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

Do you want to have a clinic? Do you want to do pulmonary consults for cough and shortness of breath due to congestive heart failure? Then pulmonology may be right for you! Otherwise, life in the sexy critical care world may be for you like it was for me!
This is a very personal question and these are my opinions. You have the right to differ in opinions.

Books I recommend for ICU Beginners.

[dr.eduardochang]

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. !!

[austinnichols]

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

[shahid]

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.

[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!

[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.

[sophiakhan]

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

[angelaissa]

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

[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.

[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!

[chrish]

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!

[ericpineda]

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?

[alvaroescandela]

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!

[icu_corey_rn_]

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

[sinuzb]

Can you do a video about anesthesiologist critical care fellowship?

[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

[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.

[michaelminichiello]

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!

[hraza]

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.

[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.

[fawadshahid]

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