Expert: Ronald Levy, M.D. - 1/5/2012

Question
Dr. Levy,

I'm currently a CA-2 resident in a midwest anesthesia program who is potentially interested in pursuing a critical care fellowship. My question is whether or not this would be feasible as I would like to go into private practice when I'm done. I grew up in Webster, TX and plan on moving back home to practice (or somewhere in the Houston area). If I had to choose between anesthesia and ICU, I would choose the OR. Nevertheless, I really enjoy the idea of being able to work outside the OR maybe 1 week a month rounding on patient's in the ICU. I know this fellowship would strengthen me as a perioperative physician, but I would hate to complete the fellowship with no hopes of working in the ICU (in a private practice setting). I havent had a chance to talk to any private groups back home so I'm not sure if this is a possiblity. My attendings only have connections locally, so they havent been able to provide me with much input as well. Thanks for your response.

Answer
It really depends on how the hospital is set up. Some hospitals have their ICUs run by surgeons, others by Medicine/Pulmonary and some by Anesthesia. You would have to check with the specific hospital to see if their Anesthesia group covers the ICU. I know for example that Methodist is run by Anesthesia so anesthesiologists there could work the deal you are interested in but I can't speak for other hospitals. Bear in mind that critical care doesn't pay very well (compared to OR cases) which is why most critical care anesthesiologists work in an academic setting where you don't have that "Eat what you kill" philosophy that is pervasive in private practice.

Ronald Levy, MD
Professor of Anethesiology
UTMB-Galveston