Program Director Q&A Issue 35 Volume 4

Sarah M. Alber, MD is a cardiothoracic anesthesiologist and intensivist in our cardiothoracic intensive care unit at the University of Colorado. I serve as the Program Director for our Anesthesiology Critical Care Medicine (ACCM) Fellowship, and our innovative 5-year Combined Anesthesiology Residency and Critical Care Medicine Fellowship which fosters critical care education over the entire program and integrates fellowship training over the final 24 months of training. My non-clinical time focuses on fellow education in critical care, career development, and critical care focused transesophageal echocardiography. I am an active member of SOCCA, and serve on the SOCCA Women in Critical Care Steering Committee.

Dr. Pannu: What are some of your favorite parts of being a critical care medicine fellowship program director?

Dr. Alber: Each year I am energized by the enthusiasm, curiosity, and passion of our fellows. What I most enjoy about being a program director is the opportunity to mentor and encourage our burgeoning intensivists to develop a growth mindset, creating a safe culture to ask questions and understand what underlies our knowledge and thought processes when managing critically ill patients. In doing so, our discussions promote questions that then trigger ideas. These ideas are the spark for the next research topic or QI project, or the development of a new curriculum. Our fellows are the future leaders of our field, and I am excited and honored to play a role in their development.

Dr. Pannu: What are some challenges program directors are facing today? 

Dr. Alber: The biggest challenge in the post-pandemic era is the waning interest for residents in pursuing fellowship training. The ACCM fellowship has been particularly hard-hit, and many programs are unfilled. While the job market outside of the ICU is gaining new graduates at high rates, what the fall-out of this will look like for the future of our sickest patients is alarming. 

As Mary Dale Peterson so inspiringly described at this year’s Rovenstine Lecture of the ASA Meeting, the anesthesiology community stood up as a voice of safety and “ran towards the fire” as leaders in the emerging pandemic alongside our emergency medicine colleagues. ACCM intensivists were essential in providing bedside care, developed methods to turn anesthesia machines into ICU ventilators, supported non-intensivist colleagues in principles of critical care, and provided procedural expertise, to name just a few of our many crucial roles.

With the current recruitment challenges, the fallout of too many patients and not enough intensivists - particularly outstanding anesthesiology critical care intensivists - is concerning. Burnout, workplace stress, social and emotional demands in complex multidisciplinary ICU environments, and a need for work-life balance is a reality we all know. It is apparent to our rising medical students and residents. They see our struggles. However, we know our unique skill set and the essential role we play in critical care. Let’s use this challenge to tap into our anesthesiology roots, to ask questions, to find new ideas, and reshape critical care into to a career that our rising generations are inspired and excited to pursue. 

Dr. Pannu: What advice would you give to medical students and residents considering a career in critical care medicine? What is something you wish you had known?

Dr. Alber: Helping someone in need remains one of the most rewarding aspects of my professional life. Sometimes that person is my patient, working in unison with our ICU team to pull them back from a life-threatening illness. Sometimes it is bringing a warm blanket to a mother at the bedside, who is ignoring their own needs while expending all their energy towards helping their child. Other times it is a fellow having a “light bulb” moment as pathophysiology and management connect, even when the patient didn’t read the protocol. These are usually instances spent in less public forums than rounds and can be during my patient visits, in a lull on an overnight call, or when chatting with a fellow after rounds.

I also do not live in the ICU. As an attending my schedule varies from 1-7 days in the ICU, then I go back to the cardiac ORs for a few days, or I have time to work on academic or administrative projects. The resident and medical student ICU rotation is not usually reflective of what a career in ACCM is like.

For residents and medical students considering critical care, seeking mentorship and opportunities to shadow an attending outside of a formal ICU rotation gives an insightful view into what life as an intensivist and anesthesiologist is like. The camaraderie and support of a team, the importance of communication and collaboration in administrative and educational missions, and the ability to affect change to improve outcomes is not as apparent within the confines of a 2- or 4-week rotation.

Dr. Pannu: What are some advances you foresee in the practice of critical care medicine? What role do you foresee critical care anesthesiologists and SOCCA playing?  

Dr. Alber: While medicine has lagged behind many professions in prioritizing work-life balance, it is time that we address this need in the ICU head on. This change is an expectation of our rising medical students and residents. Rather than insisting on the status quo, let’s adapt. Let’s be innovators in our field to develop new ICU models, non-traditional coverage schedules, and innovate advances in medicine and technology to improve access to high quality critical care for our patients, and improve balance and career longevity for our intensivists. 

Anesthesiologists are creative, observant, thoughtful, and accustomed to running towards a problem. We have revolutionized perioperative care and leveraged our collective knowledge to make the operating room a much safer space. As critical care anesthesiologists let’s leverage our collective experiences and ideas though societies like SOCCA to find new ways to optimize critical care, to foster our collaborative team for fulfilling and balanced careers, and inspire the next generation of medical students and residents to pursue critical care training for the best outcomes for our patients.