Intensivist

[Scholastica]

How does one become an Intensivist? What residency/fellowship routes are available?

[TimmyMax]

Hey,

 

If you go the ICU route out of an anaesthesia residency, it will only take you one additional year (instead of two) because the ICU and IM rotations that you have to do in order to satisfy the "off-service" part of your 5-year Royal College program can be applied against the requirements of an ICU fellowship. A number of R5s this year will be going the ICU route for their R6 year, and I have to admit that it looks very, very enticing indeed! In London, about 33-50% of the ICU consultants are anaesthesiologists by trade (50% at the north end, not sure about the CCTC at the south end, hence the 33% figure), although this number is considerably higher at other centres.

[Scholastica]

Hi FFP & TimmyMax,

 

Thanks! I shadowed an anaesthesiologist twice this summer, and I've really enjoyed my experience so far. I actually haven't done anything (no intubation yet!)... so far, I've been just observing, but I really appreciate one-on-one-teaching from a top specialist in his field!

 

I have a question about the residency program for anaesthesiology. Bear in mind that I'm just done first-year and my questions are probably dumb. As a resident in anaesthesiology, do you feel that you learn enough of physiology and pathology (like internal medicine residents) to be able to run an ICU???

[TimmyMax]

Hey,

 

Bear in mind that I'm just done first-year and my questions are probably dumb. As a resident in anaesthesiology, do you feel that you learn enough of physiology and pathology (like internal medicine residents) to be able to run an ICU???

Wow, that is a dumb question. Just kidding! There are no dumb questions.

 

Anaesthesia is pretty much all physiology and applied pharmacology, so there's no shortage of knowledge in that area. As for the specific pathologies and disease processes, I think that could be a little daunting initially, but you'll find that in general, the same sort of stuff will tend to end up in the ICU (ie: sepsis, UGIBs, ICHs and trauma), that by the time you're through, you'll be quite skilled at managing pretty much anything that rolls through your door.

 

That said, there will always be that one unique case that stumps everyone (ours involved an Obstetrical patient who went into liver and kidney failure that persisted despite delivery of her baby and eventually died- the patient, not her baby), but by the time you're done, you'll have learned enough of the ropes to feel quite confident in handling things.

 

Besides, a lot of the time, when all you're doing is trying to keep the patient alive until morning, how they became septic won't matter so much as the fact that they are septic. In cases like that, your technical skills (intubation and lines) are what you'll be falling back on, skills that you will be more than slick at by the time you're done your anaesthesia residency!

[ploughboy]

For intensive care, you can pursue a residency in...surgery....

 

Hmm...you learn something every day. Question: I'm guessing that an ICU fellowship after a surgery residency would make for a career with a nice combination of both medical and surgical practice?

 

pb

[bustylegs]

Yes, it seems that way. The surgeons I know who do ICU will rotate through the unit in 1-2 week blocks, and the rest of the time, they have a regular surgical practice complete with OR time, coverage of the surgical ward, surgery call, clinics, scopes, etc.

 

I've heard of surgeons picking up Trauma/ICU fellowships after their residency training.

 

I was wondering if such trauma/ICU surgeons are allowed to cover only trauma and ICU but are free from their regular surgical practices if they choose not to.

 

Thanks!

[Aesclepius]

Does anyone know what the job situation will be like for intensive care in the next few (3-4) years? From talking to most staff/ICU fellows, there does not seem to be many staff positions available in Ontario...