Showcase: Destination Gainesville
Kevin Ferguson MD, FACEP
Associate PD for Anesthesiology based CCM program which currently has 4 EM trained fellows. Pioneered the program in Gainesville, FL with the Dept of Anesthesiology
Univ of Michigan Medical School
EM Residency at King/Drew Medical Center, LA
Critical Care Fellowship SUNY Upstate, Syracuse, NY
Big Fan of Michigan football, loves BBQ/food smoking; still working on the perfect rub, mop and sauce; and passionate about Global Health- Directs a 2 week clerkship in Bangkok, Thailand and operates a clinic in the northern mountain villages for the Akha hill tribes of Thailand!!
I got hooked during SICU rotation in residency with the amazing William Shoemaker. I became a “perfusionist” and really loved that we titrated and tailored therapy to the individual patient. In ED I’ve loved caring for the “Bad sick” & “Bad Hurt” as opposed to the minor care patients. I know I had an impact.
Why should prospective applicants consider Gainesville, Florida?
Our fellowship is 2 years and based in our Anesthesiology department. We have a good collegial relationship and our ED trained fellows are accepted as “real” intensivists. Our fellows spend the 1st year on inpatient ICU rotations and have 4 months of ED rotations in the second year. EM fellows are permitted to expand their experience beyond what the Anesthesiology based fellows do and can rotate in MICU, and CICU in the second year.
How can the EM-CCM section help?
Like most intensivists I seek a seamless stream of care from pre-hospital, ED, ICU, OR care. I would like to have a short term ED/ICU that will permit development of protocols for the first 12-23 hours of care designed to reduce the admissions to inpatient ICUs.
Many ICUs admit patients with DKA, respiratory failure managed with NIPPV, CHF etc…all these could be managed in a short stay ED based ICU effectively expanding the critical care capacity of the hospital without building a new unit. I’d like the section to help us expand the ED based CCM arena.
The development of non-invasive hemodynamic monitoring will permit more aggressive goal directed resuscitations with increased patient safety and efficient use of physician resources.
Marie-Carmelle Elie MD, FACEP
SUNY Downstate Medical School
EM Residency NY Hospital, Queens and Mount Sinai Hospital, NY
Fellowship: R Adams Cowley Shock Trauma Center
Enjoys food, wine and volunteering on international mission trips… Served on EMRA board- oversaw the creation/ establishment of combined residency committee and EM-CCM sub-committee; chaired both; Member of the US Critical Illness and Injury Trials Group; working on the LIPS-A Lung Injury Prevention Study with Aspirin and Biomarkers in Pediatric Sepsis-and board certified in Palliative Care too!
What is your practice pattern?
Currently, my clinical time is spent 70% EM, 20% CCM, 10% Hospice- Palliative Care. My EM effort is at UF and I work independently as an intensivist in a community hospital managing 3 intensive care units. Hospice Palliative Care is mostly with the critically ill population at the University and provides me with the unique opportunity to assist patients and families to make the natural transition toward end-of-life. In my mind this is as close to holistic care that I can provide to my patients.
The Future of EM-CCM?
It’s time we perform investigations exploring the longitudinal impact of EM/CCM on the respective specialties; number of publications, our influence on current practice on EM (how many more lactates get drawn in your ED?…..How many innovations have EM-CCM folks brought to their local shops and regionally (eg, NYC- GNYHA; in Sepsis and hypothermia et al).
Emergency physicians truly are multi-talented and multi-faceted. Greatest challenge is learning how to say no! I truly envision the future of the US healthcare system resides squarely in EM where we practice the most challenging medicine in the country.
Rohit Patel MD
University of Alabama Medical School, Birmingham, AL
EM Residency at Lincoln Medical Center, Bronx, NY
Fellowship at University of Florida, Gainesville, FL
Graduate of the fellowship program, he splits time between working in the ED and surgical intensive care units; is the Director of Critical Care Ultrasound; outside of medicine, he is a tennis and golf aficionado and counts “Atlas Shrugged” and” Catcher in the Rye” amongst his favorite works!
Experiences at Gainesville?
One of the biggest fears I had prior to accepting the fellowship spot at University of Florida was how the other physicians would welcome emergency medicine residents training in the ICU. From my 2 years here as a fellow and now as faculty, I am always amazed at how receptive each physician is of ‘alternative’ pathway trainees. In the ICU fellowships here we have representatives from surgery, anesthesiology, internal medicine, emergency medicine, and even obstetrics-gynecology. The attending physicians tailor the teaching of fellows to what their deficiencies are from residents. All residents come in with different strengths and weaknesses and we tend to learn from each other throughout the training process. We have attending physicians from surgery, anesthesia, medicine, and emergency medicine and this adds to the ‘multi-disciplinary’ rounds concept
Challenges of working in two departments?
Challenges working in two different departments as a faculty member in academics can be difficult since you are spread a little thin when it comes to didactic training component. Each training program has various components of didactics and it can be difficult making attendance to each session.
It is also difficult sometimes to draw a line with what is required in the emergency department versus what items can be done in the intensive care unit. The resources available in one setting are different than another, and I have to adjust to what is around me. Practicing Critical Care would be best if we have multi-disciplinary intensive care units in the country.