<h1>2 - patients in comas are cared for in the intensive care units (some hospitals only have one ICU but others may have a medical ICU, a surgical ICU, a cardiac ICU and a neuro ICU depending on what problem put the patient in a coma, and additionally may have a Pediatric ICU, a Pediatric Cardiac ICU and a Neonatal ICU for patients of certain ages or with certain conditions). As such, there are multiple ways to reach a goal of taking care of comatose patients on a regular basis - though the number of comas may be widely variable and when possible, we try to keep patients out of comas. What are these paths?</h1>
<ul>
<li><p>Medical ICU - complete a 3 year internal medicine (adult medicine) residency then either a 2 year fellowship in Critical Care medicine or a 3 year Pulmonary Disease and Critical Care Medicine. Alternatively you may do a 4 or 5 year Anesthesia residency and then a 1 or 2 year Anesthesia Critical Care Medicine Fellowship</p>
<ul>
<li>Cardiac ICU - complete a 3 internal medicine then a 3 year Cardiovascular Disease Fellowship. </li>
<li>Surgical ICU - complete a 5 year General Surgery residency then a 1 year Surgical Critical Care fellowship.</li>
<li>Neuro ICU - Finish a 6-8 year Neurosurg residency or a 3-4 Neurology residency (and demonstrate a desire to work in acute care neuro).</li>
<li>Pediatric ICU - do a 3 year pediatric residency and then move on to a 3 year Pediatric Critical Care Medicine fellowship.</li>
<li>Neonatal ICU - (not a lot of comas per se, but 800 gram 26 week Preemies don’t do a whole lot to begin with) complete a 3 year pediatric residency and then a 3 year Neonatal - Perinatal Medicine fellowship</li>
<li>Pediatric Cardiac ICU - 3 year peds residency then a 3 year Pediatric Cardiology fellowship.</li>
</ul></li>
</ul>
<p>Now, despite this diversity of ICU settings, a lot of places will not be quite so specialized. For example, I will be applying for a Pediatric Critical Care Medicine fellowship in the summer of 2011. I will get a lot of exposure to Cardiac ICU care because in many smaller Children’s hospitals, the PICU and the CVICU are not separated and as the Intensivist those heart babies would still be my patients. Likewise, on the adult side of things, the Medicine Critical Care docs and Anesthesia Critical Care docs may be involved in any or all of the “specialized” ICU areas. And you’ve correctly identified that Neurosurgeons spend a lot of time in the ICU. Additionally, trauma surgeons and pediatric surgeons often have a number of patients in ICU settings though they may not necessarily be the primary team making decisions depending on how the ICU is set up (Trauma and Pediatric fellowships out of general surgery are 2 years in length). So if you want to take care of sick patients, there are a number of ways to get there.</p>
<h1>3 - Neurosurgery is extremely competitive and requires very high board scores while a medical student along with excellent grades. Across the board, it’s is far more competitive than general surgery although some general surgery programs will be more difficult to get into then certain NSGY programs.</h1>
<h1>4 - Plastic Surgery, Dermatology, Neurosurgery, Radiation Oncology, Otolaryngology and Head/Neck Surgery (ENT), and Orthopedic Surgery are all extremely competitive. Urology and Ophthalmology have not been part of the same Residency Match program, so I don’t have their stats, but they are also near the same level of competition.</h1>