Critical Care Fellowship in the States vs. Canada?

[Dango233]

Hi everyone, 

 

I am a Canadian Anesthesia resident interested in pursuing an ICU fellowship and was hoping to clarify a few details with the hive: 

 

1) in the US, there is a separate stream of ICU fellowship for anesthesia trainees that is only one year whereas everyone goes through a 2 year program here in Canada. I was hoping to potentially do a combined icu + cardiac anesthesia fellowship (2 years) in the states and, if needed for royal college licensure in CCM, pursue a third year of fellowship. My question is: has any heard of this combo of icu + cardiac anesthesia being recognized for royal college licensure? Also, would going to the states be worthwhile as a way to make myself stand out / increase my chances of getting a desirable job here in vancouver? 

 

2) it also seems like the anesthesia-ICU fellowship stream in the states is mostly focused on surgical ICUs. Would this be a problem for coming back to Canada and getting a job as most ICUs in Canada are combined med/surg ICUs? I would of course pursue a program that has enough medical exposure to be competent (and would be willing to do an additional 3rd year as needed). 

 

3) any other advice for anesthesia trainees interested in ICU in terms of how I could diversify my training to become more employable? I hear of IM-based trainees doing a separate subspecialty first prior to ICU (Eg nephro, ID, cardiology, even hematology) as ways to become more employable and was wondering if there's relevant/useful additional fellowships for an anesthesia trainee apart from cardiac anesthesia? 

 

PS I've completed all my USMLE steps and would prefer to work in Canada (but would be prepared to work in the states should there be no desirable jobs). 

 

Thanks everyone! 

 

 

[ParkourParkour]

Hey! - internal medicine background intensivist but a few colleagues close to me did anesthesia+CV+ICU.

1. Most academic centres will hire internally or have a job description with a candidate in mind. There are of course exceptions. Probably a decent advantage to train where you inevitably want to get hired. Large community hospitals usually don't realy care where you trained - they want someone who is reliable, a good colleague, and has a royal college base specialty + ICU.

2. Can't really answer this as I trained in Canada. TBH, my royal college ICU experience was pretty well rounded in MS+Trauma+Neuro but was lacking a bit in CV. Maybe you would get hired primarily for CVICU intensivist/cardiac OR cases?

3. Depends on academic vs. community as above. Key to both to be honest is facetime and getting to know the right people as opposed to tacking on more subspecialities/competencies. Research niche/education/QI niche is of course key in academia.

Bottom line, if you want a job in Canada, I would stay and train in Canada - you can always go to the states afterwards if you have your steps + ABA boards.

[Edict]

On 5/19/2022 at 2:32 PM, ParkourParkour said:

Bottom line, if you want a job in Canada, I would stay and train in Canada - you can always go to the states afterwards if you have your steps + ABA boards.

I think a lot of people go away for their fellowship however, I know that some programs, particularly academic, like to see the US experience as well. 

[ParkourParkour]

On 5/23/2022 at 6:46 PM, Edict said:

I think a lot of people go away for their fellowship however, I know that some programs, particularly academic, like to see the US experience as well. 

agree with this too - especially if doing something like neuro critical care or formal research training

[BCelectrophile]

@Dango233 I’d be interested in hearing what you find out as I find the combined CT anesthesia + CCM pathway very cool. From looking at CCM programs it seems that many offer up to 9 months of electives. I wonder if you could talk the department into helping you achieve the competencies/requirements for both CCM and CT anesthesia during the 2 year CCM fellowship? 

[Dango233]

@ParkourParkour Thank you so much for your input. Sorry I took a while to respond, I couldn't find my password for a bit. Your thoughts are extremely useful and I agree that it seems like all the Canadian ICU fellows that I work with are all extremely well trained, which is why I've always had a preference to train here. I've also heard that the "threshold" for ICU admission in the states is much lower so I may end up training in an environment where cases commonly treated by GIM/hospitalists may take up a bigger proportion of the demographic (all speculation though). I've been doing a bit of researching the training background of the staff at my local academic sites and it does seem like most if not all of them did their ICU training locally so I think you're right about that. I guess just with the extremely competitive job market I'm trying to find as many ways possible to increase my odds of success. The long training duration going through the anesthesia path (as opposed to IM -> ICU) also makes me want to maximize the benefit of every additional year spent in fellowship. I agree that CVICU would make for a great career, although at some of the local academic sites (I'm in BC!), cardiac anesthetists are able to staff them with just the additional 1 year of CT fellowship (based on whether or not their fellowship has a sufficient exposure to CVICU). As the market gets more competitive though I imagine this may change? 

@Edict Thanks Edict! That's reassuring. There's a big part of me that is interested in training in the states purely for the experience of living somewhere new as well regardless of job prospects so I'm glad it's appreciated somewhere.

@BCelectrophile I'll definitely update you if I find out anything else! It's been a big interest of mine as well. I've thought of reaching out to them as well in order to reach those competencies. It seems like the Canadian requirement for licensure would be around just over 12 blocks of ICU (I think it's 14? don't remember exactly, but slightly over a year) so hypothetically in my mind, in order to make it work, you would have to use up some of your CT fellowship elective time (and do purely ICU with your ICU fellowship elective time) to fulfill this. Perhaps the CVICU that you do as part of your CT fellowship could also directly count for this. I guess my worries are that 1) I may lack sufficient exposure to the different types of ICUs that Canadian trainees are expected to be able to cover given that a lot of the US programs are surgical/CVICU focused. This is more from a competency perspective, not so much a licensing perspective (I know of a current middle aged staff who did 1 year of CCM at UBC then somehow did 1 year of CT at Stanford and got licensure and is very competent, although I'm not sure if times have changed given that previously a lot of Anes staff only had to do 1 additional ICU year) and 2) using up CT fellowship elective time to do more ICU may take away from my CT training as I've been hearing that having a strong echo focus is becoming more important in CT programs. Some programs do up to 6 blocks in echo.