Critical Care

[RDB]

So how viable would it be for someone who is interested in Critical Care to set up practice in the future as follows:

 

one week locums(but dedicated to that hospital for years) out of 3/4 weeks to a unit out say in sudbury or in northern ontario. Then fly home to Toronto. I understand that there is a shortage of jobs but how bad is the job situation in northern communities? I don't mind going up north if it only meant one week at a time and slowly transitioning to a position closer to home(Toronto).

 

Then maybe do IM work 2 days aweek at a local hospital or maybe even 2 days of any given week at at a GP practice in Toronto? Is it even possible to do GP work as someone who only did 3 years of IM with CCU rather than a full GIM fellow?

[cheech10]

You could do locums with IM in your off weeks. There are jobs in Sudbury, etc, but not many; most of the ICUs that far away are quite small, and only a few will be worth it financially to go up for a week.

 

You can't do general practice, AFAIK. Well, not if you want to get paid: in order to bill for your work as an internist, you need a referral.

[bones]

Sorry for slightly hijacking the thread, but just a clarification: I thought any physician could see patients without a referall, except that specialists can't bill their consult fee for those patients?

[RDB]

Wow this is all kind of alarming how there are these great fellowships and simply a lack of jobs. It really seems like for the first time in a while, we're actually over training specialists and that primary care is pretty much the only thing you can do with good job prospects these days.

 

It's really disappointing to see this. Being an MS2 with great hopes for being a specialist in many areas, I'm starting to think maybe I should just apply for an ubercompetitive specialty just to play the lottery but really just expect family and be happy with it(and I am quite ok with family and I think it's def still great).

I did have great expectations of considering more options but being in my mid 20s and wanting to plan to set up for an eventual family, being potentially jobless really isn't so high up on my list.

 

Ideally it'd be nice to simply do work within the scope of GP and billing as a GP would 2 days on the weeks off from CC but it looks like even that route is kind of a closed door.

 

Is Canada too small to support that many ICUs or is it a lack of funding for hospital beds? It really seems like a great field and I'm kinda bummed that job prospects are bleak.

[cheech10]

Sorry for slightly hijacking the thread, but just a clarification: I thought any physician could see patients without a referall, except that specialists can't bill their consult fee for those patients?

 

Very few of the fees that I typically bill will get paid without a referring MD, not just the consult fee. Not sure if I could bill the GP codes (never tried), but they are also significantly less for the patients I see. Note though that I am in Ontario; each province may have different rules on how you get paid.

[cheech10]

Wow this is all kind of alarming how there are these great fellowships and simply a lack of jobs. It really seems like for the first time in a while, we're actually over training specialists and that primary care is pretty much the only thing you can do with good job prospects these days.

 

It's really disappointing to see this. Being an MS2 with great hopes for being a specialist in many areas, I'm starting to think maybe I should just apply for an ubercompetitive specialty just to play the lottery but really just expect family and be happy with it(and I am quite ok with family and I think it's def still great).

I did have great expectations of considering more options but being in my mid 20s and wanting to plan to set up for an eventual family, being potentially jobless really isn't so high up on my list.

 

Ideally it'd be nice to simply do work within the scope of GP and billing as a GP would 2 days on the weeks off from CC but it looks like even that route is kind of a closed door.

 

Is Canada too small to support that many ICUs or is it a lack of funding for hospital beds? It really seems like a great field and I'm kinda bummed that job prospects are bleak.

 

I'm only familiar with the job situation in Southern Ontario; things may be different elsewhere. The issue is lack of beds. Our ICUs routinely run at 100-110% capacity, and even greater strain during flu season. But these beds are a very expensive resource, so the government is reluctant to fund them. And there are more ICUs around, but most of the open ICUs are in small hospitals and it's hard to make a living managing only 4 beds at a time, for example. There are/were some expansion plans around, but many were postponed after the recent recession. If they get started on expansion, that will help.

 

In the meantime, there are still a fair amount of GIM positions/locums to keep one occupied while waiting for a spot to open up. Kind of similar to what many nephrologists have been doing for the past few years.

[cheech10]

I only know of a couple of EM/CCM docs, but neither are doing both full time. Although CCM might be considered full time at 12 weeks per year, most intensivists would rather do closer to 20 weeks. This wouldn't leave that much time for EM (maybe 5 or 6 shifts per month). It's really up to the individual doc and the department chiefs.

[Satsuma]

I don`t know any EM + CCM doing both full time.

Don't forget EM is shift work, and your day starts and ends at odd times, and your circadian rhythm is a mess. It looks like alot of free time of paper, but in reality it is less because you are recovering.

 

Also, I know an EM who dropped out of the CCM after already completing 1 year of the CCM fellowship - I am sure due to several factors, but 1 being that CCM jobs are hard to find.

[rswim]

Those familiar with EM+CC can you explain how this is integrated into the 5 year program when most EM programs usually build only 1year (or less eg UBC) of elective/subspecialty time into their curriculum?

[Lactic Folly]

I think integration means you can streamline and save some time, not that you can finish requirements for both programs in 5 years.

[cheech10]

Two of my colleagues did EM + CCM. It took 6 years.

[Satsuma]

Those familiar with EM+CC can you explain how this is integrated into the 5 year program when most EM programs usually build only 1year (or less eg UBC) of elective/subspecialty time into their curriculum?

 

Most EM programs have about 1 year of "elective time" although this is decreasing due to changes in the colleges requirements. This happens most often in PGY4. So you can do your first year of the CC fellowship during this year and this is generally acceptable to your EM program as there is significant overlap in the content of the 2 specialties. It is a bit tricky for scheduling as you will be expected to attend academic half days for both CC and EM. And your EM program will likely still have you do a minimal amount of EM shifts so you don't lose your EM skills.

 

Then you finish up your PGY 5 in EM and write your exams etc. and then you do a PGY 6 which would be your 2nd year of critical care.

 

This is how alot of people have done it. Many have suggested that unless you are particularly strapped for time, to just do the 2 years after you are done your 5 years - don't have to cram in 2 AHD etc for a year.

 

Although there is some overlap between EM and CC, having a whole year to put toward CC is going to get harder with the changes to curriculum put out by the royal college which will end up decreasing the "elective time" we have. Something you can discuss with individual programs on the carms tour. And ask the program director, not necessarily just the residents - we aren't often filled in on these things right away!

[ploughboy]

Most EM programs have about 1 year of "elective time" although this is decreasing due to changes in the colleges requirements. This happens most often in PGY4. So you can do your first year of the CC fellowship during this year and this is generally acceptable to your EM program as there is significant overlap in the content of the 2 specialties. It is a bit tricky for scheduling as you will be expected to attend academic half days for both CC and EM. And your EM program will likely still have you do a minimal amount of EM shifts so you don't lose your EM skills.

 

Then you finish up your PGY 5 in EM and write your exams etc. and then you do a PGY 6 which would be your 2nd year of critical care.

 

This is how alot of people have done it. Many have suggested that unless you are particularly strapped for time, to just do the 2 years after you are done your 5 years - don't have to cram in 2 AHD etc for a year.

 

Although there is some overlap between EM and CC, having a whole year to put toward CC is going to get harder with the changes to curriculum put out by the royal college which will end up decreasing the "elective time" we have. Something you can discuss with individual programs on the carms tour. And ask the program director, not necessarily just the residents - we aren't often filled in on these things right away!

 

Ya, what she said.

 

I don't know first-hand, but from talking to people who've applied in years above me it sounds like not a lot of CCM programs are cool on a PGY4/PGY6 split anymore.