CCFP-EM in ICU

[BCelectrophile]

Does anyone know if GPs or CCFP-EMs are able to work in ICUs at rural community hospitals (5/6 beds) with enough ICU/acute care skills/experience, where there may not be enough GIM coverage? Anybody have any data points on this?

I know CCFP-EMs can't do ICU fellowship.

[medigeek]

I've heard they do at some rural places and also may provide brief coverage at slightly larger places too (but not full time positions). There are definitely family doctors (at rural shops, but not necessarily tiny hospitals) doing the full high acuity scope. 

This is more common in USA though since GIM and FM are 1:1 equivalents in scope of practice for hospital medicine. 

[ACHQ]

Depends on where you are and the availability of GIM's (or Anesthesia or even Resp). I can only speak of Ontario. There are usually sizeable ICU's even in smaller cities which have dedicated Intensivists... most rural hospitals/EDs will ship their patients to these centres. In other rural places were they actually have an ICU, and the ICU's are that small (5-6 beds like you said) they are not usually level 3 (i.e. don't handle Vented patients), and are more like step-up/step-down units (i.e. level 2's) where patients need more closer monitoring than can be offered on a ward. From what I have heard through colleagues the patients are usually not that sick (although you have to be prepared for anything), and when patients do get quiet sick they need to be shipped out to larger centre (because small hospitals wont have a cath lab, dialysis capabilities etc...). They do have some family doctors that have experience/extra high acuity training, however i think they prefer GIM/Anesthesia to cover even these units.

[JohnGrisham]

On 5/28/2021 at 9:35 AM, ACHQ said:

Depends on where you are and the availability of GIM's (or Anesthesia or even Resp). I can only speak of Ontario. There are usually sizeable ICU's even in smaller cities which have dedicated Intensivists... most rural hospitals/EDs will ship their patients to these centres. In other rural places were they actually have an ICU, and the ICU's are that small (5-6 beds like you said) they are not usually level 3 (i.e. don't handle Vented patients), and are more like step-up/step-down units (i.e. level 2's) where patients need more closer monitoring than can be offered on a ward. From what I have heard through colleagues the patients are usually not that sick (although you have to be prepared for anything), and when patients do get quiet sick they need to be shipped out to larger centre (because small hospitals wont have a cath lab, dialysis capabilities etc...). They do have some family doctors that have experience/extra high acuity training, however i think they prefer GIM/Anesthesia to cover even these units.

This, there usually is more than enough GIM/Anes/Resp etc available to cover true ICUs. Many very small ICUS may be managed by FM that feel comfortable, but really they are really just closer 1:1 monitoring wards with maybe some extra options for care etc.  Even then, from my minimal exposure its usually a GIM or GP-A covering.