An intensive care specialist diagnoses, treats and supports critically ill and injured patients. They lead a multidisciplinary team and liaise closely with all specialists involved in the patient’s care to recognise and manage the disturbances associated with severe medical, surgical, obstetric and paediatric illness, and to diagnose and treat the conditions that cause them.
Intensive care specialists can work as a general intensivist and provide a full spectrum of care, or have a focused area of interest such as paediatrics neonatal, coronary, retrieval medicine, perioperative care or anaesthetics.
It is mainly a hospital-based career with no outpatient clinics, and although there is no long-term continuity of care, the role requires significant patient and family involvement during admission time.
To be an intensive care specialist, you need to:
You need to be aware you’re committing yourself to a lifetime of largely shiftwork, including after hours and on call commitments, resulting in long hours. Although this can be very demanding, the caveat is that you get more days off. Most hospitals in WA encourage their registrars to try and have a good work-life balance by seeking out 0.5 FTE positions. There are very few hospitals that don’t offer some type of flexibility around this.
Training to become an intensive care specialist is facilitated through the College of Intensive Care Medicine of Australia and New Zealand (CICM). The training program is roughly six years if you’re efficient, but typically it could take a little bit longer and includes two years of core ICU, a year of transitional ICU, a year of anaesthetics, then some medicine, some paediatrics, some rural and an elective.
There are lots of opportunities for you to get exposure to intensive care through your prevocational years, either directly, through ICU terms, or indirectly, through other activities such audits, research and training (ALS1, ALS2 or ATLS). You can complete ultrasound courses - intensive care medicine is becoming an increasingly ultrasound focused specialty, so it’s good to learn to do CAT scans, ultrasound guided vascular access, thoracic, etc. A lot of these opportunities are offered here in Perth via CTEC, and NEXUS.
If you do already know you want to get onto the program, you can be quite efficient in your RMO years. For example, you could do a rural or paediatrics term and get this recognised as prior learning once you get onto the training program.
Not only will these activities help you to determine whether intensive care is the right profession for you, it will provide you with great experience and background to include in your application for the college, ultimately showing that you’re keen. Getting involved in intensive care gets you a long way.
The College is quite unique in that they don’t organise your jobs for you. You need to seek out specific jobs at each of the hospitals, although the application process is becoming more centralised.
CICM only has one intake per year, generally mid-year, so it’s important you get your application completed and submitted in a timely manner. Foundation units take six months, and can be completed at most of the ICUs around Perth. You’ll get a good scope and breadth if you go to one of the more peripheral units (such as SJOG Midland and Armadale), and they’re more likely to take on a more junior service registrar.
There are two very big exams that you need to complete. The first one is an exam that you sit at the very beginning, and you will also need to sit an exit exam. Both require a lot of study – typically around 9 – 12 months. It’s challenging to get through these exams on top of the shiftwork and the many challenging situations you might encounter in ICU such as end-of-life care, palliation, brain death testing and organ donation.
Starting the training program in PGY4 is generally the best option because this allows you to get a broad background in general medicine, infectious diseases, cardiology and emergency medicine. Some trainees (particularly during the COVID-19 pandemic) stepped up from PGY3 into ICU registrar roles, which was necessary at the time, but not ideal.
Further information around training time and requirements can be found here
