Im going into an integrated CT surgery residency this year. Out of curiosity, I looked at job postings to see what the market is like. I'm seeing posts about super fellowships in specific areas, such as structural or transplant. From what I understand, you don't need separate board certification to practice in these areas (unlike congenital/pediatrics, which is a separate board exam). Also, there are some super fellowships that are non-ACGME accredited.
Why would someone choose to do one of these super fellowships instead of just getting an attending job where you can get some experience on the side? If you are going to do one of these super fellowships, does it matter if it is not accredited, as long as it's at a reputable place?
(I'm interested in the opinions of non-CT surgeons who have considered/did super fellowships in other areas of surgery, as there may be some overlap in terms of the reasons someone would do this...)
Great questions, and there is very little info about these things out there. In terms of full disclosure, I trained at a big fancy academic place for CT residency and am doing a super fellowship in transplant/VAD at another big fancy academic place. Being a PGY10 does have a ring to it I guess
None of the "super" fellowships are accredited, essentially you finish your ACGME CT training and are board eligible.....from there you can go get a job or pursue additional training. The one exception to this is congenital, which is an entire other field of surgery as far as i'm concerned, that has a much more formal application process and a separate board.
So excluding congenital, doing a super fellowship is something you can pursue strictly for your own benefit/interest. There are several for transplant/VAD, structural heart (TAVR and trans-catheter mitral), aorta (root/valve sparing techniques, arch and thoraco including TEVAR), and minimally invasive (robotic, port access, frustration). These are not accredited and so may vary significantly in structure, responsibility and opportunity.....in some of these (like mine for transplant) you are really only dedicated to those cases. In others you may have some general adult cardiac surgery coverage responsibilities.....at some places you may take call (and get paid) as an attending at the main hospital or a smaller affiliate and this can be profitable and a nice learning experience. Other places you are in the call pool with the other residents/fellows but may get to do some cabg/valve cases which can have some benefits as well.....I have a friend doing an aortic fellowship where he gets dibs on all the dissections but if he passes if falls to the chief resident so he can play when he wants. I do all the transplants/vads where I am, but occasionally a chief resident will ask me to cover an elective case which I'm okay with because I like to operate. One of the chiefs would like to do a few VAD cases and is willing to trade me for some nice elective cases, maybe a nice valve sparing case or even a few cabgs (he knows I like doing bypass surgery)....I might take them up on that. As someone already fully trained in cardiac surgery the attendings are usually okay with me showing up in their OR to do a case if you know what I mean....I get them to lunch faster.
The application process is not centralized and a lot of these positions are barely advertised so you may have to ask around to see what your options are...the salary is usually at least on your PGY level although some places will find ways to sweeten the deal with some attending/locums style call and pay you for something cush like covering the ICU or something. I found mine by word of mouth and emailed the chief of the division, they flew me out for the interview and then called me a month later and offered me the job. No frills, no pomp and circumstance, just an honest interview where I met everyone and they told me what I would be doing.
The benefits of the super fellowship were significant for me.....you can pick up a new skill set and market yourself as a mega specialist which may very likely help you get a job someplace. The average chief of the average division of cardiac surgery is not interested in going back and learning how to do TAVR or lung transplant and doesn't want to do ECMO call.....but they want to be able to offer these services....that's where you come in. This can give you significant leverage in the job market.
Where I am I have staff privileges and so act as an "attending" for some of the smaller cases and take backs, ICU/floor rounds and etc....at the same time I have someone I can call for help/advice at all times without penalty. I flex my little attending muscles sometimes, but when a big wave of **** comes my way I pull out my fellow card and load that boat pretty quick....I think its a nice transition into being an attending. I'm learning how to bill, a lot of people take this year to get boards out of the way (some places will pay for them because remember you're an "attending") so when you apply for a real job not only are you a highly trained specialist but you're board certified. Additionally as a non-ACGME fellow I don't have to fill out any ****ing surveys or hours logs, I don't have to go to any conferences or meetings I don't want to attend, no inservice exam, no mandatory wellness bull**** that just keeps me at work an extra hour.....you're done with the official training and people treat you accordingly. It beefs up your resume nicely and now you have a whole new crew of people to network with, recommend you for jobs and etc.....all it costs is one more year of your life. At this point I'm willing to pay another year to set myself up for maximum success its been what like 20 now....BFD I think.
Honestly my last day as a chief resident in cardiac I felt comfortable walking out there and tackling adult cardiac surgery, I did hundreds and hundreds of CABG/valve cases and felt well prepared for all of that. We didn't do a ton of transplant (which is what I want to do) so I picked a super fellowship that focused 100% on that because that's what I need to augment my career, otherwise I would just go out and start working. Its worth mentioning that the stigma of doing additional training in cardiac surgery is not at all met with the same derision as it is in other fields....in general surgery my staff would roll their eyes when someone did a breast or MIS fellowship and perceive them as being weak or something. I imagine if their mom needed breast surgery though they would pick someone who did a fellowship. Turns out that people who do cardiac surgery have a very good understanding of how hard this can be and what the stakes are, and if you're willing to spend a year of your life getting better at it that's quite well received. Most super fellowships are in big centers known for these types of cases....they are incredibly well connected on all levels, even the cardiologists will call each other and say "hey who's finishing up there in transplant this year we need someone!" You can't buy a lead on a job that good.
