narrowing down specialty options

[sunset823]

I'm an M2 interested in critical care, but I am somewhat overwhelmed by all the options that are available. This is what I have seen so far:

traditionally, IM (3 years) + Pulm/CCM (3 years)
alternatively, IM (3 years) + CCM only (2 years) - limited availability
anesthesia (1+3 years) + CCM fellowship (1 year)
anesthesia with a combined CCM fellowship (5 years) - limited availability, only 3 programs have this
EM (3-4 years) + IM CCM fellowship (2 years)
EM/IM/CCM combined program (6 years) - limited availability, only 3 programs have this

(and I'm not even including the surgery track, since that seems to not overlap with the rest)

Anyway, given this plethora of options, how in the world am I supposed to decide which residency I would want to pursue? I'd be happy doing any of the three above (IM, EM, or anesthesia), but say, if I do the EM/IM route, I'd be limiting myself to only 3 programs that have the CCM option, or if I do the IM route, I'd be closing myself off to surgical ICU options. If I went anesthesia, I would love to get one of those 3 combined program slots but those are super competitive from what I've heard.

Also, is the IM/EM/CCM program going to be nonexistent by the time I apply to residency? I understand that Pitt used to have that program but got rid of it, and I guess the new EM --> CCM track will make the program obsolete at the 3 programs that have it (UMD, Henry Ford, and Long Island Jewish?)
Thanks.

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[lushmd]

I think that it will become readily apparent during your MS3 and MS4 clinical rotations which primary field will be of most interest to you. Just keep an open mind and see how things go. Also, don't be in such a rush to lock yourself into a CCM fellowship when applying for residency. You're interests may change and, at least as regards the Anes/CCM programs, you won't save any time.

 

[Xerxes1729]

Do a residency in the specialty you would most like to practice even if you didn't do critical care, so that if you decide CC fellowship isn't for you, you'll still have a decent career. If you hate the OR, don't do anesthesia. If clinic or floor makes you want to die, avoid medicine. Etc.

 

[docscience]

I'm an M2 interested in critical care......

alternatively, IM (3 years) + CCM only (2 years) - limited availability

I agree with the posters above. Wait til you are at the end of your 3rd year and try to do an anesthesiology rotation/shadowing that year also. You will have to sit down and think about what kind of physician you want to be:
An internist - who works up all body systems and treats all conditions for the adult.
An anesthesiologist - who doesn't "work" up anything...they are all about intubation, resuscitation, acute physiological changes, etc (close to ICU).
Another excellent piece of advise is choose the specialty that you would practice anyway even if you were not going to do CCM. IM (hospitalist, outpatient, private practice, academic, etc) vs. Anesthesiology

I am an M4 going into medicine....it is just my very personal opinion that IM prepares you the most for working in the ICU the most. I may be completely wrong. But that is the route that I have chosen.

Also, a quick FREIDA search shows that there are about 33 programs that offer just CCM fellowship for 2 years....but there are limited spots in each program. I have heard that the straight CCM route is easier to get into than the P/CCM route.???

My questions are regarding this 2 year fellowship. I am not into pulmonology clinic as much and don't see myself getting burnt out just doing ICU medicine.
What are the limitations of just a 2 year CCM fellowship without pulmonology?
- can't bronch? limited career options? better jobs with both CCM/pulm?

 

[G-Man82]

An anesthesiologist - who doesn't "work" up anything...they are all about intubation, resuscitation, acute physiological changes, etc (close to ICU).
[/B]

Not quite. Anesthesiology is all about perioperative medicine. No, they won't work up anemia in order to find a root cause. That doesn't fall into their realm. No, they won't work up causes of chronic diarrhea, nor will they usually have to deal with placement issues for the homeless drunk frequent flyer who turns up in the ER with DTs and gets admitted. However, say that homeless drunk had to, for whatever reason, have an emergent operation, ASA physical class 5E, made it to the PACU, and suddenly got severely agitated. Then yes. They do work it up. And it is basically medicine style. Say he was found to be symptomatically hyponatremic, then yes, they could start hypertonic saline. So you gotta look at perspective of the specialty before saying they don't "work" up anything and are all about the intubations/resuscitations. To the OP, if you like the idea of being a generalist, but a specialist at the same time, it might be worth shadowing an anesthesiologist, especially one specialized in cardiothoracics, because then you can see the Echos, the bronchs (in the ICU), the swans, other lines/procedures, that an anesthesiologist does on a regular basis.

As for what prepares you most for an ICU fellowship/career, I may be biased, but I chose the anesthesiology route, largely because the entire residency will prepare me to work in a critical care environment, not just the few select ICU months that you find in medicine. I'm a medicine intern right now, and I wouldn't have it any other way. It's sharpening my diagnostic skills and teaching me to think about the whole patient, but seeing what my categorical colleagues have to go through, with clinic, medical consults, oncology months, rheumatology, etc, it's just not my cup of tea.

Don't forget, critical care as a specialty is multi-disciplinary, but in the beginning, it was anesthesiology.

 

[docscience]

I'm a medicine intern right now, and I wouldn't have it any other way. It's sharpening my diagnostic skills and teaching me to think about the whole patient, but seeing what my categorical colleagues have to go through, with clinic, medical consults, oncology months, rheumatology, etc, it's just not my cup of tea. ---it will probably make you a good internist.....prob know heme/onc and ID a lot better. But yes, physiology wise, I guess anesthesia has an upper hand?