Despite the growing demand for board- certified intensivists in the United States, the roles for medically trained intensivists (MTIs) in leadership positions in surgical ICUs remain limited. This report explores some of the challenges facing internal medicine (IM) critical care fellows who are considering careers as surgical intensivists or MTIs who are moving to a surgical ICU. A practical framework is provided for attaining these jobs and thriving in these positions once obtained. The article explores the nuances between medical and surgical ICUs and concludes by describing how surgical critical care can be a gratifying career for the IM-trained intensivist and an asset to the surgical ICU.
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