Would you do it again? If not ICU... then what?

[A Salty Girl]

I was an ICU nurse before med school, and it was really working in the ICU that drew me to medicine (I'm now an m2). However, with as much as I hear about intensivist burnout and regret going into their speciality, I'm just wondering: would you do it again?

And if you would not go into critical care, what would you choose? Were there other things you considered in med school that you wished you had pursued?

I loved critical care as a nurse but I'm wondering if I'll curse the day I didn't pursue derm/ophtho/literally anything else in 20 years. Someone please tell me you love your job and it's ICU till death do you part.

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[SurfingDoctor]

Heck yeah.

But then again, I view myself as a practicing pathophysiologist more than anything else. How can the lymphopenia be improved? How can we get them back into the Frank-Starling curve?

I leave the ethics, touchy-feely stuff and moral distress to the burnouts.

 

[A Salty Girl]

Heck yeah.

But then again, I view myself as a practicing pathophysiologist more than anything else. How can the lymphopenia be improved? How can we get them back into the Frank-Starling curve?

I leave the ethics, touchy-feely stuff and moral distress to the burnouts.

This is amazing!! So happy to hear it.

 

[CCM-MD]

Burnout is a factor but overall I love what I do. The time off and money are also great right now. I don’t know what the future looks like but I am concerned about it. Critical care has many of the same issues as EM (midlevels, staffing corporations, tied to the hospital etc.) and you can see what’s happening to them right now. If I was a medical student right now, I would try to pursue a surgical subspecialty.

 

[POW16]

Yes I would 100% do it again. 4 years out of training. I split my time between the OR and the ICU. A week a month in the ICU is the perfect balance for me. After a couple of weeks in the OR, I actually look forward to going back to the ICU.

 

[RemyMcswain]

Heck yeah.

But then again, I view myself as a practicing pathophysiologist more than anything else. How can the lymphopenia be improved? How can we get them back into the Frank-Starling curve?

I leave the ethics, touchy-feely stuff and moral distress to the burnouts.

Not trying to antagonize you, but how do you leave it to the burnouts? It’s inescapable for me. 89yo with metastatic whatever in septic shock with drains in every orifice etc… it’s hard to spend an hour figuring out how to fix the unfixable

To answer the main question. No. I realistically would have gone IM -> interventional cards. Anesthesia is fine. Critical care is fine. If I could have had an actual conversation with my 20 something year old self I would have told him to do something surgical like ortho or neurosurg or even CT.

 

[SurfingDoctor]

Not trying to antagonize you, but how do you leave it to the burnouts? It’s inescapable for me. 89yo with metastatic whatever in septic shock with drains in every orifice etc… it’s hard to spend an hour figuring out how to fix the unfixable

To answer the main question. No. I realistically would have gone IM -> interventional cards. Anesthesia is fine. Critical care is fine. If I could have had an actual conversation with my 20 something year old self I would have told him to do something surgical like ortho or neurosurg or even CT.

I mean, I can’t tell you how I do it. I suspect people have their own way of avoiding burnout. That being said, I do what I can when I’m in the hospital, realize I can’t fix everything and then when my shift is over, I do the proverbial mind wipe and completely forget the place. Good and bad… it all gets wiped.

I’ve had families come back and say how great their kid is doing… honestly, I never remember who they are. And I never go to funerals when the outcome is the opposite.

I also don’t necessarily think the grass is greener and if someone picked a different profession early on, they are just as likely to have regrets looking back no matter where life goes. That’s just the nature of getting older.

 

[Aldertonghen]

Burnout is a factor but overall I love what I do. The time off and money are also great right now. I don’t know what the future looks like but I am concerned about it. Critical care has many of the same issues as EM (midlevels, staffing corporations, tied to the hospital etc.) and you can see what’s happening to them right now. If I was a medical student right now, I would try to pursue a surgical subspecialty.

Why surgical specialties? Because of mid level creep?

 

[CCM-MD]

Why surgical specialties? Because of mid level creep?

Midlevel creep exists everywhere but they are highly unlikely to ever do actual surgery. CCM is also starting to have a significant number of corporate staffing groups like Sound, Envision, Team Health etc. They are essentially middle men that will eventually put a downward pressure on compensation. Surgical subs have potential for non hospital employed practice and bring money to the hospital giving them more leverage… while CCM, EM, anes, hospitalists are usually subsidized by the hospital which means they take money out. If I was a student right now I would be gunning for a surgical sub.

 

[chessknt]

Why surgical specialties? Because of mid level creep?

The compensation system in the USA essentially incentivizes procedures. An Ortho can generate 10x what a PCP can in the same unit of time and if they get a cut of the facility fee money through ASC ownership clearing 7 figures is guaranteed and there incoem can be 100x a PCP for unit time. Any field that can own a facility and do a well paid procedure on an insured patient is going to make a lot of money. The system will collapse under its hubris in our lifetime but it has been solved and the surgical subspecialists are the kingmakers.

 

[Aldertonghen]

Midlevel creep exists everywhere but they are highly unlikely to ever do actual surgery. CCM is also starting to have a significant number of corporate staffing groups like Sound, Envision, Team Health etc. They are essentially middle men that will eventually put a downward pressure on compensation. Surgical subs have potential for non hospital employed practice and bring money to the hospital giving them more leverage… while CCM, EM, anes, hospitalists are usually subsidized by the hospital which means they take money out. If I was a student right now I would be gunning for a surgical sub.

But this doesn’t necessarily apply to surgical specialties only- anesthesia can do interventional pain to escape mid level creep, similarly IM can do interventional cards or GI, and neurology can do endovascular. Most specialties imo do have a procedural specialty that escapes this problem, but I may be wrong. What do you think?

 

[Katheudontas parateroumen]

Critical care is certainly a passion field. It is very heavy with a lot of stress. All things you probably know. But it can be very rewarding and meaningful as well. I do anesthesia and ICU and so far it’s been a good mix for me. However, there are many times I think grass is greener wanting something less “life and death” stressful. Like a consulting specialty such as radiology, pathology, allergy, rheum, ID, endo, neuro. Personally, my burnout comes from just honestly caring so much about each patient and obsessing about every detail. It gets very tiring and I could not do it more than a week at a time. I love the field because I truly feel like this is what being doctor is. Pathophysiology, individualized care, meaningful family discussions. All things to try and make the patients better.

 

[CCM-MD]

But this doesn’t necessarily apply to surgical specialties only- anesthesia can do interventional pain to escape mid level creep, similarly IM can do interventional cards or GI, and neurology can do endovascular. Most specialties imo do have a procedural specialty that escapes this problem, but I may be wrong. What do you think?

Pain has a ton of creep due to CRNAs and non-accredited fellowship trained physicians doing the same job. It’s saturated and IMO the pain gravy train has dried up. GI is good for now but is a one trick pony driven by screening colonoscopy - midlevels/new tech are major threats. IC/EP/neuroIR are ok but 7-8 years of training. But arguably all of these are better options than critical care.

 

[Tipsy McStagger]

I love physiology, and basically the ICU is just a physiology lab. I also like working week on/week off, I've found time for hobbies and travel. Surgical subspecialties may be safer from mid levels, but the job is also much more consuming of time. So even though I enjoyed surgery, I would never pursue it. The wow-factor wears off quickly, at some point everything becomes routine. I prefer my routine to have a week off every other week, than to be pulling ridiculous call schedules while trying to maintain a clinic and rounding at multiple hospitals being stretched beyond thin.

However, if I had to do it all over again, I'd probably do diagnostic radiology. pay is good, cerebral, no bedside shenanigans. That's not to say it's an easy job, and I know they have their shenanigans. There's just something appealing about the hard facts of imaging findings, and not the ambiguous milieu of the clinical/patient interactive side of things.

 

[CardiacIntensivist]

I find ICU way more stressful than the ORs but I get so much more satisfaction from the ICU. Of course I only do 1 week a month so I'm not exactly die-hard ICU but I'm glad to have that practice mix where I get to take care of a single really sick patient in the OR but also multiple sick people in the ICU. I like working with the ICU team and coming up with a plan. I like the semi-longitudinal care I see. It is certainly terrible to also deal with the deaths but I've learned to deal with it emotionally. I would absolutely do it again. Now that I have more experience I am sure there are few other pathways I could have gone.

 

[Radetzky]

Would sooner quit medicine than do anything else. Other specialties have to deal with too much crap. Fix the physiology as best you can and then send them to the floor for them to deal with the mundane stuff.

Don’t have to see any clinic pts, don’t have to see functional pts (other than the occasional pseudo seizure or vocal cord dysfunction), don’t have to sit around in theatre all day, don’t have to take on the risk of sending pts home and having them found dead 2 weeks later. Work with smart nurses who get stuff done when you want it.

 

[bigdan]

100% would do critical care again, but with the disclaimer that I do anesthesiology and CCM, and did a cardiac anesthesia fellowship too.

Would redo that whole 6 year gig again in a heartbeat.

 

[mudderMD]

I cant imagine doing anything else.