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I have often been asked my career goals or where I see myself in 20 years. How vague or specific of an answer is appropriate? For example, would an appropriate response be "I see myself at a large academic institution where I can teach, do research and service work" or must I be as specific as "I would like to sub-specialize in GI"?

Answer: An honest answer is the best answer. What the Program Director (PD) is looking for is that you sincerely want to do internal medicine. A measure of sincerity is that you have thought about what you want to do and have decided to do an internal medicine residency to get there. If you are not sure where you want to be in 20 years, that is OK, but you still need to convince the PD that you are truly interested in being an internist. So if you have a strong idea of where you want to be, share that with the PD. If you don't, be ready to explain why you think an internal medicine residency is important for you and why it may open up options for your future.

What is the best route to becoming an Intensivist? I'm a 3rd year medical student, and I'm very interested in Critical Care. However, I noticed that there is a sub-specialty under IM called Critical Care, and there is also Pulmonary/Critical Care. Can I take either one route and eventually become an intensivist, or is it that anyone in IM can become an intensivist?

Answer: The sub-specialty of Critical Care is a separate sub-specialty of Internal Medicine and there are several programs around the country that can train and internist to become a Critical Care internist. To be a straight Critical Care internist requires two years of fellowship training. On the ACGME web site, there are 33 accredited programs listed as offering training in critical care. Many of those programs are actually Pulmonary/Critical Care programs that offer spots in straight critical care. There are 132 training programs in Pulmonary/Critical Care approved by the ACGME.

The majority of physicians who do Critical Care are Pulmonary/Critical Care, and the most training slots available are in Pulmonary/Critical Care. Critical Care can be combined with several sub-specialties of internal medicine to include Pulmonary, Cardiology, Nephrology and Gastroenterology although the first is clearly the most common. These fellowships usually combine one year of straight critical care with the IM fellowship to be eligible for both sub-specialty boards (three years for Pulmonary/Critical Care). The fellowships other than straight Critical Care and Pulmonary/Critical Care require coordination with the program directors to set up.

Why do straight Critical Care? If that is all you are interested in it makes sense to do straight Critical Care. It will be the fastest route to becoming Critical Care board certified since it will require just three years of internal medicine residency and two years of fellowship. This also allows you to focus more narrowly on issues that pertain only to Critical Care.

Why do Pulmonary/Critical Care? At age 50 and being a Pulmonary Critical Care internist, I can tell you that I am very glad to have the sub-specialty of Pulmonary to fall back on. Many of my friends from training who went into straight Critical Care are no longer doing it, because it can burn you out. I still love it and just re-certified for the second time. In my practice, we take turns being in the ICU. I am ready after my week or two in the unit to get back to the clinic, although I am always excited to go back to the ICU. From a practical standpoint, there are a lot more slots available to train in Pulmonary/Critical Care.

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