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Straight into Critical Care after Graduation?

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This topic has been touched on, but I was wondering if Critical Care PAs could weigh in for new grads on starting in the specialty versus practicing internal medicine first. Everyone comes into the field with different backgrounds and capabilities, so there is no "yes or no" answer, but opinions would be appreciated. I am considering applying for a CCM fellowship right out of school.

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I started in critical care as a new grad, it's a VERY steep learning curve. Conventional wisdom is that you're not really productive in critical care until 6 months or more on the job (depending on background).


I'm a bit of an outlier, because I had very little prior clinical experience. I did have other work experience and at least a little common sense on my side, though.


Definitely easier to get hired if you have a critical care residency. Hospitalist or other IM experience is also helpful of course.


If you have an interest and someone is willing to hire you, critical care is definitely learnable. What I have found drives attrition rates the most, is the rotating schedule (days, nights, weekends, holidays). If you are thinking of working in critical care, I would make sure you are realistic about the schedule, before making the commitment. Also some people do not do well with the (?perceived) stress, and the at least occasional need to be decisive in a hurry.

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Thanks for your input. I work as a CNA/Monitor Tech in a Critical Care department right now, and stress doesn't bother me at all. The big thing that worried me was the "not being productive in critical care until 6 months or so of experience." My time in the CCU has shown me that the pathophysiology rabbit hole can get very deep. I will definitely try to get a residency lined up immediately after school. But first I need to get accepted. First interview tomorrow morning. Thanks again, hearing from someone who did it is helpful.

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  • 2 years later...

I was wondering if you could provide an update on if you were able to accomplish your goals. I am a respiratory therapist and have been working in the ICU for the past 14 years. I have built a lot of trust with the physicians and nurses in the ICU and was hoping to transition back in to the ICU after PA school. Although I have a wealth of knowledge as it pertains to intensive medicine I am hoping the adage that its more who you know than what you know will be helpful in getting my desired position. Any update would be appreciated.

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I'm not the original poster (but I am the OR, the original replier), in my opinion an RT with 14 yrs ICU experience freshly graduated from PA school should be able to get an ICU job without too much of a problem. RT experience is pretty high quality as far as ICU patient management goes.

Even better, is if you have at least one ICU rotation in PA school.

Only caveat is, how the interview goes.

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My feel for new grads is they should do a minimum of 5 years EM. I feel EM produces some of the most well rounded PA's who can transition to almost any specialty if they choose. Yes, ICU is a different experience. I have worked 15 years EM, and recently 1.5 years ago switched to UC. Do I feel myself loosing brain cells, yes. But the hours are better. UC is not a place for new grads IMO since there is no teaching.   

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I agree with Mike that the typical ED mentality is very different from the typical ICU one.

In the ED the most important thing is disposition - that is, is there an immediate threat to the person's life? If not, where do they go - straight home with PCP followup? observation? admission to the floor (if so, which service)? or ICU? Once you have dispo, then your job is done. Along the way you take a history, do an exam, run some tests, arrive at a provisional diagnosis (or at least exclude badness).

In the ICU again you need to manage any immediate threat to the person's life, but also you need to be on top of every aspect of that person's physiology. A lot of it is about the details, and getting deep into the weeds. For example, why is the chloride uptrending? What's the hourly urine output? Are they stooling and of what quality? (Very Importantly), what is their volume status? Those are not things that the ED is concerned with, at all.

I work in the ICU, when we get EM residents rotating through, I find that some number of them really aren't a good fit for the ICU - they look too much at the big picture and don't pay enough attention to detail (and important things are missed). Other EM people, seem to 'get it'. But they still prefer working in the ED.

So to answer the question, does an 18 month APP EM residency provide enough critical care exposure to get an ICU job.. maybe? Although (to belabor the obvious) it seems if you are going to do a residency and you are interested in critical care, it might be better to do a critical care residency. 

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