So glad you’re interested in becoming an Intensivist and looking into starting a Critical Care Fellowship! Let’s get the simple stuff out of the way. You need to go to college and obtain the prerequisites to get you into a medical school. The MCAT needs to be completed. In medical school you need to pass your boards and do well in them. Then you need to choose what direction you want your residency training to go. What do you want to do for 3-5, or perhaps even more, years before starting your critical care training.
Do you want to train in Internal Medicine, Surgery, Anesthesia, Emergency Medicine, Neurology, or Pediatrics? Those appear to be the only way.
The most traditional way of going about becoming an Intensivist is to do Pulmonary Critical Care after Internal Medicine training. This is a 3 year program and I can create a post about the pro’s and con’s of this if I receive enough convincing from the audience. HERE are a list of PCCM programs if you’re interested in that. Per ATS, the American Thoracic Society, there are 170 PCCM programs. Ultimately, PCCM is not what I am here to discuss. This post was first published in July of 2020.
If you want to see what a day in my life as an IM trained Intensivist is like, click here.
Internal Medicine- Critical Care
This is the Critical care fellowship track that I am most familiar with, to be honest. This is the direction I went in. Internal Medicine Residency is a 3 year process. I won’t go into the details of everything you learn in residency but it’s quite broad and, being completely bias, it is amazing. I really enjoyed my Internal Medicine training. It’s one of the best periods of my life, no question about it. To this day, now 5+ years after completion, I still keep in touch with the faculty and my peers on an at least weekly basis. That’s enough about me. There are two different ways to be eligible to sit for the critical care boards:
2 year fellowship directly after Internal Medicine residency.
This is what I had the opportunity to do. To be quite frank, I didn’t even know this existed when I was going through my training. Funny short story is that, while in residency, I was talking to a nephrologist who would cover at the hospital where I was training. I knew he was an Intensivist at a neighboring hospital but didn’t understand how that all worked. One day, he was sitting next to me out in the wards and we started chatting. He was asking me what my plans were after finishing residency. I explained that I was most likely either going to pursue hospital medicine because I did not really want to pursue pulmonary critical care because I despised outpatient clinic. He then asked me why hadn’t I looked into the dedicated two year critical care programs? My jaw dropped.
I had NO IDEA there were such programs. Fast forward 6 years, I ran into him at SCCM in Orlando in 2020. I made sure to give him a hug and thank him for helping me find the direction I eventually went down. We took a picture. He likely thinks I’m a big nerd. It’s funny the impact you can have on someones life without even knowing it. I hope to have that impact on someones life myself.
After completing the 2 year fellowship, you have to take and pass the exam provided by the American Board of Internal Medicine.
1 year fellowship after an Internal Medicine Subspecialty Fellowship
Fellowships that allow a 1 year critical care track after completion include pulmonology, cardiology, nephrology, infectious diseases, hematology/oncology, and I think GI as well. This is where you need to be smart with choosing to go down the route of critical care. I say this because it may limit your job opportunities. This is a conversation for another day but if you go into private practice, for example, nephrology may be one group and critical care may be another completely different group. Who’s going to pay your malpractice? Who’s is going to cover your vacation time? Holiday coverage may also be a huge pain in the butt. This may not go well. You’ll likely end up in academia if you choose to do this or end up abandoning one of the fellowships. I have seen this happen to others several times in my career.
This is something new to me but word on the street is that you can complete a 2 year general internal medicine fellowship and then do the 1 year critical care fellowship. I have never heard of such things.
After completing the 1 year fellowship, you have to take and pass the exam provided by the American Board of Internal Medicine.
EMRA Database for Fellowships: CLICK HERE
EMRA, the Emergency Medicine Resident’s Association has complied a fantastic list of Critical Care Medicine programs that do NOT include pulmonology. This was last updated in 2018. It appears as if there are now 47 institutions that offer the 2 year Critical Care program. ERAS says there are 45. This appears to be far more than when I applied several years ago. It was just 34 back in 2017.
Emergency Medicine- Critical Care
If you want to pursue critical care through the emergency medicine track, you first have to complete a 3 year emergency medicine training program. After that, you have to find a 2 year program.
EMRA, the Emergency Medicine Resident’s Association, has a fantastic table linked below which lists the Anesthesia Critical Care program where the American Board of Anesthesiology (ABA) has approved EM residents to apply. They also list the non-ABA approved programs that offer EM-CCM fellowships. I really don’t know what exam they sit for.
https://www.emra.org/fellowships/critical-care-fellowships/
Per ACEP, the American College of Emergency Physicians, there are five pathways to obtain subspecialty board certification. Click here to see this information directly from them. These include Internal Medicine, Surgery, Anesthesia, NeuroCritical Care. They have their specific board certification structure.
It appears as if there are 25 Anesthesia-Critical Care programs that accept EM residents. 36 Medical Critical Care programs are accepting EM trained residents. Just 10 surgery programs are taking EM residents. This is understandable in my opinion.
The American Board of Anesthesiology also has a list of programs where Emergency Medicine Residents can train for their two year program. That list is HERE.
Anesthesia- Critical Care
After completing the fellowship, you have to take and pass the exam provided by the American Board of Anesthesiology. There appear to be 62 programs to train Anesthesiologists to be Intensivists.
One thing that many people would need to consider is that being an Intensivist, in some job markets, may actually be a pay cut to doing solely anesthesia work. Please research this further. I recommend talking to someone like Rishi Kumar, MD who has far more knowledge on the matter.
Surgical- Critical Care
Surgical Critical Care is a one to two year program after completing a 5 year residency in Surgery. This is potentially the longest road. There appear to be over 120 Surgical- Critical Care training program out there. After completing the fellowship, you have to take and pass the exam provided by the American Board of Surgery.
The second year, per Dr Yvonne Chung (@heydrchung), Surgical Intensivist, is not ACGME accredited. It is “typically for research or working as a junior faculty to gain operative experience taking acute care and/or trauma call. She explained that one can also complete a SICU fellowship after an ob/gyn residency. I appreciate her input. Dr Megan Chan (@meganchanphoto) also helped me clarify this.
Neuro-CC
After completing a neurology residency which is 4 years including the preliminary year. Residents graduating from this specialty will have to complete and additional 2 years of Critical Care training. This may be one year at some places. To be honest I didn’t dig into this too much as I don’t have many neurologists who follow me. @theyazzola helped me out with this section.
The test is administered by the Academy of Psychiatry and Neurology. There are changes happening with regards to who can take this exam. Last I read even Surgical Critical Care trained physicians can sit for this exam.
Pediatric-CC
This is the critical care fellowship track I am least familiar with. To be honest, kids scare me. I figure you have to complete a 3 year residency program in Anesthesia, the apply for a Pediatric Critical Care Fellowship. I don’t know how you become a neonatal intensivist at this time. Per ATS, there are 67 pediatric critical care fellowship programs in the country. This is a 3 year fellowship program after 3 years of residency.
After completing the fellowship, you have to take and pass the exam provided by the American Board of Pediatrics.
Neonatal- Critical Care
Dr. Ralph Ariss (@utralph) informed me that Neonatal Critical Care is a subspecialty of pediatrics. You would have to complete, like pediatric-CC, a 3 year residency but here you’d have to complete 3 years of neonatology fellowship. Appreciate the update!
Hope you all learned something and this was helpful. Please double check all this for yourself. It was written on 7/26/2020 and could change at any moment.
-EJ
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