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The Shortlist – Respirology vs Critical Care


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)

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  1. Spencer V
    Spencer V September 25, 2014

    Congratulations on making a very tough and exciting choice! All the best.

  2. CC3
    CC3 November 15, 2014

    Hi MedAholic,

    I’ve been following some of your posts with interest, especially the ones regarding specialty and sub specialty choices, so thanks for that!

    I was wondering, how big of a factor was job market for you? I hear the ICU market has been pretty bad (and for a while now, and probably will be for the foreseeable future) but that was for Ontario, I was wondering if it was the same throughout Canada? I’m guessing working in general internal until you can get an ICU spot wasn’t appealing? How many of the fellows were doing in extra fellowships (and in what??) or PhD?? Sorry for barrage of questions I was just curious!

    • medaholic
      medaholic November 15, 2014

      I think you definitely think about the job market. But if it’s something you really enjoy doing, I don’t think that should persuade you from it.

      I think the same can be applied for surgery. I did an elective in it once, and the staff basically told me, if there’s something that you enjoy doing just as much, sometimes it’s worth it not to go down such a hard path ie surgery, where the training and job search is much harder.

  3. GF
    GF February 16, 2015

    Did you match to resp?! Sorry if too personal of a question.

    • medaholic
      medaholic March 19, 2015

      I’ll have a post up soon with updates

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