CCM will be a hindrance when looking for jobs in a community setting in the future (ie are they frequently run by pulm/ccm groups that dont want straight ccm people)?

Thank you to anyone who has been out there that can comment!

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[Hernandez]

I think you'd be doing yourself a disservice by skipping pulm, there are less CCM only programs, there is a fair amount of cross over and pathology, and frankly CCM burnout is pretty high.

As someone who only wanted to do CC but am now doing far more pulm after graduation, PCCM is what I'd recommend.

 

[ORL10]

Caveat: I am a CCM only guy who couldn't do pulm because I did not do IM (did EM), I have a differing point of view for obvious reasons so reader beware.

My opinion on this topic is if ICU is your main interest a CC fellowship you will spend 24 months learning CC medicine (which it is still hard to learn all of CC in 2 years, especially if you are incorporating the surgical and surgical subspecialties in that realm. In most PCCM programs you will spend 12 months in the ICU and 24 months on a combination of pulm/research/outpt. You will spend less time on average in the ICU per year.

Although VERY variable many PCCM programs do not have a ton of ICU in their third year. For this reason someone whose main interest is CC and does not want to practice pulmonary it would seem obvious to avoid the extra year of fellowship, do an extra year of CC and focus all their attention on this topic.

Being a pulmonologist will be very beneficial in many instances, and they have a skill set you will not get doing straight CC. That being said a straight CC fellowship paired with the right attitude will probably better prepare most individuals to be an intensivist.

The main drawback Hernandez hit on is that CC burnout is high, doing sleep or some other fellowship can improve life style and make you very versatile in the future. However if you are not interested in a pulmonary clinic/consult position I don't think it is necessary to do PCCM. Tons of jobs, decent cash, shift work (1 FTE at my shop = 14 shifts, full benefits 350K plus bonus if meeting metrics at academic place) and no call. My PCCM colleagues at my shop take call, do consults, and have a clinic and the business side of medicine they worry about. Plus even at 0.5 FTE they do not get benefits from the institution they get it from their private practice.

Again just another perspective not gospel

 

[sluggs]

I agree with bits and pieces of both above. I did IM/CCM and had a large chunk of neuro and CT ICU. In a mixed CCM practice these are helpful and give me added skills and a broader perspective. However, if I do burn out (which I may very well), not much fall back.
There are pulm guys who do broad ccm, but focus more on the straight vent/hemodynamics as opposed to the nuances of the neuro or complex hearts (VADS/t-plant).
Pulm opens up a whole different world-- interventional; transplants; office based practice. Lung CA. Some really cool stuff

 

[tartesos]

I wanted to do Ccm only as well but ended up in Pulm/Ccm. Another point to look at is job availability, in Ccm you will find a good job( even a great one) but not likely where you want, if you are Ccm only, a small thing but if you are flexible or know of a gig close to where you want to be( family reasons, attractions etc) then that's no problem.


As for other Icu exposure most programs will let you use your electives in what you want, and you can get extra exposure in that if you want to.

All in all, what you get for an extra year is a lot in flexibility, $$$ and mobility.

If you end up in Ccm and burn out, you can always teach or do im, but I have not seen a Ccm only on collections... Yet!

 

[Hernandez]

I agree with bits and pieces of both above. I did IM/CCM and had a large chunk of neuro and CT ICU. In a mixed CCM practice these are helpful and give me added skills and a broader perspective. However, if I do burn out (which I may very well), not much fall back.
There are pulm guys who do broad ccm, but focus more on the straight vent/hemodynamics as opposed to the nuances of the neuro or complex hearts (VADS/t-plant).
Pulm opens up a whole different world-- interventional; transplants; office based practice. Lung CA. Some really cool stuff

Going to disagree just a smidge, I'm not only. Awesome at pulm and vents but I could step into every ICU but a PICU neonatal-ICU and OB-CCU and be comfortable.