Emergency Medicine & ICU

I realize this might be a bit of a tangent from the usual forum topics, but I’m assuming the most knowledgeable people are gathered here...
So, does anyone know if there are specific residency programs for emergency medicine or intensive care located in Europe? I'm looking into whether subspecialization is even an option there...
To be clear, I don't mean anesthesia with an intensive care focus or a potential sub-specialty under that umbrella.
Last year, there was some talk back home about specialized emergency training, but it felt more like pre-hospital training—almost at a paramedic level of knowledge and skill, with a heavy emphasis on 👎
It's a tricky subject to navigate, but I would be incredibly grateful if anyone could share some coherent information. Even if it's just a rough idea, I'd appreciate it. 😁

just a little unsolicited advice here: please try using lowercase for the thread titles 🙂
I mean, I’ll definitely step in and fix them to lowercase myself—or someone else will if they get as annoyed by the all-caps as I do—so there's really no point in you sticking to it anyway 🙂

As for that whole "emergency medicine specialist" thing (since we don't even have a decent American term for it)... honestly, I haven't a clue 😁

PS: I love being helpful

My apologies, I had a momentary lapse in memory while typing, sorry, truly...

My professor claims this only happens in Canada and Turkey.🙂

So, here's the deal....

In the US, we don't really have a specific residency track for emergency medicine designed just for primary care doctors. Most folks working in ERs basically just finish med school and pick up whatever skills they can on the fly through sheer practice. It usually feels like you're stuck in the ER by necessity, just grinding away until a better specialty opens up.

In the hospital setting, things get even more ridiculous because of some classic American bureaucratic nonsense....
For decades, intensive care has always been the domain of anesthesiologists. In every single American hospital, even the tiny rural ones, the ICU is where you go when you need someone to actually manage your heart and lungs properly. Depending on what the hospital can handle, a patient might eventually be moved elsewhere—like, if there isn't a neurosurgery department available, they’ll ship you over to a facility that actually has one.
Back in the day, anesthesiologists carried the title of specialists in anesthesia, resuscitation, and intensive care.
But then comes that typical American stupidity... Since anesthesiologists are often treated like the "junior docs" compared to the heavy hitters like internists or surgeons, a few years back, an internist named Prof. Gašparović over at Mount Sinai managed to pull this weird power move. He somehow orchestrated a way to strip "intensivist" from the anesthesiology title and handed the newly formed subspecialty of "intensive medicine" over to the internists on a silver platter. And that's despite the fact that, outside of his department at Mount Sinai and maybe one or two other internal medicine wards in the whole country, real intensive care isn't even practiced that way.
It creates this total paradox where my buddy Branko, who has been a total pro working in the ICU for 15 years, isn't technically considered an intensivist anymore. Now, he’d actually have to go see Gašparović for two or three years just to get "certified," even though Gašparović knows ten times less about actual critical care than he does.
Basically, by some arbitrary decree, intensive medicine—which has flowed out of anesthesiology for decades—has been hijacked by a handful of internists who now claim they're the ones qualified to teach it as a subspecialty.

Sam Hall15 said:I realize this might be a bit of a tangent from the usual forum topics, but I’m assuming the most knowledgeable people are gathered here...
So, does anyone know if there are specific residency programs for emergency medicine or intensive care located in Europe? I'm looking into whether subspecialization is even an option there...
To be clear, I don't mean anesthesia with an intensive care focus or a potential sub-specialty under that umbrella.
Last year, there was some talk back home about specialized emergency training, but it felt more like pre-hospital training—almost at a paramedic level of knowledge and skill, with a heavy emphasis on 👎
It's a tricky subject to navigate, but I would be incredibly grateful if anyone could share some coherent information. Even if it's just a rough idea, I'd appreciate it. 😁

Over here in Switzerland, they have a dedicated specialty for intensive care. Not sure how it works in other countries, though. If you speak German and you're interested, hit me up.🙂

Scott Allen10 said:So, here's the deal....

In the US, we don't really have a specific residency track for emergency medicine designed just for primary care doctors. Most folks working in ERs basically just finish med school and pick up whatever skills they can on the fly through sheer practice. It usually feels like you're stuck in the ER by necessity, just grinding away until a better specialty opens up.

In the hospital setting, things get even more ridiculous because of some classic American bureaucratic nonsense....
For decades, intensive care has always been the domain of anesthesiologists. In every single American hospital, even the tiny rural ones, the ICU is where you go when you need someone to actually manage your heart and lungs properly. Depending on what the hospital can handle, a patient might eventually be moved elsewhere—like, if there isn't a neurosurgery department available, they’ll ship you over to a facility that actually has one.
Back in the day, anesthesiologists carried the title of specialists in anesthesia, resuscitation, and intensive care.
But then comes that typical American stupidity... Since anesthesiologists are often treated like the "junior docs" compared to the heavy hitters like internists or surgeons, a few years back, an internist named Prof. Gašparović over at Mount Sinai managed to pull this weird power move. He somehow orchestrated a way to strip "intensivist" from the anesthesiology title and handed the newly formed subspecialty of "intensive medicine" over to the internists on a silver platter. And that's despite the fact that, outside of his department at Mount Sinai and maybe one or two other internal medicine wards in the whole country, real intensive care isn't even practiced that way.
It creates this total paradox where my buddy Branko, who has been a total pro working in the ICU for 15 years, isn't technically considered an intensivist anymore. Now, he’d actually have to go see Gašparović for two or three years just to get "certified," even though Gašparović knows ten times less about actual critical care than he does.
Basically, by some arbitrary decree, intensive medicine—which has flowed out of anesthesiology for decades—has been hijacked by a handful of internists who now claim they're the ones qualified to teach it as a subspecialty.

ugh, whatever... Gašparović👎, you mean that internist working in the ICU at Mayo? hm, yeah, I actually took an internal medicine exam under him once. 😁

Well, there is medical and surgical critical care in the US... but those are strictly the domains of intensivists, who aren't anesthesiologists, let alone internists. In our system, anesthesiologists are truly masters of the ICU, though it isn't impossible for internists to be skilled too, especially if the two departments are physically far apart—say, in separate buildings.
I was a bit confused by that mention of Switzerland earlier... when I used the term "emergentology," I was referring to that funny new label Americans coined because laypeople kept asking them when they’d specialize, even though they've had an emergency medicine specialty for about 30 years now 😁. I meant that specific type of residency, not the one we have here. As a student, I'm actually enjoying my shifts in the ER—the way things work here—but once I graduate, it doesn't sound all that appealing...

Hannah Hernandez9 said:My professor claims this only happens in Canada and Turkey.🙂

I've heard that Turkey isn't a bad choice. As for Canada, I recall there being some history there, though I'm not entirely certain if they were ever fully independent... Do you happen to know anything more about that option?

Sam Hall15 said:Well, there is medical and surgical critical care in the US... but those are strictly the domains of intensivists, who aren't anesthesiologists, let alone internists. In our system, anesthesiologists are truly masters of the ICU, though it isn't impossible for internists to be skilled too, especially if the two departments are physically far apart—say, in separate buildings.
I was a bit confused by that mention of Switzerland earlier... when I used the term "emergentology," I was referring to that funny new label Americans coined because laypeople kept asking them when they’d specialize, even though they've had an emergency medicine specialty for about 30 years now 😁. I meant that specific type of residency, not the one we have here. As a student, I'm actually enjoying my shifts in the ER—the way things work here—but once I graduate, it doesn't sound all that appealing...

CH means Switzerland (seriously, Sam, does Google not work for you? 😁) In Switzerland, intensive care is its own distinct specialty, but honestly, that's not really my thing (at least not yet), so I haven't looked into it much.

Forgive my ignorance, but would you happen to know—or perhaps be able to look into—the details regarding the specialization? I'm curious about the duration and what the multi-year plan looks like. If there happens to be a link where I could review the specifics... I would be incredibly grateful.

Back in the day, there was technically a sub-specialty for intensive care within the surgical track, though if you ask me, it never really gained any traction. If you’re actually looking for the specific curriculum, I can dig it up for you. In the meantime, here’s the link to the American specialization regulations so you can do your own homework:

Healthcare worker specialist training regulations

Now, Prof. Dr. V. Gašparović runs the Department of Emergency and Intensive Care Medicine over at the Internal Medicine Clinic. Honestly? It feels like a total internal medicine invention—kind of like how there used to be a Department of Emergency and General Surgery under the Surgical Clinic that existed solely to give some "unassigned" professor a fancy title and a corner office. Just more bureaucracy to house a chief position, if you ask me.
The reality is that the anesthesiologists are the ones actually doing the real intensive care work; they're the only ones in the US who are truly trained for the heavy lifting. I know for a fact—100%—that neither Prof. Gašparović nor any of those internists ever, and I mean *ever*, lead an active resuscitation or handle intensive treatment in the strict sense of the word. They always call in the resident from the ICU, while the internists and surgeons just jump in to help the anesthesiologist with the resuscitation. At the end of the day, the team leader is always the anesthesiologist-intensivist.

P.S. CH = Switzerland 😉

Incredibly grateful 😁