Pursue a fellowship or not?

[youngmanMD]

Incoming PGY-1 anesthesia resident considering fellowship options and whether I should even pursue one at all or not

I greatly appreciate all advice and discussion on decision to do a fellowship or not, and if so which one?

Edit: other than interest in the field, are there any economic/political/social factors to consider? (e.g., location, job security, PP vs academic etc.)

Thank you everyone for your help

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[Guillemot]

Sounds great! Thanks!

 

[aneftp]

Right now. I say if u are a well rounded resident. You don’t need a fellowship with wide open job market. Market forces can change.

5-6 years ago everyone was doing fellowships.

Same with 1994-1998 graduating residents doing fellowships due to tight job market.

 

[Modoc]

If you want to do critical care, cardiac, or chronic pain, you will need a fellowship.

 

[cchoukal]

Maybe start residency first and see what you like?

 

[nimbus]

If you want to do critical care, cardiac, or chronic pain, you will need a fellowship.

Peds too in many settings.

 

[JiPo]

You are an incoming intern... not even starting a CA-1 year. Work hard and absorb everything like a sponge the first 2 years. If a subspecialty clicks with you in the process, you will know. It is not like you are gonna do anything different next 2 years if you are set on applying to fellowship, so your question is too premature given where you are. You should ask the same question 2 years from now when you are about to finish CA-1 year.

 

[Anesthesia_Guy]

Incoming PGY-1 anesthesia resident considering fellowship options and whether I should even pursue one at all or not

I greatly appreciate all advice and discussion on decision to do a fellowship or not, and if so which one?

Thank you everyone for your help

Finish residency first. Make a decision as a CA-3. Advice given now will be worthless in 3 years.

 

[Maz777]

Possibly for the ones that are actual fellowships (ICU, cardiac, peds, pain) if it’s what you want to do for the rest of your life.

Just don’t do one of the fake fellowships (Regional, OB, Neuro, Transplant, Periop Management, the list unfortunately keeps
growing). Everyone is adequately trained to do this stuff after residency. You become a way for departments to staff locations cheaply for minimal benefit.

 

[Angus Avagadro]

In general, I think we are becoming a paper society, board cert, fellowship training, specialty call, etc.. I asked my wife to do a fellowship, years ago. She said she didn't need it to do msk Rads. Right before she retired, she was essentially unemployable because she didn't have a fellowship and all opportunities required msk fellowship to be considered. I agree with all who suggest doing residency first and see what you like.

 

[kidthor]

In general, I think we are becoming a paper society, board cert, fellowship training, specialty call, etc.. I asked my wife to do a fellowship, years ago. She said she didn't need it to do msk Rads. Right before she retired, she was essentially unemployable because she didn't have a fellowship and all opportunities required msk fellowship to be considered. I agree with all who suggest doing residency first and see what you like.

Radiology is nuts. A lot of them do two fellowships and then just do mostly general radiology...

 

[woopedazz]

I did a "fake" fellowship (you have to do one in my country). Had a great time and got my dream job in an ivory tower directly as a result of doing it.

Depends what, where, and why you're doing it... And when if you're in the US

 

[odyssey2]

Radiology is nuts. A lot of them do two fellowships and then just do mostly general radiology...

No one in radiology does two fellowships. Plenty of attending radiologists do exclusively or mostly their subspecialty, esp in academics.

 

[Anesthesia_Guy]

No one in radiology does two fellowships. Plenty of attending radiologists do exclusively or mostly their subspecialty, esp in academics.

I personally know 2 radiologists who each did 2 fellowships so.....and I know this isn't the first time you've heard this....you're wrong.

 

[odyssey2]

I personally know 2 radiologists who each did 2 fellowships so.....and I know this isn't the first time you've heard this....you're wrong.

I'm in the field and no, people don't do this. The job market's so hot now, no one needs to unless they have some masochistic desire to prolong their training. This rarely happened during the market downturn a few years back but it was never common.

 

[Anesthesia_Guy]

I'm in the field and no, people don't do this. The job market's so hot now, no one needs to unless they have some masochistic desire to prolong their training. This rarely happened during the market downturn a few years back but it was never common.

You said "no one in radiology does 2 fellowships" which I disproved. People do do multiple fellowships. I didn't say when, how often, etc. I merely said it happens to counter your false assertion that it never does. QED

 

[odyssey2]

You said "no one in radiology does 2 fellowships" which I disproved. People do do multiple fellowships. I didn't say when, how often, etc. I merely said it happens to counter your false assertion that it never does. QED

My point obviously wasn’t that it has literally never happened. Someone in every specialty has probably taken multiple fellowships at some point. But it’s not something unusually commonplace in radiology like the poster I was responding to implied, and especially not now.

 

[Anesthesia_Guy]

My point obviously wasn’t that it has literally never happened. Someone in every specialty has probably taken multiple fellowships at some point. But it’s not something unusually commonplace in radiology like the poster I was responding to implied, and especially not now.

Good. It would really suck if that were the case. Just be glad you're not an emergency medicine resident now.

 

[anesthesiadoc]

Possibly for the ones that are actual fellowships (ICU, cardiac, peds, pain) if it’s what you want to do for the rest of your life.

Just don’t do one of the fake fellowships (Regional, OB, Neuro, Transplant, Periop Management, the list unfortunately keeps
growing). Everyone is adequately trained to do this stuff after residency. You become a way for departments to staff locations cheaply for minimal benefit.

My view is evolving on this. Promotion and carving out your niche at academic centers is a lot easier when you start with a fellowship. If you really enjoy one aspect of anesthesia more than others, consider that it’s only 1 year investment that gives you leverage to do proportionally more of that kind of work and less of stuff that you dislike. It may seem less relevant to those eyeing private practice, but you never know how life will turn out. (Admittedly n=1, but writing this as a former managing partner in PP who now happily resides in academics.)

 

[youngmanMD]

Thank you everyone

Outside of interest in the field, are there any economic/political/social factors to consider? (e.g., location, job security, PP vs academic etc.)

 

[cchoukal]

Thank you everyone

Outside of interest in the field, are there any economic/political/social factors to consider? (e.g., location, job security, PP vs academic etc.)

Absolutely. Here are some things in the PRO column:

1) Anesthesidoc's points above are absolutely relevant IF you plan a career in academics
2) Sometimes a group that you like in an area you want to be in has some anticipated retirements, but not this year, and you need something to do for a year. A fake fellowship is a great way to pick up some skills, make a few bucks, and sit tight.
3) The non-fake fellowships of Peds and CV will open doors for you in groups that do SOME of that subspecialty work and who need to fill out their call schedules. Also, in many Eat What You Kill groups, CV folks make more money (CV call is usually paid and can be low-intensity, and CV cases bill more money than general cases)


And in the CON column:

1) You can easily do the math on what a year of training salary (vs that extra year of attending salary) amounts to over the course of your career. It's not crazy to imagine that number approaches several hundred thousand dollars. If you're not doing any moonlighting during the fellowship year and are truly making trainee money, that number could get to 7 figures. Is it worth a million dollars to do the fellowship?


Full disclosure, I did a fellowship, practiced that subspecialty in academics, and now work in a PP where I do not practice that subspecialty.

 

[invitro]

I can only speak for my experience in peds and then peds cardiac. I echo the sentiments of the posters above. If you do a fellowship in pediatric anesthesia it will open doors in private practice and academia. Despite the controversy over the utility of peds anesthesia boards when it was first introduced, being double board certified is a now a requirement if you want to practice in children’s hospitals or large peds anesthesia practices.

For NOW (can’t say if this will stay the same) peds anesthesia is in high demand. If you elect to additional training in peds cardiac anesthesia you definitely will have no issue finding jobs. Due to market being so hot if you are location independent 600-900k (yup that was an offer from a pediatric cardiac surgery program in dire need) is possible. Keep in mind you will WORK for the higher numbers though. The 900k was q3 call.

I also agree you will lose out on 300-500k in attending salary (600-1mil if do pediatric cardiac) so that’s a real concern. I was lucky because 10 years ago when I did the training the peds cardiac portion was only 6 months after pediatric anesthesia fellowship.

I’m happy I did it but also realize I’m not as wealthy as some of my friends who jumped into anesthesia practices in the boonies straight out of residency. There’s really no way to catch up against a guy who is making 600k 1st year out (true story..guy did general anesthesia in a small town in missouri) when you are doing fellowship (45k/year) for two years. No concern with AMCs in that small town.

My suggestion…do what you like! You will be well off either way and if you love what you do it’ll be okay. Fellowship training has possible benefits outside of financial ( I.e. better call schedule, more interesting/challenging cases, respect from surgeons-if that matters, job security, etc)

 

[DrN2O]

Thank you everyone

Outside of interest in the field, are there any economic/political/social factors to consider? (e.g., location, job security, PP vs academic etc.)

It's too hard to predict the competitiveness of fellowship when you are still 3+ years away. Even harder to predict what the economy, job market and the field of anesthesia will be 10, or 20 years down the road. Use your free time internship year to learn medicine and then read up on basic anesthesia. Keep an open mind as a CA-1, and go from there.

But call me cynical, if you just want that perfect job of location/pay/work, doing a fellowship for the sake of been competitive is not the answer. And that job usually doesn't exist.

 

[vector2]

No one in radiology does two fellowships. Plenty of attending radiologists do exclusively or mostly their subspecialty, esp in academics.

Doing one fellowship was extremely common (near universal) and doing two fellowships wasn't uncommon when my rads buddy was finishing training about 5-6 years ago. I believe the market has improved since then.

 

[Simba1711]

Agree with below.

Doing one fellowship was extremely common (near universal) and doing two fellowships wasn't uncommon when my rads buddy was finishing training about 5-6 years ago. I believe the market has improved since then.

 

[nimbus]

One of my best friends did a body fellowship and a MSK fellowship in the late 1990s. He’s retired now.

Also, as long as I’ve been at my current hospital (since 2001), every single orthopedist who has joined our medical staff has been fellowship trained.

 

[zizzer]

It's a financial ripoff unless you can't live without doing chronic pain, ICU, cardiac with TEE, or complex pediatrics. If so, then do a fellowship.

Either way, treat residency as if you will do everything. You can decide later.

 

[pgg]

Beyond the nebulous potential for better pay or job prospects, an advantage of fellowship training is that it'll tilt your practice in a direction toward stuff you enjoy.

That's assuming you genuinely like doing cases in that subspecialty, and didn't grudgingly decide to do the fellowship just in the hopes that future market forces will conspire to give you a leg up on the competition.

For me, fewer days in the GI suite is a non-trivial perk of the ACTA fellowship. And every day I'm doing a heart is a day there's no cannister of colon effluent gurgling away on the wall next to me and a day I don't have to recite the scope anesthesia spiel to 17 people who aren't interested in the subtleties of MAC vs general anesthesia and just say "I don't want to remember nothin" ...