Percent doing fellowships?

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criticalelement said:
think about what youre saying. Mega ballers you say....

How many places do peds hearts?

And out of all those places how many are socialistic?

All of them...

Can you make money in a socialistic arena where meritocracy does not exist?

NOOOOOOOOOOOOOOOO
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I know of one PP that does pedi hearts in a very desirable area.
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SaltyDog said:
I know of one PP that does pedi hearts in a very desirable area.
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I can't imagine a more miserable job than pedi hearts! I mean you spend your entire day worrying about calculating the dosages of medications, making sure there are no bubbles in the IV lines, kissing ass to some egotistical heart surgeon, and dreading that inevitable moment when a little kid is going to die and you can't do **** to prevent it!
 
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sevoflurane said:
Ummm.... the only other thing I'd throw in there would be the quality improvement fellowship. As there are not many anesthesiologists out there with this prestigious fellowship, you would STAND OUT :smack: amongst the rest of the anesthesia populous.
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To be fair, I think a lot of places can use some actual QI and case review. I review cases from time to time and people make some ... "unusual" choices.


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I would not recommend some of the rare fellowships being thrown around on this thread. I do however believe the big ones are a SMART use of one year. My group now pays more money to our CV guys which by the way erases their one year income loss in about four years. They become partner faster too. I was a bit jealous but guess who cannot complain because generalists come a dime a dozen? Plus I actually need them too. A group across town does about the same thing with their peds and CV hires.
Here is another unspoken truth, hospital administration who will ultimately be our bosses someday do in fact look at fellowship trained anesthesiologists as the 'smarter' ones. Our hospital administration hinted we need to hire more peds and cv guys to support their new model. So I am sitting here thinking, at least from my experience, the downsides of a fellowship are minimal.

Let's not even mention the fact that you cannot get an academic job these days without a fellowship. Talk about a door that has been slammed shut.
 
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pgg said:
If peds cardiac anesthesiologists got paid what they deserve to do those cases, they could retire to private islands a year after finishing fellowship.
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Agreed. But at the same time as being "limited" to academic centers you also get the ability to work in one of many "desirable" locations (most children's hospitals are in big cities etc). You also have the most guaranteed job security as exists in anesthesia (there's no Surgeons that will ever let CRNAs sit those cases nor are there percutaneous Norwoods threatening case numbers....).

Unfortunately, you have to do peds though.....
 
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Machinery said:
I would not recommend some of the rare fellowships being thrown around on this thread. I do however believe the big ones are a SMART use of one year. My group now pays more money to our CV guys which by the way erases their one year income loss in about four years. They become partner faster too. I was a bit jealous but guess who cannot complain because generalists come a dime a dozen? Plus I actually need them too. A group across town does about the same thing with their peds and CV hires.
Here is another unspoken truth, hospital administration who will ultimately be our bosses someday do in fact look at fellowship trained anesthesiologists as the 'smarter' ones. Our hospital administration hinted we need to hire more peds and cv guys to support their new model. So I am sitting here thinking, at least from my experience, the downsides of a fellowship are minimal.

Let's not even mention the fact that you cannot get an academic job these days without a fellowship. Talk about a door that has been slammed shut.
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Ummmm, you mind PM'ing me your approximate locale, practice type, and rough salary ranges strictly as anonymous market research? I'm negotiating with groups now and this sounds awesome......
 
facted said:
Did a regional fellowship and it CERTAINLY helped me find a job in the NYC area. I've since moved on to another private practice where again, they were only looking for regional fellowship training.

I would agree with some of the others here that certain fellowships are going to limit you for private practice. Particularly, peds and CC. Not to say you won't find some nice PP somewhere that needs those, but usually those are more sought after at big academic hospitals with "real peds" or large ICU's run by anesthesia. Small community hospitals aren't going to need you as much.

I also really think that fellowship depends a lot on where you want to end up working. If you're aiming for a competitive area, I think it's a must to do a fellowship these days. It's not going to increase your base salary all that much, but it will certainly help you land a job you wouldn't have gotten without it. My current PP in NY area is hiring a few people and we only hire fellowship trained nowadays. There is just too much competition and it costs almost the same to hire one or the other.
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whatever dude..
you are working in NYC which says everything.

You are someones play toy until you will be discarded...
Fellowships are a waste unltess you are some kind of an ass**** who cannot grasp things in four years.. Heck CRNAS master it in 18 months
 
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Machinery said:
I would not recommend some of the rare fellowships being thrown around on this thread. I do however believe the big ones are a SMART use of one year. My group now pays more money to our CV guys which by the way erases their one year income loss in about four years. They become partner faster too. I was a bit jealous but guess who cannot complain because generalists come a dime a dozen? Plus I actually need them too. A group across town does about the same thing with their peds and CV hires.
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Our peds and CV guys also make more, but that's because they are taking peds and CV call (home call). Their "hourly" is otherwise the same. A fellowship or >5yrs experience will shorten your partner track by 6mo. at my gig.
 
criticalelement said:
whatever dude..
you are working in NYC which says everything.

You are someones play toy until you will be discarded...
Fellowships are a waste unltess you are some kind of an ass**** who cannot grasp things in four years.. Heck CRNAS master it in 18 months
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First of all, yes, some people need to live in the NYC area for various reasons. Could I make more money and have a better quality of life in another geographical area? Absolutely. Can I move to those areas? No.

But that's exactly why I said in my post that fellowship somewhat depends on where you want to end up.

Second, how is a regionally trained anesthesiolgist discardable?

I don't disagree that you can learn some basic regional in 3 years of anesthesia. But if you think you can do blocks as well as I can after fellowship, sorry dude, but you're delusional. And if you don't think surgeons notice you take 15 minutes to do a supraclav and that it takes your colleague only 3 minutes, think again. At least they do at the hospitals I've worked at.

How many quadratus lumborum blocks did you do in residency? Adductor catheters? Infra catheters? Serratus Anterior blocks?

Umm, yea.

And CRNA's being facile at blocks is just a joke. Sorry.
 
facted said:
I don't disagree that you can learn some basic regional in 3 years of anesthesia. But if you think you can do blocks as well as I can after fellowship, sorry dude, but you're delusional. And if you don't think surgeons notice you take 15 minutes to do a supraclav and that it takes your colleague only 3 minutes, think again. At least they do at the hospitals I've worked at.

How many quadratus lumborum blocks did you do in residency? Adductor catheters? Infra catheters? Serratus Anterior blocks?
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Please don't injure yourself when you step off your high horse. Fellowship is great for learning esoteric **** like quadratus lumborum blocks and serratus anterior blocks but guess what. . .you will do those approximately never in private practice. Catheters? - really? If you can do an SS you can place a cath. No great wizardry involved there. And you are the delusional one if you think a regional fellowship allows you do any of the 4 or 5 blocks people actually use on a regular basis any better or faster than I can.

If you wanna be an academic then great - do the regional fellowship. If you wanna work at one of the 6 practices nationwide that is only looking for regional fellows then great - do the regional fellowship. If you just have to have one more certificate on your wall then great - do the regional fellowship. But please, please don't think for a second you are any better than a fresh residency grad from a program with good regional training. Hell, most regional fellowships could be completed by spending 3 hours on YouTube.
 
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SaltyDog said:
Please don't injure yourself when you step off your high horse. Fellowship is great for learning esoteric **** like quadratus lumborum blocks and serratus anterior blocks but guess what. . .you will do those approximately never in private practice. Catheters? - really? If you can do an SS you can place a cath. No great wizardry involved there. And you are the delusional one if you think a regional fellowship allows you do any of the 4 or 5 blocks people actually use on a regular basis any better or faster than I can.

If you wanna be an academic then great - do the regional fellowship. If you wanna work at one of the 6 practices nationwide that is only looking for regional fellows then great - do the regional fellowship. If you just have to have one more certificate on your wall then great - do the regional fellowship. But please, please don't think for a second you are any better than a fresh residency grad from a program with good regional training. Hell, most regional fellowships could be completed by spending 3 hours on YouTube.
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Except that I work in private practice and do those esoteric blocks every day. And guess what, not only do they work, the patients love them, surgeons love them, and my group loves that I do them. If you think these blocks are random and esoteric, read some freaking literature and bring your practice out of the stone age. Not sure about your practice, but every surgeon I work with is looking for anything to avoid post op narcotics and QL and Serratus certainly help with that for abdominal and thoracic cases. Just because you don't do them, doesn't mean they're not useful. And trust me, i went to a heavy regional residency and went into pp with a lot of the guys from residency and our block proficency is not on the same level. If you think doing 30-50 supras in residency is the same as doing 200 in fellowship, then I'm not sure what else I can tell you.
 
I would love an excuse to do the esoteric blocks but my surgeons over here have no interest and would look at me funny if I suggested it. I love regional, and I agree its great for the pts. I don't love your attitude.

I say we settle this with a good old fashioned block off. We'll meet somewhere in the middle i.e. Kansas. Line up 50 pts. Then it's a race: 10 ISB's, 10 SCB's, 10 ICB, 10 ACB's, and 10 Pop's (you do R-side I'll take the L-side so no one can claim they had pt's with more difficult anatomy. First one done wins but we'll add a minute to the finishing time for every pt who is not numb at 24H.

:horns::horns::horns::horns::horns:
 
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Another thread that devolves into a chest thumping war.

For what it's worth ... I agree with facted. I'm still in residency and rotate at a community hospital for a month for an elective. I felt like the regional fellowship trained person had a lot to offer. He was very well respected by the surgeons because he could perform bucks and avoid narcotics in just about anyone. If there was a nerve that supplied an area of the body, he could block it . . . And do it quickly.

I did serratus anterior catheters and paravertebral catheters blind and ultrasound with him. It was phenomenal watching patients get superior relief and rest that opioids were unable to touch. These are amazing blocks that I could see your average community level 1 or 2 trauma hospital in private practice would desire for rib fractures, kidney surgery, abdominal surgery, etc. And no, I do not feel comfortable doing these blocks having done a handful of them in residency. And no, you cannot learn to do them on YouTube or residency. You just can't learn to do it on using typical anatomy on YouTube and compare it to the suboptimal patients you might see in private practice (obese, post op dressings, atypical anatomy, etc). Not with the speed, accuracy, and trouble shooting a regional fellowship trained person can do. I know I'm good with an ultrasound. But it doesn't matter, I would need way more practice to feel comfortable to do it under my own license.

Though I do agree, that most ortho blocks I do feel very proficient in. But definitely not going to be able to do every block as well as a regional fellowship person. Some blocks you just need more experience doing. Can I do a sciatic block on a fatty as well as he can ... Probably not.
 
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facted said:
I don't disagree that you can learn some basic regional in 3 years of anesthesia. But if you think you can do blocks as well as I can after fellowship, sorry dude, but you're delusional. And if you don't think surgeons notice you take 15 minutes to do a supraclav and that it takes your colleague only 3 minutes, think again. At least they do at the hospitals I've worked at.

How many quadratus lumborum blocks did you do in residency? Adductor catheters? Infra catheters? Serratus Anterior blocks?

Umm, yea.

And CRNA's being facile at blocks is just a joke. Sorry.
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Who the hell is taking 15 minutes to do a supraclav? Geez, I went to a decidedly average (that may be generous) program, and I've never seen anyone but a new CA1 doing regional for the first time take that long. Three minutes from needle on skin for such a basic block is probably too long, but it's been years since I've timed it.

If your partners are taking that long, stop laughing at them, and teach them how to move faster. One of the reasons, I would think, to hire a regional fellow is to teach the partners faster/newer/better techniques in order to improve the entire group's collections and relations with the hospital and surgeons.

As for CRNAs, like intubating and lines, regional is a "monkey skill." Anyone can be taught how to do the procedure, and become quite good with enough repetition. One place where I used to moonlight was small, and the full-time CRNAs trained by the one anesthesiologist at the hospital to do things the way he liked them. Both of the full-time CRNAs were quite good at placing TAP and lumbar plexus catheters, as a result.
 
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I think a regional fellowship is silly. Show me how to do a block a few times and give me a few YouTube videos and I'm off and running. At most, a regional fellowship should be 6 months, but we all know that hospitals/departments like cheap labor.

However, I will back the above regional guru on doing a fellowship. He's in NYC metro, which is a tight market. I am on the east coast and I will tell you that the suits (aka, the people making the money) want certificates. There is no shortage of applicants and if it comes down to someone with a regional fellowship and someone without a fellowship, the regional guy will win every single time.
 
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I do applaud @facted for finding a job where he actually gets to use all of his regional fellowship. Unfortunately for 98% of regional fellows who go into to PP it will be the 4 or 5 basic blocks which you should be deft at coming straight outta residency. NYC is a weird market where each hospital tries to exploit their own little niche to hold onto market share. For some like HSS that's regional. Most of the country doesn't work like that though.
 
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psychbender said:
Who the hell is taking 15 minutes to do a supraclav? Geez, I went to a decidedly average (that may be generous) program, and I've never seen anyone but a new CA1 doing regional for the first time take that long. Three minutes from needle on skin for such a basic block is probably too long, but it's been years since I've timed it.

If your partners are taking that long, stop laughing at them, and teach them how to move faster. One of the reasons, I would think, to hire a regional fellow is to teach the partners faster/newer/better techniques in order to improve the entire group's collections and relations with the hospital and surgeons.

As for CRNAs, like intubating and lines, regional is a "monkey skill." Anyone can be taught how to do the procedure, and become quite good with enough repetition. One place where I used to moonlight was small, and the full-time CRNAs trained by the one anesthesiologist at the hospital to do things the way he liked them. Both of the full-time CRNAs were quite good at placing TAP and lumbar plexus catheters, as a result.
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If u have no one helping u and untrained staff. Yes. It does take 15 min to do a block.

I'm talking to setup. Draw up drugs. Document.

You guys are misleading when u say 3 minutes for a block. That's like a surgeon saying it takes 15-20 min for a bladder. And doesn't include the total time.

Sure the actual location and injection takes 3 minutes for a block. But not all places just wait on u hand and knee with the needle and probe with patient seen and drugs drawn up and most importantly trained staff.
 
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True, I was counting time from probe on skin to needle out, and thought he was, too, as that's the only portion that takes skill. Fellowship shouldn't change the setup time. I get no help, usually, but do have a dedicated block bay in our holding area, so getting equipment isn't as much of a CF. The rate limiting step is usually the surgeon not signing the patient on time, so I have everything ready to go, but can't start the block, because the surgeon said hello and walked off without signing the shoulder or procedure verification form.
 
How about signing the extremity yourself with a 3 person time out? Patient, nurse, physician? That's what we do for first case starts.
 
Set up times for the first case should be fast. Turn on usd, draw up drugs, chloroprep, go.

Agree, the actual block time is around 3 min. Even less for simple blocks like ACBs.
IMO 20 minutes to do a block is a bit slow. Typically we do blocks btw/cases (md only) with 15-20 min. turnovers which includes dropping off the patient, interviewing the following patient and placing the block b4 heading back and making turnover times (20 min). Obviously for this to work, you need the usd in the room turned on the circulator or preop nurse on your tail and you have to have all drugs drawn up and ready to go. In other words, the setup needs to be streamlined.
 
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SaltyDog said:
I would love an excuse to do the esoteric blocks but my surgeons over here have no interest and would look at me funny if I suggested it. I love regional, and I agree its great for the pts. I don't love your attitude.

I say we settle this with a good old fashioned block off. We'll meet somewhere in the middle i.e. Kansas. Line up 50 pts. Then it's a race: 10 ISB's, 10 SCB's, 10 ICB, 10 ACB's, and 10 Pop's (you do R-side I'll take the L-side so no one can claim they had pt's with more difficult anatomy. First one done wins but we'll add a minute to the finishing time for every pt who is not numb at 24H.

:horns::horns::horns::horns::horns:
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Those 10 bilateral ISBs are gonna be interesting for the patients.
 
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sevoflurane said:
How about signing the extremity yourself with a 3 person time out? Patient, nurse, physician? That's what we do for first case starts.
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Actual text received from one of my co-fellows a couple weeks ago:

My pacu nurse conversation when we realized ENT hadn't sidemarked their part of surgery

Rn: oh maybe thoracic surgeon could just do it

Me: if the procedural team doesn't need to, then I could just sitemark myself, right

Rn: no it needs to be a doctor

Me: well I'm a doctor

Rn: no but you are anesthesia
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Nurses. 93% of the headaches in a hospital.
 
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Around 50% historically. I'm a CA2 and it appears that maybe 75-80% of my class will be doing a fellowship. The times, they are a changin.
 
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Green Grass said:
Around 50% historically. I'm a CA2 and it appears that maybe 75-80% of my class will be doing a fellowship. The times, they are a changin.
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For the worse if you're an anesthesiologist.
 
Green Grass said:
The sky has been falling for 10+ years on here. Y'all can choose to continue to bitch, or you could just stop the negativity. We aren't gonna be out of jobs. We aren't gonna be poor. The sky is in fact not falling.


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... until one day it is. What you say is exactly what people said about the stock market back in the late 90's.

We just haven't reached the critical mass where it's visible yet in all areas of the country. It's like with gray hair: one today, two tomorrow, and in a few years you look in the mirror and your head is more salt than pepper. ;)
 
FFP said:
... until one day it is. What you say is exactly what people said about the stock market back in the late 90's.

We just haven't reached the critical mass where it's visible yet in all areas of the country. It's like with gray hair: one today, two tomorrow, and in a few years you look in the mirror and your head is more salt than pepper. ;)
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And you realize you're a gorgeous silver fox!


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In the story of the boy who cried wolf, the wolf did eventually show up.
It is getting worse. I hope the trend line will break, but I don't see what will cause it to break anytime soon.
 
FFP said:
... until one day it is. What you say is exactly what people said about the stock market back in the late 90's.

We just haven't reached the critical mass where it's visible yet in all areas of the country. It's like with gray hair: one today, two tomorrow, and in a few years you look in the mirror and your head is more salt than pepper. ;)
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You do know that the market is >50% above it's mid 90's peak, right?
 
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Green Grass said:
The sky has been falling for 10+ years on here. Y'all can choose to continue to bitch, or you could just stop the negativity. We aren't gonna be out of jobs. We aren't gonna be poor. The sky is in fact not falling.


Sent from my iPhone using SDN mobile
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Apparently denial ain't just a river in Egypt for this young fella.
 
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CA-2 here. We have 60-70 % of our class planning on doing a fellowship currently. All but 3 or 4 are doing chronic pain. 1 CV and 2 ICU. Our home program typically adds another 2-3 at the end of the year to OB and acute pain
 
Did they change the regional fellowship rules yet where u can't be considered faculty and fellow at the same time and make $100-150k during ur "fellowship year"

That's one of the appeals of a regional fellowship where u can still make better than fellow money by being an "attending" 20% of the time.
 
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aneftp said:
Did they change the regional fellowship rules yet where u can't be considered faculty and fellow at the same time and make $100-150k during ur "fellowship year"

That's one of the appeals of a regional fellowship where u can still make better than fellow money by being an "attending" 20% of the time.
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Regional is not acgme accredited, so each fellowship spot can be different in curriculum, salary, etc..
 
FFP said:
AFAIK, they are doing/have done it, for many of the fellowships which still had that arrangement. They have enough suckers applying now, so they can use them for other stuff where they play fellow/resident, for the same low pay (e.g. acute pain). As if most anesthesiologists really need an acute pain fellowship. Plus many university hospital systems have doubled their size with Obamacare, and most surgeons are becoming fans of US-guided RA, so there is much more work than before. Much cheaper to let the fellow do fellowship-type of work, maybe even have them do some acute pain calls, than pay them big attending bucks. ;)
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This definitely is not true in the NYC area. I know of quite a few programs in the area, and each one of them is a hybrid attending/fellowship year with a hybrid salary and extra moonlighting ability with OR/OB call. The reason they get away with this is because of the lack of ACGME accreditation. They don't have to pay you as PGY-5, which works to your advantage. Each regional program is also different in terms of structure. Some are pure 100% regional, some are regional/pain (though not pain fellowship accredited), and I even know of one that is regional/thoracic.
 
aneftp said:
Did they change the regional fellowship rules yet where u can't be considered faculty and fellow at the same time and make $100-150k during ur "fellowship year"

That's one of the appeals of a regional fellowship where u can still make better than fellow money by being an "attending" 20% of the time.
Click to expand...

Half the reason regional remains popular at many institutions. Some of our regional fellows make close to 200. From what I understand, ACGME accreditation is coming in the next few years so such deals (20-40% attending time) won't be allowed.
 
Wonder how this number has changed now? Really interesting to see the commentary from 2016 compared to now. I'd say the vast majority of my class is NOT planning on doing a fellowship, and this is a top ranked program.
 
Huge shift to not doing fellowships as the opportunity cost of the extra year is super high now since salaries are high. I would say it's down to 20-30% of CA3s. Once the market tightens again it will likely shift back to more fellowship takers.
 
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BLADEMDA said:
But, in the near future maybe the guy/girl with the fellowship gets the JOB over the person without the fellowship. I've seen the job market deteriorate steadily over the past 5 years. If I was in Residency today there is NO WAY I would not do a fellowship in case my first job didn't pan out. As usual, the majority of residents did the right thing IMHO in choosing to do a fellowship. I wish the other 40% the best of luck 5 years down the road when jobs are even more scarce in the most desirable areas.
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This aged poorly
 
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