Your clinical practice will immerse you in cardiovascular critical care at its most sophisticated level. The patient census varies predictably throughout the week, typically starting Monday mornings with 6-8 patients, building to 12-15 by Friday as surgical volume peaks, then cycling back down to 6-8 by the following Monday. This rhythm allows you to manage both the intense demands of peak volume days and the opportunity for more detailed attention during quieter periods. What distinguishes this practice from typical ICU work is not the volume but the extraordinary acuity: every patient in the CV-ICU arrived there because of severe illness requiring the highest level of specialized cardiac critical care expertise.
The case mix reflects the program's status as a regional referral center for the most complex cardiovascular pathology. Approximately 70% of your patients will be cardiac surgery related, with the remaining 30% coming from the cardiology service with medical cardiac emergencies. These are not routine post-operative cases managed by protocols. Your patients include heart and lung transplant recipients navigating the precarious early post-transplant period, ECMO patients with refractory cardiogenic shock or respiratory failure, patients with biventricular assist devices or LVADs bridging to transplant, complex open-heart cases involving simultaneous CABG with multiple valve repairs and aortic surgery, and high-risk vascular patients following thoracic endovascular aortic repairs or open aortic dissection repairs.
The Cardiovascular ICU serves adult patients across the full spectrum of critical cardiac and thoracic illness. Common admissions include patients recovering from isolated CABG procedures, isolated valve surgeries (aortic valve replacements, mitral valve repairs), complex procedures combining multiple interventions, heart and lung transplants, LVAD and BiVAD implantations, ECMO cannulation for cardiogenic shock or post-cardiotomy syndrome, thoracic aortic repairs both open and endovascular, and esophagectomies when thoracic surgical patients require ICU-level monitoring.
Beyond the surgical cohort, you will manage cardiology patients admitted with severe decompensated heart failure, cardiogenic shock requiring inotropic support or mechanical circulatory support devices (Impella, intra-aortic balloon pumps, tandem heart), STEMI patients post-percutaneous coronary intervention with complications, complex arrhythmias requiring advanced monitoring, and severe cyanosis requiring medical intervention. The pediatric congenital heart program accepts patients up to 30 years of age, though the majority of your practice focuses on adult acquired cardiac disease.
Your patients frequently present with the complications that define high-acuity cardiac critical care: acute kidney injury requiring continuous renal replacement therapy (CRRT), multi-organ dysfunction, coagulopathy following cardiopulmonary bypass, respiratory failure requiring advanced ventilator strategies, hemodynamic instability requiring vasoactive medication titration, and the complex fluid and electrolyte management challenges that follow cardiac surgery. These are patients whose families understand they are receiving care unavailable elsewhere in the region.
The breadth of advanced cardiac procedures and technologies you will manage distinguishes this practice from typical critical care positions. The mechanical circulatory support program provides comprehensive experience with ECMO (20-25 cases annually and growing), LVADs, BiVADs, Impella devices, intra-aortic balloon pumps, and tandem heart support. You will become proficient in the hemodynamic optimization, anticoagulation management, and complication surveillance these devices demand.
The robust transplant program performs 40-50 heart and lung transplants annually, with volumes increasing year over year. More hearts than lungs are transplanted, though both programs offer the full range of transplant critical care challenges. You will greet heart and lung transplant patients directly from the operating room, managing the critical first hours when primary graft dysfunction, bleeding, and hemodynamic instability are most likely to emerge.
Your procedural skills will expand or remain sharp through regular central line placement including pulmonary artery catheters, arterial line insertion, lumbar drain management for thoracic and vascular cases, and airway management for critically ill cardiac patients. While the CRRT program is currently managed jointly by a PICU physician and an off-site nephrologist, all patients requiring renal replacement therapy receive it promptly, and program development offers opportunity for intensivist leadership in building a more robust acute kidney injury support infrastructure.
The cardiac catheterization program is exceptional, run by Dr. Ivory Crittendon, providing immediate access to interventional cardiology support when your patients develop ischemic complications or require mechanical circulatory support device placement. When patients exceed the CV-ICU's capacity, flow agreements allow appropriate distribution to the broader Surgical ICU, ensuring bed availability never compromises access to necessary care.
Your schedule will be structured to provide predictable time off while maintaining continuity during your clinical weeks. The current model employs week-long rotations where each cardiac critical care specialist covers the CV-ICU for one week straight, taking night call from home during that week. Monday and Tuesday following your clinical week become post-call recovery days, acknowledging the intensity of 24/7 responsibility in this high-acuity environment.
Current Schedule Structure:
Future 24/7 Model (as team grows):
During day shifts, you will have robust support. The CV-ICU attending (you) works alongside an advanced practice provider and shares a resource physician with the Surgical ICU who can assist with admissions or procedures. Rounding occurs with your APP presenting cases, followed by admitting post-operative cardiac surgical patients as they emerge from the OR. The interprofessional team includes respiratory therapy, occupational therapy, and dedicated nursing staff who understand the unique demands of cardiac critical care.
Night coverage currently includes you as the attending taking call from home, with increasing APP coverage moving toward 24/7 presence, and a backup attending available at home for consultation. The afternoon and overnight window (12:00pm-6:00am) sees the highest volume of new admissions as operative cases finish and patients decompensate during evening hours, making this the time when APP support becomes most valuable.
Weekend coverage aligns with your weekday ICU rotations. When you are on the cardiac critical care call team, your ICU week includes the weekend, with no additional weekend commitments beyond your scheduled service. This structure prevents the fragmented schedules common at many academic centers where clinical weeks never align with weekends off.
If you choose to participate in subspecialty call teams beyond cardiac critical care, additional compensation recognizes the significant lifestyle impact of transplant and ECMO coverage. The liver transplant team is highly compensated since cases occur predominantly on nights and weekends. Heart and lung transplant team participation also carries additional compensation, though transplant surgical timing cannot be predicted and these cases demand immediate in-house response regardless of hour or day.
Holiday coverage is distributed fairly across the critical care team, with schedules created six months at a time and published three months in advance, allowing you to plan major life events well ahead. High-demand vacation periods operate on a lottery system to ensure equitable access to desirable time off.
Your educational contributions will be woven into daily clinical work rather than added as separate obligations. The CV-ICU operates as a resident-run unit for documentation, with a daily mix of surgery and anesthesia residents rotating through the service. Typically 2-3 residents round during daytime hours with one resident in the unit overnight, providing graduated responsibility under your supervision. You will teach ventilator management, hemodynamic optimization, mechanical circulatory support troubleshooting, and the nuanced decision-making that defines expert cardiac critical care.
Beyond residents, you will contribute to fellowship education across three programs: Adult Cardiac Anesthesia fellows learning the post-operative critical care of their surgical cases, Pulmonary Critical Care fellows managing complex respiratory failure in cardiac patients, and Neurocritical Care fellows encountering the neurologic complications of cardiac surgery and circulatory support. With 70 anesthesiologists, 100 CRNAs, and more than 45 house staff in the department, teaching opportunities abound but never overwhelm clinical responsibilities.
Research participation is welcomed and supported but never required. One of the most prolific researchers in the hospital is a cardiac intensivist who retired from operative anesthesia but maintains academic time. The research infrastructure exists for those interested in clinical investigation, quality improvement projects, or outcomes research, but publication pressure does not exist for those who prefer to focus on clinical excellence and education.
The culture of collaboration between cardiac intensivists and cardiac surgeons represents one of this position's most distinctive features. You will round daily with the cardiac surgical team, including Dr. Patrick Parrino and Dr. Aditya Bansal, engaging in genuine shared decision-making rather than the territorial dynamics that plague many programs. As Dr. Yockelson describes it, the surgeons do not tell intensivists how to manage ventilators, but they voice concerns based on surgical experience and expected trajectories. Similarly, intensivists respect surgical judgment about when patients are ready for chest closure or when delayed sternal closure better serves recovery.
This partnership is built on trust earned through consistent good outcomes and mutual respect for complementary expertise. When complications arise, the response is collaborative problem-solving rather than finger-pointing or defensive positioning. Surgeons and intensivists have learned to depend on each other's experience to provide higher quality care than either could deliver independently. For physicians who have experienced toxic relationships between surgery and critical care in other institutions, this collaborative environment offers remarkable professional satisfaction.
Support from anesthesiology colleagues is equally strong. Nobody criticizes you for calling for help, and the group's collaborative culture means assistance arrives quickly when complex cases demand additional expertise. If you choose the blended track with operating room time, you will work with CRNAs on 50% of your cases (typically managing 2-3 rooms simultaneously when paired with a CRNA) and with residents on the other 50% of cases (guaranteed two resident rooms when residents are assigned). Rarely will you start more than two cases simultaneously, even with CRNA support, allowing focused attention on the cardiac and thoracic cases that require your subspecialized skills.
This clinical environment offers what many cardiac critical care physicians seek: the opportunity to practice at the highest level of complexity and acuity, supported by institutional resources and collaborative colleagues, with schedule structures that prevent burnout, in a program committed to growth and innovation. You will manage patients who cannot receive this care elsewhere, teach the next generation of specialists, and help build the infrastructure for a world-class cardiac critical care program.