Alternative Career Paths in ICM

In the earlier stages of my training, I disliked the discomfort I felt when patients deteriorated to a level beyond my skill set. The ICM doctors who arrived at such times clutching bags of impressive sounding drugs and equipment before whipping them away with an air of proficiency impressed me. I applied for ACCS training, hoping to join their ranks. Vocalising an interest in ICM prompted a range of responses from colleagues. “Are you sure?”….

“Don’t you want a family?” “Keep your options open” and “You’ll change your mind” were common. Interestingly, none of these responses came from intensive care consultants, most of whom had interests and responsibilities outside of clinical work yet appeared to be getting along quite nicely. I kept their quietly competent example firmly at the front of my mind and pressed on.

Once I was pregnant with my eldest, my mind shifted from the “could I?” question to the “should I?”. I knew I had the determination and work ethic to make it work, but at what cost? I was immediately cognisant that my choices and ambitions might have impacts beyond myself. The last few ICM jobs under the old scheme were advertised and filled at the beginning of my maternity leave, where I was deep in the trenches of breastfeeding and sleeplessness. It felt like the decision had been made for me, and to be honest I felt some relief that was the case.

Once I returned to work, I faced the uphill battle of completing my FRCA with a small baby and a partner who worked away from home. I was completely overwhelmed and actually turning up for work and remaining sane became my priorities. All other ambitions beyond that vanished in that period of survival mode. I actually completed an application form for a psychiatry training scheme as the attraction of more predictable work patterns loomed large. It is to the eternal benefit of the psychiatric patients of the West of Scotland that (as was typical of this chaotic period) I missed the deadline. I returned to putting one foot in front of the other in my current career path. There was little room for anything else.

The loss of a sense of self in early motherhood is an entirely common phenomenon as the basic physical and psychological needs of others trump everything else. I didn’t even have the brain space to mourn any of that for a few years as my family grew and the small pockets of time I had once been able to carve out for myself completely imploded. A steady trickle of often well-meaning comments, assumptions, omissions and overlooks slowly seeped into the corners of my consciousness, and I almost didn’t notice the subtle shift in my own ambitions and behaviours as I learned what was expected of me.

As I entered higher anaesthetic training, I was often asked what my “special interest” was, and I didn’t have an answer. It had always been critical care but even saying it out loud made me felt defeated. At roughly this stage I returned to ICU for my higher training and I was surprised to find that I was genuinely excited. I felt more at home and more like myself than I had for a long time.

The team I was now a part of was supportive and encouraging and I felt welcome and safe. Most of them had caring commitments or interests outside medicine yet seemed to be flourishing. I appreciated their honesty about the challenges of maintaining a semblance of balance and it helped normalise my own experiences. I tentatively expressed my interest in ICM and was warmly encouraged and given helpful, practical advice. The option of accessing advanced ICM training during my anaesthetic training was suggested, which seemed like a perfect compromise. I approached our local FICM representatives and the anaesthetic training committee and was given the go-ahead. Suddenly advanced ICU training was not only going to happen, but very soon. This was probably for the best as it gave me less opportunity to overthink what I was getting into. I was both excited and mildly terrified.

I started my advanced block at one of our local district general hospitals, which was perfect for me. It was a good-sized, busy unit where I encountered a steep learning curve, but was part of a hugely supportive team. Again, the importance of role models became key for me in terms of riding out my initial imposter syndrome as I moved out of my comfort zone. Here I had some fantastic ones who were full of helpful advice and encouragement. This was replicated at my next two placements, where once again I was surrounded by excellent role models who helped me develop my ICM knowledge and leadership skills and were both inspiring and supportive. Many of the exceptional consultants I worked with had also had less conventional paths to ICM and were happy to share their experiential learning with me.

I had some concerns about how I would be looked upon as an ICM consultant when the time came to apply for “grown up” jobs because of my unconventional training path. Whilst some positions do stipulate formal dual training as a mandatory requirement, I was pleasantly surprised to see that many units were not put off by the mode of my ICM training. My advice to anyone in a similar position would be not to downplay your own individual skills and personal qualities. It is possible to build a very competitive CV regardless of your mode of ICM training. Meetings, courses, special skills, teaching and management opportunities are accessible to all advanced ICM trainees and should be encouraged and embraced. In addition, there are many “soft skills” which departments are often looking for in a colleague that go beyond this. Commitment to specialty, work ethic and interpersonal skills are highly prized and should not be underplayed.

My summary to anyone considering an alternative path to ICU is to ask yourself where you see yourself working happily in ten years’ time, rather than where you are right now. Imagine what you want your working life to look like, as it will be where you spend a rather hefty chunk of your time. In my early career I was quite blinkered (understandably) by what suited me at that moment and didn’t really have the bandwidth to think beyond that. As my children have gotten a little older and those pockets of time for me are starting to reappear, I’m really glad that I’ve made choices with my future self in mind. Look around you and find role models and ask them how they made it work. If you’re feeling very brave, ask them if they are happy and if they would make the same choices again. Don’t make any choices based entirely on the advice of others, including me! Only you and those closest to you know what is best for you as an individual. If ICM is your passion, there are ways and means to make it work, outside of the standard career path. So, I would spend less time focusing on the can I do it, than the should I do it. If the answer to the second question is yes, the rest can and will follow with patience, perseverance and support.