ICU + (blank)

[BDog]

Hey guys,

 

I'm aware that there are several paths to critical care. The most common being the anesthesiology route. However, I haven't been able to find much about ICU docs that have done 3 years internal directly into a critical care fellowship or the emerg doc that completes a year after their FRCPC program.

 

What does an intensivist without an additional sub-specialty do when they aren't in the ICU? Do they have the option of still working in clinics?

 

Is it a feasible lifestyle to pursue both emerg and ICU? I imagine after 1-2 weeks on in the ICU followed by 4 weeks of shift work could exacerbate burnout. Does the emergentologist have the option to reduce to 0.5 and work 5-6 shifts in between ICU shifts?

 

Thanks for any input!

[strider2004]

Hi BDog,

 

You are correct that there are multiple ways to do critical care. Basically, almost any Royal College acute care program can be used as a pathway into the ICU. It is typically done by surgeons, anesthetists, emerg, and internal medicine. As a career, people usually done one week of ICU at a time since it is prone to burnout. A typical schedule might be a week a month. The remaining three weeks could be spent doing your primary specialty, like emerg or whatever.

 

The way that ICU fellowships work (if you do them before the completion of your fellowship) is that they are interspaced into your fellowship. For example, if you do emerg+icu, you would do 3 years emerg residency, one year ICU, one more year emerg, last year ICU for a total of 6 years. Yes, this means you end up doing 4 years emerg and 2 years ICU for a savings of 1 year. A Royal College mandates that you can truncate a 5 year residency by one year if you add an extra fellowship. This is in fact how all of the internal medicine subspecialties work.

 

For example, you technically need 4 years of internal medicine to be an internist. All of the subspecialty fellowships are 2 or 3 years. However, we shave our last (4th) year off internal medicine and start the subspecialty early. To be an internist, it takes 4 years. To be a respirologist (which is my training) takes 5 years including 2 years of specialization. I hope that makes sense.

 

So, everyone who does an ICU fellowship also has a Royal College certification in something else. Going through the internal medicine route, you can fall back to internal medicine and all that it entails - clinics, wards, consults, etc. You could do ICU for a week a month and then run exercise stress tests the rest of the time. Or you could really slow down and run an outpatient diabetes clinic. Or you could do a couple of weeks as a hospitalist. It's very flexible.

[leviathan]

In the US the majority of anesthetist intensivist work in surgical ICUs. Is that the same in Canada, or do they also have the chance to work in MICUs? I know I have only ever seen a Canadian anaesthesiologist in a cardiac surgery ICU.

[Fred]

Does the pulm/CCM combined fellowship, which seems to be big in the US, exist in Canada?

As far as I know it seems that it's not offered here...

 

I planned on doing pulm and critical care but the prospect of a 7 years residency is giving me second thoughts...

[leviathan]

Yes, there are Canadian anaesthetists who work in medical or mixed medical/surgical ICUs.

 

I know lots of respirologists who do intensive care, but they have all done the respirology fellowship (2 years after internal medicine), followed by some sort of dedicated intensive care training. I think that many of them were kind of "grandfathered" in that they didn't do a full ICU fellowship... but some of the people I know now who are interested in that sort of thing have been told that they need a full 2 years of ICU now that it is a recognized subspecialty with the Royal College. I'm not 100% sure on the specifics of this, though.

 

Thanks for the info, ffp. Must just be a coincidence that I have so far only run into internists in the ICU.

[ploughboy]

Thanks for the info, ffp. Must just be a coincidence that I have so far only run into internists in the ICU.

 

Maybe it's a regional thing? (You're in BC, right?). The majority of intensivists in London seem to be from anaesthesia, with some internists, emergency docs and surgeons thrown in for good measure.

[leviathan]

Maybe it's a regional thing? (You're in BC, right?). The majority of intensivists in London seem to be from anaesthesia, with some internists, emergency docs and surgeons thrown in for good measure.

 

Could be a regional thing. I'm in BC, definitely thinking of anaesthesia + critical care down the line.