Very interested in CCM, but a few questions...

[mig26x]

I really loved my CCM rotation during my intern year, I can see myself doing this for the next 25-30 years of my life, my only concern is the time that I will have to spend with my family, I have search in the internet the schedule of a normal ICU job to take a look at the hours but very few info!!

any info appreciated!!!

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[fakin' the funk]

I really loved my CCM rotation during my intern year, I can see myself doing this for the next 25-30 years of my life, my only concern is the time that I will have to spend with my family, I have search in the internet the schedule of a normal ICU job to take a look at the hours but very few info!!

any info appreciated!!!

I think the CCM/pulm guys are either too busy
1. working too many hours
2. twirling their mustaches about whether the pt has UIP or BOOP or IPF
to come to this forum, which is incredibly stagnant. You could try the anesthesia forum.

 

[KGUNNER1]

I think the CCM/pulm guys are either too busy
1. working too many hours
2. twirling their mustaches about whether the pt has UIP or BOOP or IPF
to come to this forum, which is incredibly stagnant. You could try the anesthesia forum.

Nice one.

Mig, pure CC docs (not mixed with pulm or anything else) usually work similar hours/shifts that EM docs do. About 14-18 shifts/month (busy practice). Many hospitals are trying to include into this shift work some sort of night time coverage. So, it is not uncommon to find a practice offering something like a week of days, week off, week of nights, week off, etc...

Those who combine another speciality such as Pulm have much more demanding schedules. It is not uncommon for groups like that to cover both their clinic and unit patients (maybe even hospital consults) all at the same time. Some of the guys I know in private practice work their tails off doing this.

Hope this helps,
kg

 

[alfamax4562]

I worked as a paramedic in a MICU/SICU/NEUROICU for 5 years before i got into med school. I would love to do a fellowship in CC. but I have questions
1. Is there a website where I may find a list of CC fellowships in the south east and their requirements?

2. Are there any navy fellowships in CC? and how many spots are there per year?

3. how hard are they to get into?

thank you

 

[KGUNNER1]

I worked as a paramedic in a MICU/SICU/NEUROICU for 5 years before i got into med school. I would love to do a fellowship in CC. but I have questions
1. Is there a website where I may find a list of CC fellowships in the south east and their requirements?

2. Are there any navy fellowships in CC? and how many spots are there per year?

3. how hard are they to get into?

thank you

Alfamax,

1. Just go to the ACGME website and take a look. http://www.acgme.org/adspublic/

2 and 3 - Don't know and really don't know where to look. Sorry.

kg

 

[souljah1]

I think it really depends.

If you work as a critical care doc in the community, there is a huge trend of moving towards shift work. It would be similar to the current lifestyle of an emergency medicine doc. Plenty of time to see the family. $$$

If you go into academic medicine as a p/cc doc it also depends. If you plan on being a clinical investigator, you will most likely attend any where from 2-4 months per year. The rest of the time will be involved in either basic science, clinical epidemiology or health policy research. You'd be expected to be independently obtaining grant support to pay for a portion of your salary. You can do this as solely an intensivist or you can do this as a pulmonologist/intensivist that consults, has clinic and occasionally attends in the ICU. Most academic intensivists will tell you that when they are on service, it is really busy. But when they are off service, they make their own schedule and do NOT have clinic and do NOT do consults. For those that also want to practice as a pulmonologist, they'll also have clinic and ward months as consult attendings. Consult blocks can run late into the evening occasionally. $

I hope to be an academic intensivist after a p/cc fellowship. Right now, I see myself more geared toward health policy research (resource allocation, leapfrog, regionalization, end of life issues, evidence based bundles, etc) and administrative duties (fellowship/resident education). On average, I'd probably like to attend in the MICU 2-4 months per year w/ 2 wk blocks at a time. I think this sort of diversity of responsibilities will keep me the most interested over the long run. Of course, academic docs don't get paid nearly as much as in the community, but when I'm not on service I'd be free to moonlight in Tele-units and stuff like that. If I attempt academics and fail or want to bail, I can always go out and get a community ICU job and get paid.

 

[howelljolly]

It seems there are a couple of folks here that might be able to give me some advice. Im strongly considering P/CCM, and also considering Emergency med. Ive worked as a paramedic in both an ED and ICU.

Im afraid that as a P/CCM doc, I am going to feel like Im missing out on treating a diverse population of patients, especially different ages and pathologies that an Emergency physcian would encounter. In other words, the opportunity to be able to treat many different ages and pathologies is something that sells me on EM, and though Im leaning more towards P/CCM, Im afraid that in the future, I'll regret not going into EM for specificially this reason.

Do you folks think this is a valid concern? Are there career planning choices to get around it? Ive heard that if I were to work in a tertiary academic center, I'd be more likely to see a diverse patient population. Any other thoughts?

 

[souljah1]

My experience at a large urban center can be summed up with the following questions...

Where does that 19yo college student who presents with meningitis to the ED get admitted? MICU

Where does that 26yo man who OD's on tylenol get admitted to for impending fulminant hepatic failure? MICU

Where does that 56yo woman go who presented to the ED with pneumococcal bacteremia after a viral pneumonia get admitted to? MICU

Where does that 42yo woman w/ ESRD get admitted to after presenting with septic shock and pus at the site of her HD catheter? MICU

Where does that 88yo woman go with urosepsis get admitted? MICU


I'm currently doing some research in our MICU the demographics of our patient population suggested an average age of 54 with a standard deviation of 16. Not every one is at the expected end of their life. Personally, the ED does have a diversity that keeps you interested. But it also has a diversity of real problems and fakers, on run of the mill outpatient issues and very interesting patients that will be admitted. When I worked in the ED, I always wanted to follow that septic or altered or hypoxic patient upstairs to the MICU to figure out what is wrong with them and to navigate them to a potential recovery. I also like rounding and discussing things. "don't just do something, stand there" - appeals to me.

 

[leviathan]

"don't just do something, stand there" - appeals to me.

My new favourite quote.

 

[howelljolly]

Ditto

 

[yobabydoc]

how competitive is p/ccm now and any thoughts on the astanford program versus UCSF?

 

[DD214_DOC]

I recently developed an interest in CCM after my last IM selective, which was P/CCM. I have come ot the realization that I suck at memorizing stuff and function much better, "figuring stuff out", so CCM seemed right up my alley.

My concern is the lifestyle issue. I'm wondering what the best course really is? DOes anyone even do the CCM-only fellowship after a general IM residency? I don't know that I would want to combine pulmonary with CCM as I don't really know if I want to see another 75-year old with severe COPD who is still smoking. Maybe do some general IM primary-care type stuff on top of CCM? Who knows. I'm still figuring out my options.

 

[howelljolly]

I recently developed an interest in CCM after my last IM selective, which was P/CCM. I have come ot the realization that I suck at memorizing stuff and function much better, "figuring stuff out", so CCM seemed right up my alley.

My concern is the lifestyle issue. I'm wondering what the best course really is? DOes anyone even do the CCM-only fellowship after a general IM residency? I don't know that I would want to combine pulmonary with CCM as I don't really know if I want to see another 75-year old with severe COPD who is still smoking. Maybe do some general IM primary-care type stuff on top of CCM? Who knows. I'm still figuring out my options.

I know of three people who are CCM trained, without pulmonology. Of those, only one does critical care at all.... and that's only in the last few of his 20 year career. One is still in an ER job he got years ago, and one does Internal Med exclusively. So, I don't really know what to make of that.

Conversely, I know two or three pulmonologists without a CCM fellowship who attend in the ICU. Does that fly only because the skill-set is so similar?