Why did you become an intensivist?

[Maybedoc1]

Soon to be 4th year med student (applying to residency in September) really struggling to decide between a couple specialties. One would allow me to pursue critical care (IM) and one where I could not pursue critical care (radiology). I know these are very different fields and I’ve spent many hours of my life trying to decide between them. Both would be ~6 years of training. I love both the ICU and radiology but for different reasons. The rational part of my brain tells me that radiology is probably better although I’m having a very difficult time letting go of the ICU. This is probably med student naivety, but in many ways I feel “called” to the ICU as dumb as that may sound.

My first experience in an ICU was when I was 13 after my mom had had complications during an aneurysm clipping (bilateral ACA strokes and right MCA stroke). 17 years later I still remember going to the ICU to visit her and being simultaneously terrified, but amazed at everything I saw in that room. All the lines, monitors, vitals, etc. I guess that experience stuck with me and is making my decision feel very difficult. I've spent a lot of time shadowing in the ICU and also spent a fair amount of time in the SICU during trauma surgery in my core rotations and enjoyed it a lot.

Anyway I feel that people pursue critical care for different reasons than someone who goes into derm or orthopedics so I’d love to hear why you all chose it.

Thanks!

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[SurfingDoctor]

Procedures used to be fun. But that becomes routine... and as a over-the-hill person... they kinda suck.

Frankly, if you don't enjoy physiology above all else... this field aint for you.

 

[CCM-MD]

Do radiology and make your way into neuroIR, you’ll get a nice mix of imaging, procedures and light clinical work (including some ICU patients). I did critical care because I was already in IM, ended up hating outpatient, liked doing procedures, and liked the flexibility and time off that came along with shift work.

Educate yourself on the negatives of critical care before committing to it: potential for midlevel expansion, more corporate intrusion etc. I think rads is a better option, especially neuroIR, so you can mitigate any potential issues that AI might pose.

 

[gro2001]

Soon to be 4th year med student (applying to residency in September) really struggling to decide between a couple specialties. One would allow me to pursue critical care (IM) and one where I could not pursue critical care (radiology). I know these are very different fields and I’ve spent many hours of my life trying to decide between them. Both would be ~6 years of training. I love both the ICU and radiology but for different reasons. The rational part of my brain tells me that radiology is probably better although I’m having a very difficult time letting go of the ICU. This is probably med student naivety, but in many ways I feel “called” to the ICU as dumb as that may sound.

My first experience in an ICU was when I was 13 after my mom had had complications during an aneurysm clipping (bilateral ACA strokes and right MCA stroke). 17 years later I still remember going to the ICU to visit her and being simultaneously terrified, but amazed at everything I saw in that room. All the lines, monitors, vitals, etc. I guess that experience stuck with me and is making my decision feel very difficult. I've spent a lot of time shadowing in the ICU and also spent a fair amount of time in the SICU during trauma surgery in my core rotations and enjoyed it a lot.

Anyway I feel that people pursue critical care for different reasons than someone who goes into derm or orthopedics so I’d love to hear why you all chose it.

Thanks!

I don't think that this is either naive or dumb.

The most useful thing you can do in life that will help you make decisions big and small is figuring out your core values. Once you figure those out, everything else becomes fairly simple. There are a number of coaching methodologies, including self guided ones, that can help you do that. Thinking back to the most meaningful events of your life, particularly from childhood, is one of those. So you are well on your way there. The next step requires a few more levels of introspection into what exactly made this experience so meaningful.

-Was it because it was your mom that was the patient? Maybe your core value is spending time with family.
-Was it that you saw cutting edge medicine? Maybe your core value is innovation.
-Was it the compassion that the medical professionals showed? Maybe your core value is care.
-Was it the nature of the fight against death? Maybe your core value is preservation of life.

Depending on which it is, will lead you down different paths. If family is your core, then pick the specialty that will allow you to spend more time with them (between the two you mentioned, that would be radiology). If it's innovation, pick the one you are most interested in the unanswered questions of. If your value is care, then I would recommend either critical care or palliative care. If you value is preservation of life, then critical care.

I picked my primary specialty (emergency medicine) after seeing some resuscitations while shadowing. At first I convinced myself that I did not have to do a critical care fellowship and the ER resuscitations were sufficient for me to be fulfilled, though I did feel sad and disgruntled whenever a shift would go by without a good resus. After a coaching session I realized that saving lives was a core value, and instead of spending maybe 5-10% of my time doing critical care, I could go back to training to do a fellowship and bring that number way up. That made the pro/con consideration very easy (prior to that I spent a lot of time thinking how crazy it would be to be giving up the relatively cushy and well paid job I had at the time, as well as the opportunity cost of going back to training (at least a $500k hit in lifetime earnings)). No regrets since. Other than marrying my wife, best decision I ever made.

The thing about core values is that once you figure them out, it's not a matter of being able to stick to them. The only decisions that will feel easy are the ones that let you embrace them more fully. But you do have to figure them out so you don't get distracted by the noise.

 

[TexasMed22]

Do radiology and make your way into neuroIR, you’ll get a nice mix of imaging, procedures and light clinical work (including some ICU patients). I did critical care because I was already in IM, ended up hating outpatient, liked doing procedures, and liked the flexibility and time off that came along with shift work.

Educate yourself on the negatives of critical care before committing to it: potential for midlevel expansion, more corporate intrusion etc. I think rads is a better option, especially neuroIR, so you can mitigate any potential issues that AI might pose.

NeuroIR seems like a great way to take Q3 call for the rest of your life

 

[CCM-MD]

NeuroIR seems like a great way to take Q3 call for the rest of your life

This is true. It’s actually been Q2 at many places I’ve worked.

 

[Katheudontas parateroumen]

Truly think about what you actually enjoyed during your rotations. If radiology is something you rotated in and you enjoyed the work, then go for it. It’s ok to have a “reason I went into medicine” that is different than what you actually enjoy professionally. For me, I was also between doing radiology/IR and anesthesia/ccm. But when I shadowed radiology, I just didn’t enjoy it. As a med student, I enjoyed playing with the vents and giving my own meds and doing some hands on stuff as well. Looking back I probably would have liked radiology more but I just didn’t understand it enough to appreciate it. Critical care is all about physiology and clinical medicine. I enjoy rounds. I enjoy teaching. I enjoy talking about the next paper being published. It is all very intellectually satisfying. I enjoy being at the bedside getting to know my patients. I really do not mind and actually find family goals of care conversations fulfilling. Although I went into anesthesiology for all the physiology and intellectual things, ccm satisfies the human aspect for me that is more than just personal gratitude.

I think radiology would satisfy a lot of intellectual stimulation and being able to help move along cases. I think being a doctor to the doctor is a huge role. Now after doing what I’ve been doing, I do really think I’d miss seeing the human and emotional aspect as stated above.

I’d also say don’t go into a residency with the intention of doing whatever fellowship. The fellowship is not guaranteed (sadly) and you may be stuck doing hospitalist or whatever. You have to be ok with that. Same with radiology.

I have no regrets at this moment. I found a job I really like which makes a huge difference. The only times I think about radiology is “grass is always greener” type of thinking where I wish I wasn’t dealing with life or death situations in my face everyday, where I bear responsibilities for patient’s lives by my decisions and dealing with emergencies on a daily basis. In radiology, I don’t pretend to know what it’s like or what different stresses there are.

 

[The Knife & Gun Club]

I ended up in ICU because there’s literally nothing I like more than resuscitating a catastrophically sick person. At some point when people are sick enough it becomes like a video game and you’re basically just using your understanding of physiology to bring them back from the dead. Bonus points if you can do this without crapping your pants under pressure.

I originally chose EM for the same reasons, but came to find most of EM is actually dealing with clinically well people and a heavy burden of social issues. Critical care has this too but I found wrangling consultants and having GOC discussions with families in the unit to be far less unpleasant than kicking out the unpleasantly drunk but otherwise well 50yo Karen who is threatening to write angry google reviews about you on line.