Women in Critical Care?

[spumoni620]

Hi all,
I'm an intern who has absolutely fallen in love with ICU/critical care medicine. I love the constant learning, the challenge, procedures, emphasis on pathophysiology, etc. (not to mention every ICU attending I've ever worked with is crazy smart).

In 4 years of med school and 1 year of residency, though, I've never worked with a female attending or fellow. What's up with that? Is it burnout? The work/life issue? Although I'm not married/don't have kids yet, one day I'd like to - is that hard to do in CCM? It seems like with the shift work thing it might be doable, but how does that work?

Also, on a related note: how competitive is pulm/CC? Do I need to have done specific research in the field?

Thank you for any insight and help!!

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[KGUNNER1]

Hi all,
I'm an intern who has absolutely fallen in love with ICU/critical care medicine. I love the constant learning, the challenge, procedures, emphasis on pathophysiology, etc. (not to mention every ICU attending I've ever worked with is crazy smart).

In 4 years of med school and 1 year of residency, though, I've never worked with a female attending or fellow. What's up with that? Is it burnout? The work/life issue? Although I'm not married/don't have kids yet, one day I'd like to - is that hard to do in CCM? It seems like with the shift work thing it might be doable, but how does that work?

Also, on a related note: how competitive is pulm/CC? Do I need to have done specific research in the field?

Thank you for any insight and help!!

There are many excellent CC docs that are women. Pam Lipsett (Hopkins), Heidi Frankel (UT SW), Janice Zimmerman (Methodist Houston), Mathilda Horst (Henry Ford), Marie Baldisseri (UPMC), Deborah Cook (McMaster) just to name a few (no particular order). We have 6 female intensivists at our hospital (1 surgeon, 1 EM/CCM, 1 IM/CCM, 3 Pulm/CCM) and they are all excellent role models and wonderful docs.

I'm not a woman, so I can't give you any personal insight about some of the specific issues you raised. However, just like EM, shift work should help with burn-out and job satisfaction related issues. Most shift based groups usually start out around 180 shifts/yr or so. This boils down to roughly 15 per month. In academic settings, this number can be reduced with an increase in non-clinical activities (research, education, etc...).

I think Pulm/CC is mod competitive. Of course the traditionally strong programs will always be more competitive, but overall there isn't a large increase in Pulm/CC applicants over the years. It is not even close to cards or gastro. Research won't hurt and will help at larger, more prestigious institutions, however if you haven't published, most places wont won't penalize you.

Hope this helps.

KG

 

[spumoni620]

thank you! very helpful. i am torn as i'm finding myself truly captivated by ICU medicine but wary of lifestyle issues (it is exhausting - yet exhilirating - being in the ICU). All the same, the kind of medicine that I see here on a daily basis is truly interesting, to the point where I think I'd escape burnout just by the guarantee of exercising brain cells every day.

One quick question: You mentioned academic pulm/CC. If I were not particularly interested in research per se, but practicing in a setting involving clinical education of residents (for example) at a university center, is that possible? Or are you essentially expected to have some type of ongoing grantwork/research to even be appointed at an academic center?

I'm an 'academic type' but don't have much in the way of scientific pubs. However, I'm getting a dual (non-PhD) degree with my residency. If I need research/pubs to be competitive at a good program, should I still aim to get something pulm/CC-oriented in the way of research?

Thanks again for your help!

 

[Tigerz_Fan]

Believe me, you will not be the only woman in critical care!

As a woman in critical care, you will have the opportunity to have a family, and a life. The field is trending towards shift work, which helps. If you really are interested in CCM, when you are researching programs, look for the ones that do not require in-house call. It will be easier that way if you have children.

Also as a woman, you will have to hold your own. You will need to be assertive and aggressive in your patient care. It is a male-dominated field, but more and more women are entering the work force.

I do know AMGs who did not do research, and matched into a competitive fellowship. But, if you are an IMG, I would recommend trying to join a research project.

Good luck to you!!

 

[roflcakes887]

This thread is inherently sexist.

Why should there be special threads for women in a medical specialty, yet not the same thread for men in said specialty?

Do you expect special treatment?

 

[souljah1]

There are definitely women practicing pulmonary/critical care medicine in ICU settings. Two fantastic women that come to mind that are currently practicing academic pulmonary/critical care as clinical educators are Leslie Zimmerman and Trish Kritek.

Leslie Zimmerman works at UCSF and directs the ICU at the SF VA Hospital. She attends in the ICU there, does bronchs, etc. She also directs the preclinical blocks at the medical school and teaches a lot of pulmonary medicine. The combination of patient care, administration and medical education pay for her salary. All in all, she probably takes care of patients somewhere around 30% of the time.

Trish Kritek is the fellowship director at Brigham and co-runs the Partner's pulmonary and critical care fellowship. She's amazing. She obtained, as part of her fellowship training, a Master's in Education and has devoted her life to a career in academic clinical education. She attends in the Brigham ICU, does some out-patient pulm clinics and teaches pre-clinical and clinical medical students at Harvard medical school and has a huge role in the training of the fellows at Partner's.

I would really encourage you to do what you feel passionate about. There are plenty of academic pulmonary critical care jobs that give you flexibility and balance. If you wound up going into community practice, there are jobs that include work in the ICU in shift works.

I would encourage you to reach out to some female attendings doing what you want to do and ask them for advice. Most women in critical care medicine are acutely aware of the predominance of men in the specialty and would welcome the opportunity to provide mentorship to a young up and coming person with a lot of interest in the field.

 

[souljah1]

Also, on a related note: how competitive is pulm/CC? Do I need to have done specific research in the field?

It appears that pulm/critical care is becoming a bit more competitive. Overall, I'd say it is less competitive than allergy, cardiology or GI. At big academic centers, it is about as competitive as Heme/Onc. It is more competitive than endocrine, rheum, renal, and others.

Similar to other stages of training, research is one component of the application. To be expected, most large academic centers want to see some sort of commitment to academic medicine in your application (other than saying "i want to be an academic physician" in your personal statement). For application purposes, you don't have to have research completed prior to applying. What will definitely help (at minimum) would be a current project that will result in an abstract at one of the big conferences (i.e. ATS). There are many areas of the field with interesting research going on -> from basic science to clinical epidemiology to end-of-life care to health policy and how it relates to the ICU. I don't think that the absence of research is a deal breaker, but I would begin to put the feelers out for what is going on at your residency institution with regards to interesting and practical projects. With or without research, you can successfully match in fellowship. However, if you want to get a decent amount of interviews at big university program, you might find that research helps.

I agree wholeheartedly with your feelings about critical care. I think it is an amazing field and "fell in love" with the ICU as well. Having been on the interview circuit, that is very common and almost expected from faculty. I think that, in the end, it is what draws the majority of applicants to enter the field. It definitely did for me.

 

[spumoni620]

souljah,
thank you so much for the informative post! i really appreciate your time/insight. i'm actually very interested in health policy and resident education - part of the reason i love the ICU is because the learning and education is so intense.

Is it possible to maintain a career in ICU academic medicine focused on resident teaching without, say, having to have your own lab/depending on grants for funding?

I definitely am interested in some sort of clinical/outcomes research. In your experience, what are the pressing, as yet unexplored issues that come to mind with research related to health policy/prevention in the ICU? Some things that come to mind initially are glycemic control, leapfrog, systems of intensivist coverage (in-house vs home call) and impact on patient mortality, etc....

would a degree such as an MPH will help a candidate stand out at some of the more competitive programs?

thanks again for the guidance.

 

[souljah1]

souljah,
thank you so much for the informative post! i really appreciate your time/insight. i'm actually very interested in health policy and resident education - part of the reason i love the ICU is because the learning and education is so intense.

Is it possible to maintain a career in ICU academic medicine focused on resident teaching without, say, having to have your own lab/depending on grants for funding?

I definitely am interested in some sort of clinical/outcomes research. In your experience, what are the pressing, as yet unexplored issues that come to mind with research related to health policy/prevention in the ICU? Some things that come to mind initially are glycemic control, leapfrog, systems of intensivist coverage (in-house vs home call) and impact on patient mortality, etc....

would a degree such as an MPH will help a candidate stand out at some of the more competitive programs?

thanks again for the guidance.

No problem.


The answer to your first question is yes. You can have an academic career that involves medical education and does not involve the requirement of grant funding. Having said that, academic attendings have to pay for their salary some how so if you aren't getting grants you are earning your way through taking care of patients, maybe teaching at the medical school and having administrative responsibilities. Some programs have more leeway for this sort of career than others. Most academic programs LOVE junior faculty that have successfully gained funding and can devote ~80% of their job to research. Ultimately, it earns more money for the university than teaching or taking care of patients. This truth is very frustrating for lots of people, but to my knowledge it is the way it is.

There are countless interesting questions related to health policy and the ICU if you ask me (it is what I'm planning on doing). The leapfrog recommendations are pretty controversial, but are provoking lots of interesting questions - from evidence-based bundles to regionalization. Health policy research usually plays out 20,000 feet off the ground looking at the ICU from above with regard to how it is run and how it can be improved with the existing knowledge we already have. Clinical outcomes has more to do with coming up with creating prospective studies that seek to improve the way we do things and is a bit more novel. There are tons of things to get involved in with clinical outcomes. Most clinical investigators doing cool stuff with clinical outcomes ICU research have formal training in clinical epidemiology (which some big fellowship programs may be able to provide). They also devote the majority of their professional time to research. It is really difficult to dabble in research and have a successful research career. It takes commitment.

That being said, clinical educators often collaborate with clinical investigators and enroll patients, get involved in portions of grants, etc. Many doors are open.

Personally, I think that the career of an academic intensivist is very promising. Aside from the shortage in critical care physicians and the growing literature that evidence-based critical care that results from intensivist staffing saves lives (except one study), ICU medicine is a young field that is growing at an enormous rate. As the baby boomers boom and our society continues to value quantity over quality, the ICU physician will continue to face enormous challanges weighing the balance between end of life care based on palliation and aggressive care based on stabilization and cure. I love that struggle.

With regard to your last question - a degree in public health or clinical epidemiology or health policy or robert wood johnson scholar's program would all be incredibly useful for a career in clinical investigation in pulm/critical care. Lots of good fellowship programs offer a graduate degree in the above disciplines free of charge (included in T-32 grants). The combination of formal scholastic training with the supervision and guidance of a mentor is a pretty sweet recipe.

I'm going through the fellowship application process right now and I'm super excited to start!

Feel free to PM me if you have any specific questions about programs, residency, etc.

 

[rmpa45]

I am a woman, finishing second year of pulm/cc fellowship, and I have to tell you honestly that first year of fellowship nearly destroyed my marriage. I have 2 kids, one born 4th year med school, one between second/third year of residency. My husband has worked part time since start of residency to keep things going at home, but became increasingly clear that not really happy doing so, esp with my crazy hours, always "one more thing" at work. I love what I do, but was a real sacrifice to do it. I'm at a pretty tough program, meaning lots of on service months, less down time than some of the surrounding programs, etc. This of course makes a big difference. I feel like I'm getting great clinical training, but also makes fellowship harder. My situation may be different than yours, with marriage/kids, but for me, is a continual challenge to try to balance it all, and usually there is something undone. You really do feel at least once/week that your family is getting the shaft. And, as I'm a perfectionist, that you not only don't have time to read enough, but your house is a mess, you just yelled at the kids cause you were tired, the pages about when you're coming home sometimes never seem to end, etc. Things are better now, as first year no matter where is the worst, but just would recommend to you that you take a long time to think about what you want to be best at. Unfortunately, in pulm/cc, the patient often must come first and that means that in the long run, your family will often come second.

 

[porthcurno]

Hey Spumoni, I just PMed you but I happened to see this post of yours too. I know a female intensivist who loves it, but I know that fellowship was rough on her. A non-IM doctor recently told me that you have to be careful with pulm/CC because the coolness of the academic cases give way to "old dudes with PNA who are gonna die on the vent" in the real world. I personally love CC too, but I think i would ONLY do it as an academic--people to take those first pages for you, less call, AND WAY COOLER cases!!