The Shortlist – Respirology vs Critical Care

Lungs

I’ve been busy these last few months, and what’s currently pre-occupying me is applying for fellowships.

I remember putting together a shortlist of specialties that I wanted to do in 1st year, 2nd year, 3rd year medical school, as well as subspecialties of internal medicine in first and second year residency.

I finally narrowed it down to two specialties that I really enjoyed – respirology and critical care, but in the end, I only applied to respirology – also known as pulmonology for my American readers.

It wasn’t an easy decision to forgo critical care. In fact, if they had the combined respirology / critical care fellowships in Canada like they do in the USA, I would have done it in a heartbeat. When I was a third year medical student, I did an ICU elective that solidified my interest in internal medicine. I loved the complexity, the physiology, the need to integrate broad fields of knowledge to make a difference and save lives. It also helped that I was pretty good at doing procedures and became quite comfortable putting in chest tubes and central lines. It was life and death situations and being there for patients and families in poignant and life-changing moments.

Fast forward to residency and I found I still very much enjoyed critical care. I enjoyed carrying the code team pager and found resuscitation and leading a well run team to be exhilarating.  I was touched by the patients I encountered and the dedication their families had for them when they were critically ill. But I also realized that loving what you do is not everything there is to a career. For everything that you invest time in, you must also consider what you may be sacrificing. My decision was also helped out with the fact that I liked respirology just as much.

On the surface, respirology and critical care share many common attributes. The airway and oxygenation physiology is a key subject in both. There are procedures in both specialties and a good breadth of practice in both, with perhaps critical care requiring a wider base of knowledge. But when you start practicing, you realize the day-to-day is intrinsically different.

In respirology, you see a wide breadth of ages and acuity of illnesses. You may see a young man with a new diagnosis of mild asthma, and in the same day see a patient with pulmonary fibrosis who is pre-transplant and waiting for lungs. You get to talk to patients and get to know them, and follow and treat them for years. It’s a good mix of clinics, procedures and inpatient consultations. And you can have a fulfilling career that won’t involve you being in-hospital call and answering pages overnight.

I ended up talking to fellows and staff physicians in both specialties. I even talked to staff that practiced both respirology and critical care. The reality these days is it’s hard to practice both, especially since critical care has matured into its own specialty rightfully so. There really is too much to know to be good at both. Most respirologists who work in the ICU have given up their respirology practice.

Furthermore, I talked to fellows who were on their second fellowship or in the middle of their PhD. The job situation is a lot tighter in critical care, as you need to find a unit to be tied to, and it has to be big enough to be financially feasible. Many told me, “if you like any other specialty as much, you should go do that instead.”

It’s these combination of factors that have made me apply solely to respirology. I am happy with my choice. I do have moments where I wish I could go work in the ICU from time to time. But I don’t think I’ll mind having my evenings and most of my weekends free from work. I’ve been told I could pursue a critical care fellowship afterwards, but would I want to do more training after being a trainee for over a decade?

So that is my shortlist for now. Just respirology. I hope I get accepted to my program of choice. If so, tune in for the next edition of the shortlist: respirology subspecialties.

Photocredit : lisabuddka (CC)

Under Pressure

atlas final

The weight of residency has been hitting hard lately. It’s akin to Atlas trying to hold up the world with his might but struggling. Struggling to find the time and energy to keep my life balanced. CaRMS fellowship applications are starting. There has been a flurry of activity in my personal life. Only thing I can do is keep my head up and dig deep to find strength. (Photo)

When to Stop Resuscitation

Another amazing talk from Cliff Reid (resus.me) – inspirational and powerful.

Cliff Reid – When Should Resuscitation Stop from Social Media and Critical Care on Vimeo.

The Hundred Hour Week

During residency, there are ebbs and flows to each work week. In a typical 1 in 4 call schedule, you may find yourself working fifty to a hundred hours a week – based on a 8-10 hour workday, and 24-26 hour call shift.

A light week would be doing a call on a Wednesday or Thursday, approximately 50 hours. A moderate week would be doing Tuesday/Saturday call, roughly 75-80 hours. And finally, once a month you’ll do a Monday, Friday, Sunday call, which works out to be a hundred hours.

Similarly, when call schedules are swapped around, you sometimes end up working two weekends in a row.  This translates to physically being at the hospital for 19 days straight.

Regardless to say, my second year has been filled with lots of time in the hospital. Today, I just finished a stretch of 19 days with my last week being a hundred hour work week. The scariest part about this is I’m not even the hardest working resident. Most surgical residents I know work 100+ hours/ every week consistently.

I remember in undergrad, when I first learned of resident work hours, I thought working 80+ hours every week was very doable. I was already spending roughly the same number of hours with my classes and studying, how hard could working 80+ hours be? Now, having done this for a few years, I realize that working 80+ hours isn’t the hard part. It is certainly doable. You get used to pulling all-nighters in the emergency room. You get good at looking after patients and getting stuff done in the hospital.

But what becomes incredibly hard is balancing your life outside of work.

The amount of sleep and the quality get degenerates. You will be pressed for time to buy groceries, cook food and clean up after yourself. Your laundry piles up, emails go unanswered, parties are missed. Blog post? I’d rather sleep. You find yourself detached from the lives of the people around you, as you become more involved with your patient’s lives in the hospital.

If I could talk to my younger-self, I would tell him that residency workload is doable but be prepared and aware of the sacrifices you will make. I would tell him to treasure his time outside of his career, and to nurture healthy relationships that will last. I don’t regret going into medicine. I just wish I had more time for my life outside of medicine right now.

(Photo credit: Stevedunleavy)