Critical Care Medicine vs. Pulmonary Critical Care: Why I Chose CCM.

[@dr.eduardochang1906]

I have been a Pulm CCM doc for over 20 years. I think that knowledge is power. ICU medicine has great advantages as it is shift work, better quality of life as when you are off you are off. After practicing in SICU, NeuroICU, Trauma ICU, transplant ICU, CVICU, Pulmonary skills acquired in 12 months have more than repay and has been an great rate of return of 12 months over a 20 years. This knowledge goes beyond the clinic. As you see respiratory failure as an intensivist, it is useful everyday, to distinguish top of you mine DAD,vs AIP, vs CEP, UIP, NSIP, LIP, vs LAM etc. and many other patterns on biopsies or films, that could either tailor your therapy to wean extubate vs tracheostomy long term care. Pulmonologist, in most program are people attracted in physiology and basic science which can be applied everyday to any ICU or acute care setting. But as you mention , intensive care is a wonderful field and it is nice to work shifts and have a personal life. Good job. !!

[@austinnichols33]

ICU CCRN here working on getting into med school, really enjoy your videos man! Very informative!

[@eddyjoemd]

Good luck!!

[@shahid7635]

After being a hospitalist for 12 years I am going to start a 2 year CCM fellowship in July 2023. I thought this thru very much. For exactly the reasons mentioned by Eddy I chose to stick with CCM rather than PCCM even though I had a good option to match into PCCM. Lets see how I do. For now I am pretty excited.

[@eddyjoemd]

Congrats! I’m excited for you!! Best of luck!

[@shahid7635]

Eddy, I just seen you are coming to our University to give us a talk. I heard your talk on Impella @ SCCM 2024 but couldn’t say hello because of too many people around. Will look forward to meeting you in person this time.

[@DrAdnan]

I’m actually rotating on pulmonary critical care right now 😂. I’ve been leaning towards outpatient care, but the more flexible inpatient time is one benefit of inpatient medicine I didn’t consider. Great video!

[@angelaissa456]

Most realistic video ever! Literally was looking for this video for long time, very helpful! Thank you so much and good luck in your career

[@eddyjoemd]

Good luck! Glad I was able to help 👍🏼

[@sophiakhan1538]

Great to hear all abt ur life Eddy u hv made the Lord happy .May Allah swt bless you.

[@epistleofdude]

I think pulm/CC makes on average $500-$600, while CC makes on average $300-$400. This is a few years into your practice. Pulm you have to build your practice. Starting salaries are lower (I've seen $300-$350 for pulm/CC starting salaries). Pulm/CC works more in general. Schedules vary, but CC might work 14-15 shifts per month (e.g. 7am to 7pm, 7pm to 7am), and probably half of those shifts will be at night, while pulm/CC might work something like 5-7 shifts in the unit per month and the rest of the month pulm clinic and consults. I think pulm/CC you can gradually move to doing pulm only if you want and not have to work nights and weekends (unless on call), though it depends on the practice. I also think in the future pulm will be increasingly separate from critical care. Pulm and CC are already separate in other nations such as the UK and Canada.

[@alvaroescandela4495]

What's the difference between an IM + CCM and an Anesthesia + CCM? Do the Anesthesia ones are more procedure oriented? Or they tend to work more like in surgical CCM?, The field is very interesting!

[@kaushikraghu6311]

Yeah I had the same exact question.

[@philtheo]

There are many routes to ccm in the US. At the end of ccm training, I'd say people are more or less the same in terms of ccm knowledge and skills. The real differences are in things not directly related to ccm as a specialty such as job market. For example, if you want to work in the community and in the MICU, it's mainly IM/pulm/ccm, hence it's an advantage to be IM/pulm/ccm. Hospitals and private groups will often want you to cover inpatient pulm consults as well as the ICU as well as see outpatient pulm patients. Granted, much of this is changing, but that's traditionally been the case. In private practice, anesthesia/ccm tends to go back to anesthesia since doing straight anesthesia usually pays a lot more than mixed anesthesia and ccm. Again, this is changing too, but that's traditionally been the case. Otherwise anesthesia tends to find academic work (which usually much pays less than private) doing anesthesia and the sicu where often surgeons are the ones in charge or want you to do things their way. Again there are increasingly exceptions to everything I've said. I'm just giving a general answer. Hope that helps.

[@alvaroescandela4495]

@@philtheo thanks a lot! This is very helpful

[@NollieBackBigSpin]

Thank you doc for the informative video. Later on in life, can you practice primary care with your internal medicine background?

[@ScaredBears]

I think you’d make a great guest on the Specialty Stories podcast. You should contact Dr. Gray and see if he’s interested in getting your perspective on solely CC as a specialty. I imagine he would like to have the contrast with the other ICU doctor he interviewed, who was Pulm/CC.

[@eddyjoemd]

Thanks for sending me in that direction. I had never heard of that podcast. I’ll reach out to Dr. Gray. 👍🏼

[@minalyan]

Hi, Eddy! I’m one of your recent subscribers. Thank you for sharing your thoughts on this very important topic about career preferences. I do agree with that it’s challenging to be good at both (crit care and pulm). In Europe, Australia, and New Zealand they don’t have a hybrid sub specialty. If you are in the ICU world, you belong there and manage those patients rather than doing pulm consults. ICU is a very demanding field as you mentioned and you cannot “cheat on it” doing other stuff. I assume that is one of the reasons why Dr Josh Farkas (I’m a big fan of this guy) is doing exclusively iCU although he was trained in both pulm and critical care. Regarding feeling burned out, I think one of the solutions is to work in a teaching hospital where you may spend some time teaching students and residents. Anyway, thanks for the great video!

[@eddyjoemd]

Thanks for the sub! Glad to share my thoughts if it’ll help someone. Thanks for sharing the international take on the speciality. I’m also a big fan of Farkas. I need to actually talk to him instead of silly back and forth on Instagram and Twitter. I think he does great work and is a smart smart dude. I didn’t know he only did CCM and left the Pulm behind. The solution of being in academics is a good one. I’ve thought about it. I was offered several academic gigs but turned them down for my private practice gig. Need to make a video on why I did that. Thanks for checking out my videos! If you have any ideas let me know.

[@sinuzb3115]

Can you do a video about anesthesiologist critical care fellowship?

[@ericpineda6147]

Awesome videos, doc. I'm starting medical school this fall and I'm interested in Emergency Medicine and Critical Care medicine. Do you think you can do a video on the differences between EM/CCM and perhaps even Trauma care?

[@eddyjoemd]

Thanks, Eric. To do trauma-CC you need to do a surgery residency (5 years) + a trauma fellowship (I think 1 or 2 years). To do EM-CCM you do 3 years of EM residency and 2 years of CC.

[@Joeyjackson5]

@@eddyjoemd I am a bit confused because for the EM-CCM I thought it was 4 years of EM residency then 2 years of critical care.

[@Joeyjackson5]

@@eddyjoemd also what board certifications do you get from the EM-CCM residency vs the EM PCCM resideny

[@nateheathcoat4656]

The vid I’ve been waiting for!

[@eddyjoemd]

haha! you should've just asked me in person! by the way, have you left yet? I need to buy you a beer/bourbon/something.

[@nateheathcoat4656]

I leave Sunday! Ready to crush this first semester.

[@eddyjoemd]

Damn dude. I’m out of town until Friday and then on nights. The departure date came on quick. Sooooo happy for you

[@chrish8331]

Hey Eddy, Later this summer I have my rotation through our SICU as a pa student very excited for that opportunity - watching your videos to prep!

[@eddyjoemd]

Awesome! Let’s me know how I can help. Surgeons do some funny things in the SICU. Always remember that 2+2=4 and 3+1 also =4. I say that bc it’s a different style but also good outcomes.

[@AllThingsToeseen]

I like that you chose your sanity 😂

[@icu_corey_rn_903]

It’s very interesting to see how intensivists and pulmonologists differ when caring for patients from a nurses perspective being right there at the bedside with them

[@nicklosardo9363]

I feel the same Eddy. Good points.

[@thewholehealthlab]

thank you! very helpful

[@Benji_nobody]

Can you share your approach to acid/base ABG problems you frequently encounter in the ICU? I would like to learn about any tips and tricks you have mastered that I can implement as a medical student now into my approach to practice questions and eventual practice as an intern in the future. Thank you for sharing your sights of CCM vs PCCM.

[@eddyjoemd]

I’m not a good person to teach ABG or acid base interpretation. I do it so often that I just run all the shortcuts in my head and can’t explain it without skipping steps. I even wrote a lecture to make a video but it flat out sucked. I wasn’t good at it. Wish I could help, though. Now I just look at the ABG, BMP, and what’s going on with the pt and figure it out 9 times of 10 in just a few minutes. I’m not bragging, it’s just routine.

[@aedo2378]

hey! this is @dramanda_do ! I am aiming towards CCM too. I don't want to do clinic for similar reasons! It makes me feel better that I don't feel alone about it.

[@aedo2378]

also, critical care is the dream, so more exposure, more rotations in icu sounds so much better!

[@AHMED-iy5sg]

A question, how about getting into pulmonary Critical Care fellowship, working first decade in critical care and the rest in pulmonary clinic? Work load in hospitals these days is unbearable.

[@eddyjoemd]

I know some people who are trying to do that. My question is how well is your knowledge base going to stay after a decade? Are you going to be able to keep up with the Pulm literature and new therapies with so much cool stuff coming out over the decade? I wouldn’t trust myself. I can’t even keep up with the primary care stuff anymore.

[@hraza2222]

Hey! Great video! So where are you practicing, if you don't mind me asking? Or if you can't give the institution, how about the state? Because I'm wondering if working only 175 days a week is enough to get by financially.

[@the_jacked_doc]

Great video doc, I just matched into a IM program that allows me to do many electives in the ICU. I really love hospital medicine and i love the aspect of how Critical Care medicine would allow me to do a mix of both bedside procedures as well as manage very difficult pathophysiology . However, I am scared that it will be difficult to match into a critical care fellowship as I go to a community hospital program (700 beds but no in house critical care fellowship). Did you start reaching out to fellowship programs your intern year and did you do research or away rotations? thank you doc

[@caribaez5711]

Can you please talk about being a respiratory therapist?

[@lolalolalola3801]

Also leaning towards CCM vs Pulm/CCM since I don't really see myself being happy doing clinic either. Do you think it's possible to scale back to hospitalist work (maybe can take open ICU) if you do get tired of managing the unit when you're older?

[@eddyjoemd]

You’ll realize that you won’t want to do hospitalist work once you’re brain is fully trained in Intensivist mode. Their work is still hard, just different.

[@titibibi]

I am a hospitalist staring my application for CCM. The 2 years is very attractive than three years fellowship. The job market I belive now is diffrent. Most ICU are now run by CCM doctors than PCM. PCM losing intereste in doing urgent intubation and central lines. But what are the options as one gets older and not up for the mental and physical demand of CCM? Academic stuff or hospitals?

[@eddyjoemd]

I’m 5 years in and am not burnt out at all while doing the 7on/7off. I’m working on several side hustles that could potentially supplement my income should I get burnt out. To be honest, though, it’s not as mentally demanding once you have sufficient experience. It could potentially even become mundane to some.

[@airsh003]

Hey Dr. Joe, I'm a pgy1 down in Florida and im interested in pure cc fellowship. I was wondering if you could give your input on 2 questions: 1) How important is academic activities to help get cc spot? This past year I have been able to present 2 case reports at acp and got one abstract accepted at chest. Some of my peers have atleast a dozen publications etc and I'm worried I'm not doing enough. 2) I've been doing a lot of research into practicing locum solely. It's got its pros and cons but for my goals I feel it suits me best (I like traveling, I'm single, I dont mind the nomad lifestyle). I know some hospitalists who do it and love it, however, I have never met a intensivist who does locums pretty much. I imagine starting at a new ICU for different locum jobs can be challenging. Sorry about the long post, and great videos, glad I found your channel.

[@eddyjoemd]

Ahmad, academic activities are important but some institutions are more research heavy than others. I didn’t have anything published when I started my fellowship but I’m definitely not the standard. Locums is a great way to make some good money but you need to think that a lot of those institutions that offer locums positions are because they can’t keep staff. There’s usually a reason for that that’s unfavorable to you as a clinician. Poor ancillary staff, unfavorable equipment where the chances of liability are high. Terrible EMR’s. No consultants. I’ve thought about picking up some weeks here and there but haven’t pulled the trigger. Also, when you’re first practicing on your own, you want to be at a place where you’re going to almost immediately feel comfortable. Somewhere where your partners can show you the ropes rather than just get thrown into the fire.

[@emilyhaines8456]

Hey there Eddy Joe. Love your videos! I’m very interested in going into critical care medicine and spend a lot of time in the ICU. However, I’ve noticed that most CC docs are male. In my area with over 200,000 people, there are no female CC docs. Why do you think CC is such a male-dominated field?

[@eddyjoemd]

We can talk offline about this because inevitably someone will misconstrue my words, but it is multifactorial and the landscape is changing. I appreciate your support.

[@emilyhaines8456]

Is there a way I can DM you?

[@eddyjoemd]

Email me: [e-mail]. It may take me a bit to get back to you 👍🏼

[@hockeydude471]

Great video!

[@eddyjoemd]

Thanks!!

[@argunc]

there is a clear difference in sophistication between my colleagues that are pulm/cc trained compared to those that are only cc trained. if you want to be nothing more than a glorified hospitalist, choose straight cc.

[@michaelminichiello9433]

Great video Dr. Joe! I am a new IM intern and definitely very interested in CC or Pulm/CC medicine. Appreciate your insight on this topic. I have heard of some pulm/crit trained docs doing more of the 7on/7off type schedule in the ICU but not sure how their pulm clinic time factors into that. I am assuming you work a similar 7on/7off strictly in the ICU but do you know generally what the weekly schedule of a pulm/crit trained doc looks like who does do a lot of ICU time especially early in their career? Thanks for taking the time to do this!

[@fawadshahid2735]

U can always fall back to doing hospitalist if u feel burned out!

[@THEBIGHURT326]

Great video mate. Currently a med student and trying to figure out what I want to do with my life

[@imranasif8533]

Salary of CCM after fellowship?

[@HMS20th]

What is the difference between acute medicine and ccm? Regards

[@ayeshakhan950]

I am MS3 and I was a EM medical scribe before medical school. I always thought I would do Emergency medicine, but I was diagnosed with an auto-immune health issue and being female, I am not sure if I will have longevity in an Energency Med career with rotating day's and nights, I can't imagine what that will be like for my body in my 50's and 60's. Critical Care also sounds so fun, and knowing ahead in time I will have a week off I can work on keeping my body healthy. However, I can't help but still wonder if there is longevity in CC. I keep hearing it probable isnt for me because of the burnout.

[@eddyjoemd]

It’s something I think about regularly which is why I have backup plans in the works. Burnout is real. Two years in and I’m fresh but I can’t speak about how I’ll feel after 10 years.

[@ayeshakhan950]

@@eddyjoemd Can Critical Care Docs go back to being internist/hospitalists FTE? If they experience burnout or can they be part time in CC and hospitalist?

[@eddyjoemd]

I actually think that there's more burnout for hospitalists. I don't have the data to support that. Also, I don't think seeing the pay cut from CCM to Hospital Medicine helping out the burnout sensation. Lifestyle creep is real. Some people who do Pulm/Critical Care shift more to the Pulm side of the world when burnout happens. I am working on several strategies to mitigate burnout as well as lifestyle creep. Earning money through KZbin is a seed I'm planting that perhaps could earn me a certain amount of passive income if I do it right and do it long enough. Let's see. What else can I help you with? Also, you'll very likely have to do nights with CCM.

[@andreferrer9350]

Thank you! One question: Once you end medical school, how long does it take to become a critical care doctor, if I take the emergency -> pure critical care path?

[@eddyjoemd]

My pleasure! 3 years of EM and 2 years of CCM. 👍🏼

[@renedavis7]

Can you do half out patient half in patient

[@pranjalshukla3913]

Hello Dr Eddy , Just a quick question who according to you can provide better critical care, An intensivist with internal medicine background (better diagnostic skills) or one with an anaesthetic background ( better procedural skills). Which pathway would you advise to someone interested in pursuing CCM?

[@eddyjoemd]

I’m bias and I would say IM. Either is fantastic, though.

[@pranjalshukla3913]

@@eddyjoemd thank you , you are doing a great job

[@abdulrahmankatabi8543]

Are you able to do bronchs with biopsy, or VATS?

[@argunc]

no, but he can suction mucus from the lungs! (so basically he does what a nurse does, just goes a bit deeper)

[@cbl6520]

Couldn’t be certified in both an JUST do critical care?

[@eddyjoemd]

Yep. But you’re going to lose a year of your life and a significant financial opportunity cost.

[@eddyjoemd]

Yep. But you’re going to lose a year of your life and a significant financial opportunity cost.

[@matthewsherman9771]

have you seen osteopathic physicians having success with an IM-CC fellowship track? ERAS has a list of several programs but very few with current fellows being DOs. Several MDs and MBBSs fellows. USMLE is a requirement for most DO schools and for those who pursue fellowship programs after IM/EM, most students take those exams as well as COMLEX. (we won't get into step 1 P/F...). Nonetheless, curious what your thoughts are and what you are seeing in the field. Thanks in advance, great videos!

[@donovanknowles2641]

whats the difference between a pulmonary/CC, and a general pulmonary doctor?

[@eddyjoemd]

No critical care. A 2 year fellowship rather than 3.

[@joeyjosern]

So can you do just pulmonary with no CCM?

[@eddyjoemd]

Yep! You definitely can. 👍🏼

[@epistleofdude]

I believe Mayo-Rochester is one example of pulm only.

[@caribaez5711]

You are probably more analytical and logical than hyper and energetic.. 🤷‍♀️😃 even though you seem an ambivert..

[@andreferrer9350]

Is it normal for ICU doctors to get so much time free or yours is a special case?

[@eddyjoemd]

Due to the high burnout rate, the market has accommodated jobs with schedules such as mine for critical care work as well as hospital medicine. Every job I interviewed for had between 155-182 shifts. No more.

[@andreferrer9350]

@@eddyjoemd Thanks!

[@eddyjoemd]

My pleasure. Thanks for checking out my videos!