IM/Anes vs. IM/EM for Career in Academic Critical Care

[kingofkiribati]

Hello, I am a third-year medical student. I am a former paramedic with a passion for critical care. I would like to pursue a career in academic critical care, but I am unsure which residency would best prepare me for this. Combined IM/Anes, Combined IM/EM, only IM, or only Anes? I have ruled out straight EM because of the projected job market. Thank you!

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[CCM-MD]

IM-Pulm/CCM if you prefer medical patients or anesthesiology-CCM if you prefer surgical patients. Dual residencies are a waste of time, money and energy.

 

[the argus]

I agree that dual residencies are generally a waste except for a small number of people with very specific interests, med/peds for CF specialists for instance.

Since you specifically mentioned "academic" critical care, then your choice of base specialty is important. Academic places tend to be more segregated in that MICUs are run by IM trained, SICUs by anesthesia/surgery trained , neuroICU by neuro trained.

Community hospitals often don't have such specialized units, and tend to allow any CC trained person work regardless of base specialty.

Interests during residency also change. I would make sure you choose a base specialty that you could tolerate non-critical care practice in.

 

[nimbus]

The only specialty where dual residency makes sense is pediatric intensive care. There is a well-trodden path for academic pediatric intensivists: peds residency->anesthesia residency->PICU fellowship + pediatric anesthesia fellowship.

Anesthesia residency is focused on adult patients with only 2-4 months dedicated to pediatric patients so it is a weak foundation for PICU and by itself is not an even a possible pathway to PICU. Most pediatric residencies don’t provide much procedural training. So you need both.

Most of the pediatric intensivists in our community, both academic and PP, have dual residencies.

 

[Katheudontas parateroumen]

Only IM makes the most sense if you don’t have a specific passion for a certain base field. Pulm crit make the majority of ccm docs in the USA. It’s the shortest way to give yourself the most options. I’d say the next is IM/EM if you’re passionate about EM because I know many IM/EM/CCM docs who still practice icu and EM. Anesthesia/IM is a whole other realm where you are not practicing both but just using IM as a stepping stone to ICU unless you want to do multiple fellowships like cardiac anesthesia and critical care and nephro etc. I am only anesthesia and then did ccm fellowship. I’m lucky to find a place that is academic and allows me to do both micu and sicu, but it’s probably more common to be pigeon holes into some surgical icu in most academic places.

 

[SurfingDoctor]

Most of the pediatric intensivists in our community, both academic and PP, have dual residencies.

That is incredibly uncommon.

 

[CopaceticOne]

I did an IM/Anes residency and loved it. But I agree with the statement:

dual residencies are generally a waste except for a small number of people with very specific interests

My interests were very, very well served by doing the combo.

The heavy focus on adults during anesthesia residency probably contributes to why there aren’t more IM/Anes programs. The extra knowledge isn’t needed. Peds/Anes totally makes sense if folks are quite sure they want to only take care of kiddos. I’ve never understood the IM/EM pairing.

Also, I know quite a number of people who finished IM residency, then did Anes. I’ve never met someone who did the opposite.

 

[kingofkiribati]

I did an IM/Anes residency and loved it. But I agree with the statement:

My interests were very, very well served by doing the combo.

The heavy focus on adults during anesthesia residency probably contributes to why there aren’t more IM/Anes programs. The extra knowledge isn’t needed. Peds/Anes totally makes sense if folks are quite sure they want to only take care of kiddos. I’ve never understood the IM/EM pairing.

Also, I know quite a number of people who finished IM residency, then did Anes. I’ve never met someone who did the opposite.

What were your interests?

 

[HemeOncHopeful19]

The only specialty where dual residency makes sense is pediatric intensive care. There is a well-trodden path for academic pediatric intensivists: peds residency->anesthesia residency->PICU fellowship + pediatric anesthesia fellowship.

I realize this is an old post but doing 2 residencies + 2 fellowships with the end result being paid as an Academic Peds subspecialist sounds about as far from “makes sense” as anything I’ve ever heard proposed on these forums

 

[dozitgetchahi]

I realize this is an old post but doing 2 residencies + 2 fellowships with the end result being paid as an Academic Peds subspecialist sounds about as far from “makes sense” as anything I’ve ever heard proposed on these forums

Yeah I was like “do you really have to go through all that BS just to be a peds intensivist”?

And you’d go through all that training to probably be paid <$200k, as any peds sub specialty (especially if academic) usually gets paid peanuts.

If it actually is true that you have to go through all that, it’s a miracle they get anyone to be interested in peds intensive care…

(Also, I just looked through the profiles of all the peds intensivists at the local tertiary care center. Not one of them had peds + anesthesia training. All were trained in peds residency followed by PICU fellowship.)

 

[nimbus]

Yeah I was like “do you really have to go through all that BS just to be a peds intensivist”?

And you’d go through all that training to probably be paid <$200k, as any peds sub specialty (especially if academic) usually gets paid peanuts.

If it actually is true that you have to go through all that, it’s a miracle they get anyone to be interested in peds intensive care…

(Also, I just looked through the profiles of all the peds intensivists at the local tertiary care center. Not one of them had peds + anesthesia training. All were trained in peds residency followed by PICU fellowship.)

Perhaps it’s regional and they make a lot more than 200k. These folks are usually internally motivated.

Faculty

Sandeep Khanna, MD Division Chief, PICU Medical Director Pediatric Residency: University of Texas Medical Branch (UTMB) – Galveston Pediatric Critical Care Fellowship: UC San Diego, Rady Chil…

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