Critical Care Medicine Physician/Intensivist: Want to be one?

[@eddyjoemd]

Thank you for checking out my video. Follow me on Twitter and Instagram @eddyjoemd Twitter: twitter.com/eddyjoemd Instagram: instagram.com/eddyjoemd Books I recommend for ICU Beginners. Marino's The ICU Book: amzn.to/2M2oFVm The Washington Manual of Critical Care: amzn.to/2MfmDR4 The Ventilator Book: Second Edition: amzn.to/2BYbyhK The Advanced Ventilator Book: amzn.to/2nhvyTY Essentials of Mechanical Ventilation: amzn.to/2vqQAnF @eddyjoemd is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com I haven't been making as many videos as of late because I've been using my time to learn more about how to invest my money myself. I have found the following books very helpful along the way. These are affiliate links and I will make a small commission if you buy something from Amazon after you click on a link listed below. Rule #1: The Simple Strategy for Successful Investing in Only 15 Minutes a Week! by Phil Town amzn.to/2Ql27kW Invested: How Warren Buffett and Charlie Munger Taught Me to Master My Mind, My Emotions, and My Money (with a Little Help from My Dad) by Danielle Town amzn.to/2Usevy9 Payback Time: Eight Steps to Outsmarting the System That Failed You and Getting Your Investments Back on Track by Phil Town amzn.to/2UvGb56 The Dhandho Investor: The Low-Risk Value Method to High Returns by Mohnish Pabrai amzn.to/2EoYRi2 The Education of a Value Investor: My Transformative Quest for Wealth, Wisdom, and Enlightenment by Guy Spier amzn.to/2EoYSCC The Little Book That Still Beats the Market by Joel Greenblatt amzn.to/2QtLaVO One Up on Wall Street by Peter Lynch amzn.to/2XsqNrA Invest Like a Guru: How to Generate Higher Returns At Reduced Risk With Value Investing by Charlie Tian amzn.to/2ED7dBu

[@zhangcd07]

Joe I want to say thank to you. I just took a critical care fellowship position yesterday. Your video helped me so much. It opened my eyes. You are the first person telling if I don’t enjoy outpatient it is ok to pick critical care only programs. My interview experience is amazing. The critical care training you can get from CCM fellowship is unique and different from PCCM.

[@eddyjoemd]

CONGRATS!! It's going to be an incredibly fun ride. I'm glad I was able to help, that's the point of all this. It is definitely a unique opportunity. You can stand side by side with the cardiologists managing their toys, the CT surgeons and their toys, help out, contribute in surgical patients and trauma patients without any hesitation. MICU is just a piece of the pie. Being proficient in EVERYTHING makes you a true asset to any institution.

[@michaelbrown2849]

I subscribed because of your humility. I am doing my last rotation as a Nurisng Student, ultimately I am going to be an Orthopedic Surgeon. I'll be in the Surgical ICU for this rotation. Came across your vid while researching what to expect in the icu, the personnels, machinery and processes. Your vids are informative. Respects

[@eddyjoemd]

I'm glad you stumbled upon my page, Michael. I wish you the best on your journey. It's definitely worthwhile. I have been a bit more focused at the time on Instagram (@eddyjoemd). There's plenty of ICU data that I've been covering there as of late. Let me know if you need anything along the way. 👍🏼

[@GauravPande1]

Superb! Thank you!

[@dannyelbaz4142]

Would be awesome if you could make videos about how it feels to work in ICU full time, as far as the high mortality rate, the ICU is sometimes viewed as a place that prolongs suffering due to the fact the seriously ill patients usually don't hop out of bed ok after treatment.. how does it feel to be an ICU doc, how much success is there as far as helping patients, some storys would be awesome to try and understand the general feeling of the floor when being there full time :)

[@mbo1523]

Great Video! the system is similar in my country, 3 years of Internal Medicine/EM/Surgery or Anesthesia and then 2 years of Critical Care, thank you for answering all the questions hope you keep uploading more videos!

[@eddyjoemd]

Gracias mi amigo!

[@BK-iv1jw]

I know you posted this a long time ago, but I'm doing a project to help decide what specialty I'd be interested to pursue. I am doing critical care currently! This gave all the information I needed for all categories. You are so inspiring and kind. Keep doing what you're doing.

[@eddyjoemd]

Good luck on your project!

[@BK-iv1jw]

@@eddyjoemd Thank you so much!

[@YeshuaAgapao]

ICU in AZ at Banner is scarce of doctors and overflowing with nurses. My sister died from septic shock from hospital germs. She was well past her life expectancy from her kidney failure (severe pre-eclampsia in two pregnancies) and liver cirrhosis (self-inflected alcohol sex/hepatitis opiates ectasy). Olive leaf extract very good at multiple-resistant staph-type hospital germs. She refused to take it (she only 'takes' the bottle)

[@eddyjoemd]

That's sad. Sorry to hear about your sister.

[@alyssamedlife]

Happy to know New Jersey has a lot of pure intensivist fellowships :) I agree with you doc, pulmonary and pure is just a lot to handle. Btw, what state do you currently practice medicine?

[@ethanmillan3048]

Thank you for the break down I'm really looking at this for a career choice if there is any tips I would love to pick your brain at some point

[@3876LIZ9879]

I'm overjoyed I found this video! I've always wanted to be on the front line (Primary Care, General IM or Peds). But when we started clinicals, I've found that clinics drain me emotionally (that wanting to help everybody and feeling helpless against a multitude of problems in healthcare). I did a month of ICU/CCU and I think I can see myself doing it for life. It had been a very busy time though, so I wasn't able to really sit down with my seniors to talk about the pathways. I hope to make it in Match 2020. So thank you for clearing things up! Subbed for inspiration!

[@eddyjoemd]

I'm glad you my video was able to help you out! Let me know if you have any other questions or need advice along the way.

[@3876LIZ9879]

eddyjoemd Thank you so much! Appreciate it. :)

[@ezekielhand6988]

Is research experience during medical school or IM residency important/make or break for matching into a CCM fellowship like it can be for PCCM?

[@crofregernish4695]

Can you do a video about getting into medical school for atypical students? Everyone I see was pre-med, good grades, great schools, etc. Whereas I'm a microbiology major, GPA is like a 3.3, I left in my sophomore year to go to rehab. PS: Intesive care has actually always been my interest. When there was that Ebola outbreak a few years ago, I was very jealous of the doctors working in Africa.

[@SalmanAli-xd8kv]

Hi Joe , can u plz make a video regarding CCM and PCCM training opportunities outside USA and Canada especially for third world country doctors who want to persue critical care but they don't have opportunities at their home country .

[@hockeydude471]

Great video, keep em coming. I'm kinda relieved we have someone that can tell us in depth about CC. Keep up great work😊

[@eddyjoemd]

My pleasure! Let me know what else you'd like to hear/learn about. As I mentioned in the video, hopefully 2018 will be a big year for the channel. Thanks for watching!

[@hockeydude471]

Where do I start?😂. I guess to start, advice for US Imgs wanting to match into residency. How do you pick an internal medicine program that sets you up to enter CC? How to set yourself apart from others in the fellowship pool? Is there an IMG bias in CC? Can strong board scores overcome this for fellowship applicants? I shouldn stop there before the message gets too long😂

[@hockeydude471]

Thank you so much, I really appreciate this. It probably doesn't seem like much but it's priceless to be able to learn about CCM and the process involved. Keep up the great work!😊

[@umsterpumster347]

You’re an amazing doctor:) proud of you!!

[@eddyjoemd]

Thanks Umer!!

[@Fandomonium456]

Thank you!! As someone applying to medical school and likely to enter next fall this is extremely helpful since I’m interested in pursuing internal medicine! I definitely want to do something that’s invasive, broad, meaningful, but not as tough lifestyle and stress-wise as EM or surgery. I also like the teamwork approach as well despite having the autonomy as a physician. I definitely recognize the importance of working with other professionals to deliver the best care. Why did you pursue this fellowship compared to others like oncology/cardiology/GI/allergy etc.? I know it’s too early to think about it but what are some things I should do as a medical student to ensure I obtain the best possible IM residency and then hopefully a fellowship? Also, if somehow I want to pursue pediatric critical care, do I have to initially pursue peds or can I do IM?

[@eddyjoemd]

Oh man, that's quite the question! I was planning on doing that topic on another video. I'll write it and let you know when it's filmed and posted. I definitely have much to say regarding all that. 👍🏼 Thanks for watching!

[@aliciascott5419]

Awesome video! As a freshmen in undergrad, you're becoming a huge inspiration and role model for me. Critical care is amazing! Do you think more fellowships will developed within the next 10 years?

[@eddyjoemd]

It's very nice to hear that I'm inspiring you. Critical care IS amazing! Unfortunately, I cannot predict many more fellowship programs opening unless something big changes with regards to graduate medical education. It gets extremely political (and I'm not talking about left/right) but let's just say that the organizations that one thinks would fight for us are actually hurting us. That's a conversation for a different day. Good luck in the rest of your trek. It's a loooooong road but it's worth it.

[@Excalibur833]

Such a helpful video,, thank you. There’s a good bit of talk at my institution of the national shortage of critical care-trained physicians, especially in smaller hospitals and more rural settings. Since a good fraction of hospitalists in these (and other) settings are family medicine boarded docs and cover unit patients, the Society of Hospital Medicine has apparently petitioned the American Board of Family Medicine to sanction a critical care training pathway for family physicians that would give them access to the field along with the specialties you mentioned. Am wondering what your thoughts are about that. Thanks again.

[@eddyjoemd]

I went on quite a rant on this the other day. I saw some article on it somewhere. Anyway, here's the short synopsis on it. 1. We are crushing our IM and FM colleagues with responsibilities that they weren't trained for, perhaps responsibilities that they do not want to assume. 2. This was caused by the AMA, or whatever all-mighty regulating institution, bottlenecking the creation of fellowship spots for any critical care subspecialty. Supply just isn't meeting demand. People need to be held accountable. Demand is growing FAST so they need to act now. 3. A crash course training program is a band-aid, but doesn't eliminate the root problem which is an insufficient amount of fellowship training. 4. I commend SHM in petitioning the ABFM for this pathway, but if the spots aren't regulated into existence, then it won't help quick enough. 5. Family medicine is, at least the way that I focus on medicine (trying to know absolutely everything I can), the most intellectually challenging specialty given the vast scope of knowledge a true FM outpatient/inpatient physician needs to know. The brain can only handle so much. Adding Critical Care to that base will only push out information that could be used to treat other patients. 6. My fellowship was two years. During the first month of second year I made a bonehead mistake, a lapse, which didn't cause any harm bc it was caught in time, but my program director proceeded to make fun of me and say "now you know why this fellowship program is two years instead of one. I have more thoughts but I need to head to work! I'd like to know what your thoughts on the matter are.

[@Excalibur833]

In principle I am not opposed to it, since these guys are already taking care of unit patients, so better preparation in itself is not a bad thing. A similar issue occurs in EM, with too few boarded EM docs to cover EDs around the country, especially in the more rural/secluded areas, and that's where FM docs fill in of course. I think there's a more natural "fit" between the roles of the EM doc and FM doc though, at least at that Level III or maybe Level II -type facility. Thus a one-year "added qualification" fellowship in EM that they can do through family medicine is probably sufficient. Critical care is a different creature, as I don't need to tell you. So I don't know as a practical matter how it could happen, at least in the near-to-medium term. Are we talking access to CC fellowships that lead to actual board certification? I did the P/CC pathway, and that of course is not an option because of the pulmonology end of it, and if it's the stand-alone CC path, where would these people train as there are already too few options? Or are we talking about added qualification "fellowships" purely through FM that do not lead to independent board certification, as is the case with EM? How will the ABFM even respond to the notion? On the one hand, those guys are (rightly) concerned with maintaining the role of the competent generalist physician in a world of increasing specialization, so adding another "backdoor" path to specialization might be viewed as further diluting that mission. On the other hand, one of FM's principles is to be community-oriented, i.e. that their training is broad enough to meet whatever demands a particular community may have regarding the provision of health care. So if there are communities that need competent CC providers, and family docs are there and willing, why not train them to be better at it? I have not seen the actual proposal presented to the ABFM about the issue, so I don't know what it actually states or what its status is. But I have lots of questions about all of it.

[@utsavshrestha4069]

Hello. Very informative channel, thanks. I am a third year internal medicine resident interested in pulmonary and critical care medicine. I like critical care, but my concern in doing just CCM is that the sub specialty does have a high rate of burn out. Also, personally I don't really believe that I could keep up the 12 hour 7 on / 7 off schedule for the entirety of my career as a physician. Thus eventually I would likely shift to outpatient pulmonary service or inpatient consults. Do you agree with my concerns? What are the things you do to prevent burn out in this subspecialty?

[@eddyjoemd]

That's a fantastic question that went through my head as well when I was in your shoes. I do agree with your concerns as I had the same concerns. I will make a video soon addressing them for you. I'm actually on a self induced 11on rotation right now (fortunate enough to take several weeks in a row off to travel).

[@hraza2222]

eddyjoemd looking forward to that video! This is also one of my concerns, leaning me more towards PCCM.

[@rikliu1179]

thx for the advice

[@eddyjoemd]

👍🏼👍🏼👍🏼

[@philtheo]

Great video! Thanks for doing it. Just a question - how do you deal with burnout as I’ve heard critical care medicine has the highest rates of burnout of any specialty?

[@eddyjoemd]

That's a great question. I work 14 to 15 days a month so that certainly helps. I don't know if that's the right number or anything but I feel pretty good a day or two after I finish my week.

[@annalisa1842]

eddyjoemd hey.........this post is old but I just found your channel. How many years of studying did it take you become a CCM?

[@eddyjoemd]

Welcome to the channel. I think I covered that in another video. My journey was definitely not traditional so it took longer than most.

[@annalisa1842]

eddyjoemd thank you. I’ll search for the video

[@alimir1994]

Great video, very informative. Is there a list of all the programs which offer critical care fellowships? I was unable to find a page with all of them listed. Thanks!

[@eddyjoemd]

I'm try to find it when I get a chance. It wasn't easy when I looked for it years ago.

[@alimir1994]

@@eddyjoemdthanks a lot doctor

[@disurgeon]

Very informative. Thank you.

[@eddyjoemd]

My pleasure!

[@123miltos]

Great Video ! Thank you

[@eddyjoemd]

My pleasure. Thanks for watching!

[@hraza2222]

What do you think of the fact that PCCM is not the same as CCM only in that PCCM has a much larger focus on MICU while CCM has a larger focus on all the units, like MICU, SICU, and neuro-ICU

[@eddyjoemd]

I think they're quite similar but definitely not the same. Nothing against my PCCM colleagues, but you can't replace the amount of months I spent in the CVICU, SICU, CCU, and NSICU in my CCM fellowship vs the 2-4 weeks my colleagues who were in PCCM spent in those units.

[@eddyjoemd]

every program is different, though. some PCCM programs may be stronger in the ICU department.

[@folumb]

I'm interested in general surgery and internal medicine, but lean towards surgery because I like the OR and know that if I did IM, I would most likely try for critical care. Do you think the demand for critical care is similar in surgery? On that note, do you work alongside surgery, EM or anesthesiologists in the ICU (given that they all can do critical care from those specialties)? Might be a dumb question as my center affiliated with my school has different ICUs staffed by each specialty (NICU, BICU, MICU, SICU and even a subset of beds in the SICU for transplant patients), but perhaps in a smaller area the ICU is combined and needs docs across all specialties to see the same critically ill patients? Let me know what you think

[@eddyjoemd]

The answer to your question is as complicated as you can imagine. It all depends on where you want to practice. In the three hospitals where I've worked and trained, they've all had different models/roles for their surgeons regarding critical care. Let me try to make this easy for both of us with my narrow experience on the matter. "Do you think the demand for critical care is similar in surgery?" No. In many places, like the shop where I'm at now, the surgeon wants to operate. They leave the critical care stuff to intensivists such as myself and we chat daily about their patients. Where I trained, Ivory tower types of places, there were surgical critical care attendings but they would have to leave the floor to operate quite frequently. If acuity is what you're seeking, then you're aware that you can't really leave the floor for 4 hours to go operate and leave your other patients to be managed by god knows who. Where I did my residency and fellowship, we had surgical critical care guys, but the residents and/or fellows managed the ICU. That means you're likely going to end up in an academic center. "Do you work alongside surgery, EM or anesthesiologists in the ICU (given that they all can do critical care from those specialties)?" At my current shop, no. EM CC guys usually stick to the academic centers and it has to do with who is going to pay for your malpractice/benefits. If they still want to practice in the ED and also in the ICU, they need to find a shop where the critical care department and the emergency department is run by the same owner (i.e. hospital). That's a whole other tangent. It narrows where one can work significantly. Let me try to get back on track. If you want to do real critical care, as in, have enough work to justify your salary with JUST critical care, you need to be at a shop with 400+ beds. The places smaller than that are usually run by IM pulmonary-critical care guys in one combined med-surg unit. Anesthesia-CC, from my experience, usually stick to the bigger centers where they do significant cardiothoracic surgery. I trained alongside people from the whole spectrum of critical care but where I work now, as well as mostly every place where I interviewed, the vast majority of docs were PCCM trained. "in a smaller area the ICU is combined and needs docs across all specialties to see the same critically ill patients?" This is where egos get in the way. A surgical critical care doc is not going to want a medicine-trained critical care doc to manage their patient, and vice versa. Imagine a surgeon treating DKA, just not going to happen. As mentioned above, where I currently practice, the surgeons are available via text and we have great communication. But they'd rather be operating and they leave all the critical care stuff up to me. Ultimately, I do not know what the right answer is. I had to make a similar decision as you're facing right now and chose medicine. No regrets. Perhaps you can ask Buck Parker what his thoughts on the matter are. -EJ

[@modarsaleh91]

what a gr8 Video .. u have influenced me alot 😘😍💜💛💚 .. specially this time that I am having bad days in my residency ... wish ya best of luck .. 😙😘😍

[@eddyjoemd]

Thanks, Modar! Hopefully you'll have more good days than bad. Not all days are meant to be good. Without the bad days you won't learn anything.

[@lp8650]

Thanks for the video man. Take care =) ..

[@eddyjoemd]

My pleasure!

[@tidanotes4376]

Thank u for Inspiring us..

[@eddyjoemd]

My pleasure!

[@hockeydude471]

Hey, another question. I'm studying for Step 1 right now and the consensus seems to be to do a lot of questions, study them and learn from wrong answers. I've been doing that, but when I go through questions again later after studying the right answer it almost feels like I'm cheating. As soon as I start reading the case I pick out the key words and then I "know" the answer. I guess I don't know if I know the answer because I know the concept or because I subconsciously remember the case. How do I differentiate the two if that makes sense?

[@eddyjoemd]

That's the right way to approach it. You'll find a lot of questions are similar to UWorld and the like where you'll be able to answer the questions just by looking at the answers. That's called "test taking skills". Then again, I'm sure you know that. For those questions where you already know the answers ahead of time, I would focus on learning why the wrong answers are wrong. For example, say the right answer is C, you need to teach yourself everything about A, B, D, and E because chances are that those will show up on he exam as the correct answer with a slightly varied vignette. That'll give you a more broad base of knowledge. That's how I studied for my boards. Hope that answers your questions. Best of luck!

[@hockeydude471]

Alright, thanks a lot, really appreciate it😊

[@justingaither69]

I’m A Pre Medical Student And Don’t Know What Major To Take When It Comes To Being A Critical Care Physician????

[@eddyjoemd]

Hey, Justin! Step 1. Get in med school. Step 2. Get into and complete an Internal Medicine, Emergency Medicine, Anesthesiology, or Surgery residency. Step 3. Apply for a Critical Care Fellowship. Step 4. Spend the rest of your life loving going to work saving lives. Thanks for watching!

[@christianblake88]

good stuff

[@eddyjoemd]

Thanks, Chris

[@Thatguitarist]

Hey, can Pediatric Intensivists work in both the NICU and PICU?

[@eddyjoemd]

I honestly do not know the answer to that question. Sick kids terrify me.

[@Thatguitarist]

eddyjoemd Oh. Thanks for your time

[@eddyjoemd]

No problem. Good luck getting the answer!

[@Thatguitarist]

eddyjoemd I found out the answer. They work only in the PICU but can take care of newborns.

[@eddyjoemd]

Oh gotcha! Thanks for teaching me that.

[@herdestbethel4413]

Hey doc, do you have an email I could reach you? I have a kind of a personal question! (If you don’t mind)

[@eddyjoemd]

[e-mail] If it's career/educational advice, I can try to help. If you need me to sort out a health issue of yours or a family member, I'm sorry, I can't help.

[@ashirshabir8092]

gret stuff

[@eddyjoemd]

Thanks!