Fellowship for Job Security

[nimbus]

I don't agree but here is one perspective.

http://www.kevinmd.com/blog/2016/07/obstetric-anesthesiology-next-frontier-medicine.html

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[BLADEMDA]

I don't agree but here is one perspective.

http://www.kevinmd.com/blog/2016/07/obstetric-anesthesiology-next-frontier-medicine.html

I agree with the blog in the sense that tertiary academic centers should have fellowship trained Anesthesiologists in all subspecialties. But, outside academia this fellowship is, sad to say, useless.

 

[vector2]

I don't agree but here is one perspective.

http://www.kevinmd.com/blog/2016/07/obstetric-anesthesiology-next-frontier-medicine.html

This guy's entire argument is that an OB fellowship is a good idea if you want to work in a tertiary women's hospital that takes care of ASA 3-4 parturients. No sht sherlock. The anesthesiologists who wanted this kind of practice setting were doing unofficial OB fellowships before the era of "everyone must do a fellowship"

 

[GravelRider]

I don't agree but here is one perspective.

http://www.kevinmd.com/blog/2016/07/obstetric-anesthesiology-next-frontier-medicine.html

I know a lot of CRNAs that do OB without a fellowship.

There must be money in OB and GYN because there are a lot of hospitals that are building "women's health" wings and even separate buildings. Usually these additions are reserved for ortho, oncology, and cardiology. With that said, if you want to be in academics doing really high risk OB or eventually be the chair of anesthesia at one of the these "women's health" centers then an OB fellowship may suit you well. Don't do this fellowship if you like doing routine OB in the community. Again, with all fellowships, you need to know what you want out of your career. OB fellowship could be a good decision for the right person.

 

[kidthor]

A lot of people knock OB anesthesia fellowships, but I think for someone interested in the field it's a decent enough idea... as stated above, you can be the OB anesthesia chair/director at one of these women's centers - and such places are certainly big business these days. Plus nobody else really wants to do it.

People are getting fatter, older, and sicker when they have children nowadays too.

 

[AdmiralChz]

There must be money in OB and GYN because there are a lot of hospitals that are building "women's health" wings and even separate buildings.

You have the opportunity to bring in healthy (and not indigent, they go to the university hospital) women and introduce their children directly into your hospital system from the moment they are born. These healthy women (insured) pay well and their children (also insured) may become years-long patients at your facility feeding the coffers. Then they might refer their friends and family for the nice staff and settings of the new wing. The cycle goes on.

So yeah, some solid money there. Plus low-risk if you don't take the sickies (and if you do, potential billboard opportunities for the rare cases you guide through pregnancy).

 

[pgg]

I bet there's no bigger cash cow in the anesthesia world, except maybe a pill mill skirting the edges of ethics and the law, than an OB anesthesia gig with a rich payor mix. And those are exactly the patients that are going to be lower risk (less obesity, good prenatal care).

 

[aneftp]

Issue with ob in general is payer mix is even worst at many hospitals due to "automatic" Medicaid coverage if they get pregnant (regardless of opt out states).

Some hospitals are literally 70-80% Medicaid OB patients. I know a very profitable hospital system (large hospital system with 10-15 plus hospitals plus outpatient facilities) in Florida. Very profitable and they are in works to shut down their Ob program completely at one of their hospitals because the Medicaid population is pushing very high.

So they will shift it to another hospital.

So they cherry pick where my wife delivers via C/s and payout for anestheisa (payout). Not billing. But payment to anestheisa was $4100! For healthy Asa 1 epidural labor for 8 hours plus 30 min c/s

Repeat c/s was payout (again not billing). Payout for anesthesia was $2100 for 29 min c/s skin to skin.

There is ridiculous money to be made IN PRIVATE OB ANESTHESIA.

my buddy in Texas where payer mix is 60% commercial was literally making 15k A NIGHT on Ob. You betcha he was motivated to be workin all night on OB anesthesia call.

 

[DetectiveAlonzo]

Cardiac fellow vs OB fellow...

which one has to deal with less fear of being replaced by a CRNA?

 

[deleted162650]

Cardiac fellow vs OB fellow...

which one has to deal with less fear of being replaced by a CRNA?

 

[DetectiveAlonzo]

Sooooooo....

 

[deleted171991]

Sooooooo....

The one who has a top 20 MBA.

 

[Nivens]

The one who has a top 20 MBA.

Do we really think that's true? No doubt a hospital CEO position has it's perks, but would you really encourage someone with a chance to do cardiac fellowship to pursue, say, a Wharton MBA instead?

They may be a great thread in it's own right...

 

[DetectiveAlonzo]

The one who has a top 20 MBA.

It's really that bad huh?

I for some reason think OB fellows can make bank.

But you have to deal with pregnant women.

 

[Notorious T.E.E.]

Do we really think that's true? No doubt a hospital CEO position has it's perks, but would you really encourage someone with a chance to do cardiac fellowship to pursue, say, a Wharton MBA instead?

They may be a great thread in it's own right...

Yes.

 

[GravelRider]

Do we really think that's true? No doubt a hospital CEO position has it's perks, but would you really encourage someone with a chance to do cardiac fellowship to pursue, say, a Wharton MBA instead?

They may be a great thread in it's own right...

If you can get into a top 10 business school for an MBA then you should absolutely do that over cardiac fellowship. It's not easy getting into a top 10 business school and certainly more competitive than a cardiac fellowship. You often have to demonstrate a reason for wanting an MBA beyond being disgruntled with medicine.

 

[deleted171991]

It's really that bad huh?

I for some reason think OB fellows can make bank.

But you have to deal with pregnant women.

I don't think OB fellows can make bank more than any of us. I don't think high risk OB pays well (usually Medicaid and academic). What pays well is doing OB as a partner in PP, which is something anybody can do (even a CRNA).

 

[deleted171991]

Do we really think that's true? No doubt a hospital CEO position has it's perks, but would you really encourage someone with a chance to do cardiac fellowship to pursue, say, a Wharton MBA instead?

They may be a great thread in it's own right...

There is a problem looming with cardiac fellowships, which is about the same as with general anesthesiologists or peds: provider inflation. There will be many more cardiac people than needed, so most won't do cardiac more than a few days a month. Just give it another 10 years.

Plus the moment trans-catheter procedures become more popular, those too will be done with CRNAs. The only job security one gets with a cardiac fellowship is if it helps one become a great overall anesthesiologist.

 

[deleted126335]

The MBA by itself is not super meaningful. I know several docs who got MBAs hoping to transition from blue scrubs to a blue suit. They couldn't make it happen.

Some administrative credential (MBA, CPE, FACHE, etc. ) for MDs who want to go down the administrator path are necessary, but not sufficient. One also needs the temperament and interpersonal skills to make it happen. Being a sociopath helps.

 

[deleted171991]

Being a sociopath helps.

Priceless.

 

[deleted126335]

Priceless.

Unfortunately not joking.

http://www.payscale.com/career-news/2015/04/why-a-disproportionate-number-of-ceos-are-psychopaths

 

[GravelRider]

Agreed. An MBA is useless unless you have some kind of career plan beyond just wanting to get into administration. Most people who can get into a top 10 business school have a touch of sociopathy. Didn't Donald Trump go to Wharton?

 

[pgg]

If you can get into a top 10 business school for an MBA then you should absolutely do that over cardiac fellowship.

Has anyone mentioned i-banking yet?

There's a common notion among doctors that because we're all such awesome students, that we'd all be successful at any career path that involves school. No matter what kind of school it was. We have good ass calluses from sitting in class and we can smash multiple choice tests, so that must mean the whole world of school-based careers is our oyster, right?

Business success is schmoozing and building social/professional contact networks, usually with a good helping of "started on 3rd base" circumstances, plus a smattering of connections made in school (if you have the aptitude to make those connections in the first place). I think most doctors, even the sociopaths, would be mediocre if not horrible businesspeople.

Even if they passed the classes and got the MBA.

 

[deleted162650]

I for some reason think OB fellows can make bank.

There are certainly some very lucrative private OB hospitals out there. Having an OB fellowship isn't gonna put you on their radar though. These jobs are passed down through word of mouth. Ob fellowship is ONLY good if you intend to make an academic career out of taking care of high risk OB pts and writing papers about it.

And being able to make bank has nothing to do with job security from midlevel encroachment which was your original question.

 

[GravelRider]

Has anyone mentioned i-banking yet?

There's a common notion among doctors that because we're all such awesome students, that we'd all be successful at any career path that involves school. No matter what kind of school it was. We have good ass calluses from sitting in class and we can smash multiple choice tests, so that must mean the whole world of school-based careers is our oyster, right?

Business success is schmoozing and building social/professional contact networks, usually with a good helping of "started on 3rd base" circumstances, plus a smattering of connections made in school (if you have the aptitude to make those connections in the first place). I think most doctors, even the sociopaths, would be mediocre if not horrible businesspeople.

Even if they passed the classes and got the MBA.

Usually, if you can get into a top 10 MBA program, you have already demonstrated some business acumen. MBA schools usually have a lot of networking opportunities built in. Many of these top programs do not accept people directly from college. You need to have some real world experience. I'm obviously talking about the Harvards, U of Chicagos, and Whartons here and not an MBA from ITT Tech (too soon?). If you have the chance to get a Wharton MBA, I wouldn't pass that up...especially if you are looking for insulation from CRNAs. Again, I think I mentioned before, but these programs are probably a lot more competitive than a cardiac fellowship and are by no means a guarantee just because you are a doctor.

 

[nimbus]

Usually, if you can get into a top 10 MBA program, you have already demonstrated some business acumen. MBA schools usually have a lot of networking opportunities built in. Many of these top programs do not accept people directly from college. You need to have some real world experience. I'm obviously talking about the Harvards, U of Chicagos, and Whartons here and not an MBA from ITT Tech (too soon?). If you have the chance to get a Wharton MBA, I wouldn't pass that up...especially if you are looking for insulation from CRNAs. Again, I think I mentioned before, but these programs are probably a lot more competitive than a cardiac fellowship and are by no means a guarantee just because you are a doctor.

Your academic pedigree counts a LOT more in that world too. Much more so than medicine. I do think the average doctor wouldn't get much consideration.

 

[Nivens]

There is a problem looming with cardiac fellowships, which is about the same as with general anesthesiologists or peds: provider inflation. .

I think some of this depends on CT anesthesia's role in catheter-based interventions. Ive read some stuff on this idea of "interventional echo" where TEE is used over fluoro for TAVI, MAVI, stents, VSD devices. Will be interesting to see how it plays out. Seems to be a glut of postings on gasworks for Cardiac positions. It's hard to compare these things, but a top 5 MBA vs a top 5 cardiac fellowship seems like a tough call. I agree the best insurance against encroachment is inroads into a whole new field, but some of those advertised salaries for CV trained folds look hella tempting...

 

[AdmiralChz]

You think you are looking over your shoulder now to protect your job from encroachment from others? Check out business (especially banking!!) where the threat of layoffs and replacements looms everyday. They have minimal to no job security.

My friends with top MBAs are very, very envious of that. Get a good job and are respected and you could stay there for the duration of your career.

 

[Nivens]

You think you are looking over your shoulder now to protect your job from encroachment from others? Check out business (especially banking!!) where the threat of layoffs and replacements looms everyday. They have minimal to no job security.

My friends with top MBAs are very, very envious of that. Get a good job and are respected and you could stay there for the duration of your career.

Fair point- I guess I should clarify by saying Im referring to the combination of an MD and MBA where one remains clinically active with potential for a larger administrative role, especially later in ones career. I agree leaving medicine for banking would be throwing the baby out with the bathwater.

 

[AdmiralChz]

Fair point- I guess I should clarify by saying Im referring to the combination of an MD and MBA where one remains clinically active with potential for a larger administrative role, especially later in ones career. I agree leaving medicine for banking would be throwing the baby out with the bathwater.

Oh absolutely understand that, many hospital administrators / med director types go this route. The ones I've worked with in med school and residency just did an executive (meaning weekend/night) MBA at a reputable institution to get to the next level in their early to mid-40s, so that remains an option and you can stay clinical during this time.

 

[deleted547339]

Cardiac fellow vs OB fellow...

which one has to deal with less fear of being replaced by a CRNA?

More importantly, who has to deal with CT surgeons?

 

[sevoflurane]

More importantly, who has to deal with CT surgeons?

Meh... My experiences have been great. That's not to say that is a unanimous observation.

OB on the other hand... That can be a never ending shift at a busy center. I can only muster the energy to do it once or twice a month.

My last 24 hr shift went like this:

C/S x 14
Epidural x 8

Didn't see the call room until 3:30am... for about 20 min. until the morning C/S rush.

Busy. You have to really like it if that is what you want to do most of your time.

 

[sevoflurane]

I think some of this depends on CT anesthesia's role in catheter-based interventions. Ive read some stuff on this idea of "interventional echo" where TEE is used over fluoro for TAVI, MAVI, stents, VSD devices. Will be interesting to see how it plays out. Seems to be a glut of postings on gasworks for Cardiac positions. It's hard to compare these things, but a top 5 MBA vs a top 5 cardiac fellowship seems like a tough call. I agree the best insurance against encroachment is inroads into a whole new field, but some of those advertised salaries for CV trained folds look hella tempting...

Yeah. At a conference now on Waikiki and spent the day listening to George Gellert. Rockstar echocardiographer and an anesthesiologist. Mitral clips, transeptal interventions, ASDs, 3D amplatzer and helex, lariat LAA exclusion, PVL device closure, valvuloplasties, etc.

BTW, he's gone back to mostly GA w/ tee for TAVRs over "minimalist approach." No Aline or CVL, but not on board with a TTE over a TEE. If u do your job right, there is no difference in hospital stay or procedure time or patient recovery time. You only need .5 Mac for those cases. What increases procedure time is access not GA vs sedation. It's a cardiology push not a patient centered decision.

Saw my first TMVR today.... we have a ways to go b4 that becomes mainstream.

Great conference.

 

[sevoflurane]

I think some of this depends on CT anesthesia's role in catheter-based interventions. Ive read some stuff on this idea of "interventional echo" where TEE is used over fluoro for TAVI, MAVI, stents, VSD devices. Will be interesting to see how it plays out. Seems to be a glut of postings on gasworks for Cardiac positions. It's hard to compare these things, but a top 5 MBA vs a top 5 cardiac fellowship seems like a tough call. I agree the best insurance against encroachment is inroads into a whole new field, but some of those advertised salaries for CV trained folds look hella tempting...

And 3D tee is da bomb.
Great to see echocardiography continually evolving.

 

[criticalelement]

There is a problem looming with cardiac fellowships, which is about the same as with general anesthesiologists or peds: provider inflation. There will be many more cardiac people than needed, so most won't do cardiac more than a few days a month. Just give it another 10 years.

Plus the moment trans-catheter procedures become more popular, those too will be done with CRNAs. The only job security one gets with a cardiac fellowship is if it helps one become a great overall anesthesiologist.

Very true post.

Just look at the open cardiac procedures of 2004 vs now.. We probably do 50% less open procedures than we did 12 years ago. And the trend is not your friend if you are cardiac anesthesiologist. I agree it will make you an overall better anesthesiologist. IS that worth a year? I cant answer to that.

 

[criticalelement]

The MBA by itself is not super meaningful. I know several docs who got MBAs hoping to transition from blue scrubs to a blue suit. They couldn't make it happen.

Some administrative credential (MBA, CPE, FACHE, etc. ) for MDs who want to go down the administrator path are necessary, but not sufficient. One also needs the temperament and interpersonal skills to make it happen. Being a sociopath helps.

An MBA is not super meaningful because most who do the MBA are not putting their all into it, they get degrees from online programs or sub standard universities and they dont wanna solve problems. And lets face it most people fall on the left side of the bell curve in terms of talent.

You take a talented individual, who gets a business degree from HARVARD Business or the like, (not an online degree) and wants to solve problems truly, everything is his/hers.

 

[criticalelement]

Meh... My experiences have been great. That's not to say that is a unanimous observation.

OB on the other hand... That can be a never ending shift at a busy center. I can only muster the energy to do it once or twice a month.

My last 24 hr shift went like this:

C/S x 14
Epidural x 8

Didn't see the call room until 3:30am... for about 20 min. until the morning C/S rush.

Busy. You have to really like it if that is what you want to do most of your time.

first of all, I dont believe you.
And if i did i have a question.
How much did you get paid for doing 14 c sections?
ANd if you tell me the standard salary.... there lies the problem

 

[criticalelement]

..

 

[IlDestriero]

first of all, I dont believe you.
And if i did i have a question.
How much did you get paid for doing 14 c sections?
ANd if you tell me the standard salary.... there lies the problem

That's a cash cow practice there. Major loot unless they're all Medicaid.


--
Il Destriero

 

[deleted162650]

Meh... My experiences have been great. That's not to say that is a unanimous observation.

OB on the other hand... That can be a never ending shift at a busy center. I can only muster the energy to do it once or twice a month.

My last 24 hr shift went like this:

C/S x 14
Epidural x 8

Didn't see the call room until 3:30am... for about 20 min. until the morning C/S rush.

Busy. You have to really like it if that is what you want to do most of your time.

Please don't hurt yourself pushing that wheelbarrow full of cash up to the bank. Ski season is about to start and you don't wanna be stuck in the lodge nursing a hernia.

 

[Nivens]

An MBA is not super meaningful because most who do the MBA are not putting their all into it, they get degrees from online programs or sub standard universities and they dont wanna solve problems. And lets face it most people fall on the left side of the bell curve in terms of talent.

You take a talented individual, who gets a business degree from HARVARD Business or the like, (not an online degree) and wants to solve problems truly, everything is his/hers.

 

[sevoflurane]

first of all, I dont believe you.
And if i did i have a question.
How much did you get paid for doing 14 c sections?
ANd if you tell me the standard salary.... there lies the problem

I'll start with IDGAF if u don't believe me and I don't have to tell u $hit.

I will tell u that it's THE regional center in my part of the STATE and a cash cow. Not only do I get a stipend for taking that call, I keep nearly everything after 3pm on weekdays and nearly everything for the entire shift on the weekends.

Started my shift with 5 SCHEDULED 45 min. c/s back to back.

10k+ sounds about right for that kind of shift.

And I will repeat myself.... IDGAF if you don't understand a busy OB practice and don't believe me. This is not the only heavy OB practice I've worked at. They all make bank when you have repeated c/s and "running epidurals" on the floor.

 

[IlDestriero]

My program sends a resident or two to Harvard Business School every couple of years. It's definitely an option, which is why I asked.

If you plan to practice clinical medicine I don't think that's the right time in your career for an MBA.


--
Il Destriero

 

[deleted162650]

I'll start with IDGAF if u don't believe me and I don't have to tell u $hit.

I will tell u that it's THE regional center in my part of the STATE and a cash cow. Not only do I get a stipend for taking that call, I keep nearly everything after 3pm on weekdays and nearly everything for the entire shift on the weekends.

Started my shift with 5 SCHEDULED 45 min. c/s back to back.

10k+ sounds about right for that kind of shift.

And I will repeat myself.... IDGAF if you don't understand a busy OB practice and don't believe me. This is not the only heavy OB practice I've worked at. They all make bank when you have repeated c/s and "running epidurals" on the floor.

Dude, I'm gonna start coming up there and doing OB locums work 1 weekend a month. Put in a good word for me.

And don't let criticalelement get you all ruffled. He's just jelly that some of us have managed to find good jobs and are actually happy practicing clinical anesthesia.


P.S. I don't have an OB fellowship, I hope that's OK

 

[sevoflurane]

Please don't hurt yourself pushing that wheelbarrow full of cash up to the bank. Ski season is about to start and you don't wanna be stuck in the lodge nursing a hernia.

Retired my old relic T. Rice and have brand new never used 2015/2016 gear sitting at home.

Excited to get out and try the new tech from NOW bindings. Cool stuff.

Couple of inches at the resorts last week, but still in the upper 80's in th high desert.

CO saw some snow the last couple of days as well. Here is hoping for a season like last years.

 

[sevoflurane]

Dude, I'm gonna start coming up there and doing OB locums work 1 weekend a month. Put in a good word for me.

And don't let criticalelement get you all ruffled. He's just jelly that some of us have managed to find good jobs and are actually happy practicing clinical anesthesia.


P.S. I don't have an OB fellowship, I hope that's OK

Ya. Could care less 'bout him. Complainer type... prolly the reason he's stuck where he is. Def. not the attitude that would fit in my practice. CV would go straight to the trash.

 

[criticalelement]

Ya. Could care less 'bout him. Complainer type... prolly the reason he's stuck where he is. Def. not the attitude that would fit in my practice. CV would go straight to the trash.

First of all, CMON.. 14 c sections... thats hard to believe. But i said I would believe you if you would assign a number to that. And you said 10K.. I call another BS on that. NFW you are making 10 large for a 24 hour ob coverage.. IF you told me 4-5 large that is probably more believable.. And you are just mad cuz i called you out on it.

 

[sevoflurane]

First of all, CMON.. 14 c sections... thats hard to believe. But i said I would believe you if you would assign a number to that. And you said 10K.. I call another BS on that. NFW you are making 10 large for a 24 hour ob coverage.. IF you told me 4-5 large that is probably more believable.. And you are just mad cuz i called you out on it.

Let me spell it out for you since you are completely clueless:

14 c/s = 7 units start up + 3 u time + 2 units for emergencies (9 of them): 158 units.

8 epidurals: 5 start up units + time (let's say 5 hrs average): that's 80 units.

158 + 80 = 238 units. Blended OB is 40/u, which isn't great.

That's $9520. + $1500 stipend=

$11.2 k you dumb f**k!

Now go crawl back into your hole and keep your mouth shut.

 

[DetectiveAlonzo]

Let me spell it out for you since you are completely clueless:

14 c/s = 7 units start up + 3 u time + 2 units for emergencies (9 of them): 158 units.

8 epidurals: 5 start up units + time (let's say 5 hrs average): that's 80 units.

158 + 80 = 238 units. Blended OB is 40/u, which isn't great.

That's $9520. + $1500 stipend=

$11.2 k you dumb f**k!

Now go crawl back into your hole and keep your mouth shut.

You definitely hit a lick.

That's it.

I'm doing OB.

 

[sevoflurane]

You clearly have never been in a busy OB practice. Prolly wouldn't make it past the 3rd c/s and likely take 45 min per epidural.

Def. wouldn't fit in my current group.