Cvicu

[Katheudontas parateroumen]

Hello everyone,

As I’m looking into my first attending job one of the ones I’m interested in is a semi academic CVICU. Although not my top choice as in my training cv surgeons are tough to work with; the location pay etc hits the check boxes in my search. To be honest though, I’m not too comfortable handing VV/VA ECMO, LVADs on my own. Not super high volumes. They have heart failure service but I’ll have to see what their input generally is. Is this something I can learn on the go or should I not try looking into this job for now? Just jump right in? I’m upfront with the group with what I think are my limitations at the moment but I am more than willing to learn and dive in. Thoughts? Thank you.

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[jdh71]

Yes you CAN learn and get good at those things on the job with the correct and supportive mentorship. The question is DO YOU WANT TOO?

 

[grt398]

It's a very different patient population, but I think it's learnable, though per jdh having supportive mentorship is going to be REALLY important. When things go wrong with your ECMO/impella/LVAD patients, or even your post op hearts without those things, they can go wrong very very fast. Faster than many MICU patients. I will have done 6 months over 2 years and my comfort with these patients is very different than fellows that have done maybe 1-2 months total. And the helpfulness of your heart failure service can be quite variable.

Feel free to PM me if you have specific questions as I will be working with this patient population as part of my first attending job.

 

[vector2]

Yes, you can learn on the job, but doing a couple things will give you a big head up. One is try to get some TEE and TTE experience and take the advanced periop TEE exam. The second is take an ELSO-approved 2 or 3 day ECMO course if your fellowship doesn't offer much ECMO/MCS experience. Third is start reading (and watching videos like Navin Kapur at Tufts' presentations) voraciously right now because there is so much in the cardiac anesthesia/CT surgery/advanced HF literature that you have not learned in your training.

 

[lunaire]

If this is your first attending job, without any prior extensive exposure in this field, I would recommend caution.

There are large variations on the amount of support you get. Some places are highly protocolized, with perfusionists, on-site surgeon/fellow, device reps etc that can help out. Many other places can have minimal support, especially after regular working hours.

If you are new to this patient population, a good mentor (ideally a whole group of mentor) is critical. You need a pretty specific skillset to be a good open heart ICU doc, and you can't learn that from a weekend course.

Finally, know what kind of work environment you're joining. These programs can attract some toxic personalities, usually the CVT surgeons. Some CVT groups are also very outcome/metric obsessed; these factors can add up to make the job feel like a pressure cooker for the new guy.