Fellowship for Job Security

[DetectiveAlonzo]

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.

But could you teach me is the question?

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[sevoflurane]

But could you teach me is the question?

Meant for critical, not u browski.

 

[deleted162650]

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 forgot the 3 units for duramorph/follow-up on each section.

But could you teach me is the question?

He was talking to criticalelement. And don't for one minute think that an OB fellowship is at all helpful to practice busy OB like this. It's just one year you'll miss out on making 10K per call. OB fellowships of which 90% are a total joke are only relevant if you do one of the true fellowships where you will be taking care of the highest risk OB pts (Eisenmenger's, etc.) and have a desire to continue taking care of those pts in an academic center for the duration of your career.

 

[sevoflurane]

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.

Residents: This is why you do OB. Buts it's a tough gig to do as the main part of your practice. Burn out is super high.

You don't need a fellowship to do it, but the fellowship will likely open doors to these types of practices.

 

[pgg]

The key is an OB who can do a section in 20 minutes.

Most can't.

I like doing OB but the 90 minute sections absolutely sucked away my will to live.

 

[sevoflurane]

You forgot the 3 units for duramorph/follow-up on each section.

Ohh shoot... forgot about that part.

 

[criticalelement]

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.

K.... Im crawling back into my hole. of your mama.

But before I do I must state, I understand what the call is worth. But in this day and age why anyone would let one particular provider make that much money without cutting into it. Whether it be an AMC or a predatorial anesthesia group.

 

[deleted126335]

A busy OB service is frequently the single most productive part of an anesthesia practice. Of course the six rooms of Medicare total joints, with half of them flip rooms, no pay trauma, etc.,dilute out the overall efficiency and productivity of the practice.


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[aneftp]

The key is an OB who can do a section in 20 minutes.

Most can't.

I like doing OB but the 90 minute sections absolutely sucked away my will to live.

Nah. The key is payer mix. And who's collecting.

During the goood days of 2005-2008. My buddy in Texas was raking in as much as 15k a night on OB anesthesia call. Good payer mix and collecting his own billing.

He still collects his own billing but demographics have changed a lot. Some nights maybe $3000. Some nights $10k. But not consistently 10-15k a 24 hour block.

 

[criticalelement]

Nah. The key is payer mix. And who's collecting.

During the goood days of 2005-2008. My buddy in Texas was raking in as much as 15k a night on OB anesthesia call. Good payer mix and collecting his own billing.

He still collects his own billing but demographics have changed a lot. Some nights maybe $3000. Some nights $10k. But not consistently 10-15k a 24 hour block.

What you are describing is straight-up, un adulterated "Pimpin".

Nobody reading this board will be seeing that.

Most of us will be in the 300-400 range irregardless of how much we work.

while its nice that the AMC president never leaves his house and makes millions... I cant do anything about it unless we have a massive revolt in anesthesia which i totally advocate.
This is where the ASA has dropped the ball.

 

[Direct Laryngoscopy]

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.

Serious smack down right there. LOL


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[Nivens]

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


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Il Destriero

Seems to be a common opinion. Would you mind expanding on this a little?

 

[IlDestriero]

Seems to be a common opinion. Would you mind expanding on this a little?

MBAs teach you leadership strategy, management techniques, financial management, etc. and most importantly they teach you how to think like a businessman (the board and CEO) who you will have to interact with. That's great for people that want to advance to leadership positions in the hospital, run a large department, start some side business, etc. a resident who wants a career in clinical medicine isn't going to do any of that any time soon. They'll be lucky to get any kind of leadership position, beside trivial committee work, for years. Around 10-15 years into your career when that might actually be a possibility, all your MBA businessology will be stale and forgotten and any contacts you had for networking will be cold. Someone who does an executive MBA from a good program mid career will be in a position to actually use the degree to negotiate a promotion or relocate to a management position elsewhere. That's one of the things keeping me from getting one, even though I have the GI bill and/or faculty discounts to pay for one. I'm a medium sized fish in a big ocean. I'd likely have to move to become a bigger fish in a smaller pond. I like my job, and it's a good one for a number of reasons, so I don't know that the effort would pay off.


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Il Destriero

 

[GravelRider]

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.

Relax. You're awesome and we know that. Your trophy is in the mail...as well as a freshly baked batch of cookies. When you are done patting yourself on the back we can get back to reality.

You are in a top percentile group (that's the very very right most skinny part of a bell curve). One that 99.99% of residents will never ever ever see. That is the point here. You hit the lottery that most people training now literally have no chance of seeing. The vast majority of residents will never have a chance at a practice like this. Most residents will be working for someone and a busy OB practice is not what you want. You get a $300k salary whether you do 14 c-sections on call or you watch Netflix all night.

Calling someone out on their epidural time is weak. Are you a CA-1? I used to have an 18 minute epidural time as a CA-1...that included history taking, consent, epidural placement, and charting. Who cares? No one cares how fast you are. I bet I can find some CRNAs who are faster. It's a monkey procedure.

 

[sevoflurane]

Relax. You're awesome and we know that. Your trophy is in the mail...as well as a freshly baked batch of cookies. When you are done patting yourself on the back we can get back to reality.

You are in a top percentile group (that's the very very right most skinny part of a bell curve). One that 99.99% of residents will never ever ever see. That is the point here. You hit the lottery that most people training now literally have no chance of seeing. The vast majority of residents will never have a chance at a practice like this. Most residents will be working for someone and a busy OB practice is not what you want. You get a $300k salary whether you do 14 c-sections on call or you watch Netflix all night.

Calling someone out on their epidural time is weak. Are you a CA-1? I used to have an 18 minute epidural time as a CA-1...that included history taking, consent, epidural placement, and charting. Who cares? No one cares how fast you are. I bet I can find some CRNAs who are faster. It's a monkey procedure.

I have no beef w/u and I'm plenty chill. I am definitely NOT at the 99% tile. I'll tell you what though: I have a problem when I try to give a real life heavy OB perspective (for those who are contemplating doing the fellowship- point of this thread right?) and some d-bag comes on here and thinks that it's not possible to do that kind of work. It can be a tough 24hr. call.
That's the point of my post in case you missed it. Doing it as the majority of your daily work may not be worth the fellowship in the end. I used to laugh at the idea of an OB fellowship. Now IDK, might get u in if that is where u want to be.

I completely disagree with you when you say you get paid the same if you do zero c/s vs 14 c/s per night. Where do you think it all goes? If your pay is the same you didn't sign with the right group. Plain and simple. There are plenty of good/fair groups still out there. Why do I know this? Because I was on the interview trail 2+ years ago and found some very nice PP jobs scattered around in nice places. So yeah, not all groups are predatory and not all jobs are AMCs. You can def. do better than 300k for 60 hrs a week w/ 6 wks of vaca. If you signed up for that, then that's your problem.

Procedure times always matter. If you are consistently outside of the bell curve everyone notices: partners, surgeons, nurses, etc. it definitely matters when you suddenly have 4 epidurals to place, and you have 2 rooms with non reassuring FHRs + you are the only game on the OB floor. So I disagree with you there as well.

This thread has spiraled out a bit, so my apologies for my part in that.

Is fellowship worth it? I think so, but it's not a be all and end all. You have to really like it.

It used to be that you graduated and you did everything. The problem is that now, the landscape has changed.

 

[GravelRider]

The majority of jobs that current residents will be taking will be employed jobs...if you do 14 c-sections or 1 c-section on call you get paid the same. It sucks, but it's the reality. Thinking otherwise sets current residents up for disappointment. It creates resentment. Expectations should be set appropriately. If you get lucky and find something better, great...work hard and count your lucky stars (or $$$).

I would assume anyone who is practicing at a relatively high volume OB practice can place an epidural quickly. It's really not hard. Managing and triaging a busy OB floor should be something you have begun to master by the end of CA-2 year. That's not what an OB fellowship should be for.

It's fun to brag how slick we are at epidurals or how sweet and smooth our wake ups are, but those are not hard skills to master at all. If that is where we think our value is then the specialty is doomed. Finesse and efficiency are certainly important, but I know plenty of CRNAs who are pretty slick with procedures. Our value lies in being a good doctor...problem solving, figuring out a plan for a tough case, saving the day when things go bad, etc... Our procedural skills are fairly simple. We're not performing brain surgery...

 

[Jose Luis Chilavert]

An OB fellowship can be a phenomenal idea when done at the right place for the right reason. All the dinosaurs on this forum who trained pre-ultrasound can bicker about it all they want-- these days it opens the door not only to any academic setting you want, but also is very attractive to PP groups . Why? Because PP groups feel the increasing need to take their masks off and get involved in hospital leadership committees, and bringing fellowship trained attendings to these circles does help, believe it or not. The suits are invariably more impressed with fellowships, and the suits do have power... Also, in an increasingly hostile environment with AMCs lurking, PP groups have to advertise to their surgeons and OBs, to their hospitals, and to their communities that they have "specialists"... It looks better. Like it or not.
The OB fellowship will give you more value and an edge if you consider academia or OB heavy practices. It is not uncommon to be offered an OB director position when looking for jobs during your OB fellowship year. If you can find a very busy place for your fellowship that gives you exposure to high risk OB, and you get to hone your understanding and your skills, go for it. Anyone who tells you different either doesn't know what they are talking about or trained in the 80s.

 

[BLADEMDA]

An OB fellowship can be a phenomenal idea when done at the right place for the right reason. All the dinosaurs on this forum who trained pre-ultrasound can bicker about it all they want-- these days it opens the door not only to any academic setting you want, but also is very attractive to PP groups . Why? Because PP groups feel the increasing need to take their masks off and get involved in hospital leadership committees, and bringing fellowship trained attendings to these circles does help, believe it or not. The suits are invariably more impressed with fellowships, and the suits do have power... Also, in an increasingly hostile environment with AMCs lurking, PP groups have to advertise to their surgeons and OBs, to their hospitals, and to their communities that they have "specialists"... It looks better. Like it or not.
The OB fellowship will give you more value and an edge if you consider academia or OB heavy practices. It is not uncommon to be offered an OB director position when looking for jobs during your OB fellowship year. If you can find a very busy place for your fellowship that gives you exposure to high risk OB, and you get to hone your understanding and your skills, go for it. Anyone who tells you different either doesn't know what they are talking about or trained in the 80s.

So just for discussion purposes only here are my questions:

1. What unique skill set does that OB Fellowship bring to the table over say someone with 10,000 plus Epidurals already placed in private practice?
2. What unique knowledge base does that OB Fellowship bring you that can't be found with a 2 minute google search and lots of "on hands" experience with the tough cases?

The emperor has no clothes but the piece of paper looks nice on your wall.

 

[Jose Luis Chilavert]

So just for discussion purposes only here are my questions:

1. What unique skill set does that OB Fellowship bring to the table over say someone with 10,000 plus Epidurals already placed in private practice?
2. What unique knowledge base does that OB Fellowship bring you that can't be found with a 2 minute google search and lots of "on hands" experience with the tough cases?

The emperor has no clothes but the piece of paper looks nice on your wall.

Ok... So just for discussion purposes, I'll reply...

1) The question, at least in my fellowship mind, seemed to be whether or not doing a fellowship can offer job security (and for people coming out of training, I am assuming the question is "Does it help me get a better job?"). Given that this is a resident forum, the question applies primarily to those graduating from residency soon and contemplating a fellowship. So comparing an OB fellow to somebody who has placed, say, 10,000 epidurals in many many years of PP.. is completely besides the point. Why don't you compare somebody who has done 10,000 hearts or 10,000 neonates to a cardiac or peds fellow? Following your line of logic, there is no point in doing a fellowship ever because somebody 20 years out of training has more numbers and more experience than a fellow. If that is the point you are trying to make, then you are wasting my time.
2) Did you read my post above? I clearly remember writing about doing an OB fellowship in a busy place with lots of high risk OB-- in a tertiary academic center, you actually do take care of patients that you won't see in smaller community hospitals. Now I am sure you perfected the art of googling clinical information, but I am going to go out on a limb here and say that is NOT the same!! Can you believe that...

What is your point of arguing anyway? I have not invented the current medical landscape, it is what it is and I am stating facts here. You want an academic job? Two candidates being otherwise equivalent, the one with the fellowship gets the job. You want to join a practice that does lots and lots of a given subspecialty? Fellowship sure helps you, everything else being equal. Shocker!

And about your emperor comment...

 

[Psai]

Ok... So just for discussion purposes, I'll reply...

1) The question, at least in my fellowship mind, seemed to be whether or not doing a fellowship can offer job security (and for people coming out of training, I am assuming the question is "Does it help me get a better job?"). Given that this is a resident forum, the question applies primarily to those graduating from residency soon and contemplating a fellowship. So comparing an OB fellow to somebody who has placed, say, 10,000 epidurals in many many years of PP.. is completely besides the point. Why don't you compare somebody who has done 10,000 hearts or 10,000 neonates to a cardiac or peds fellow? Following your line of logic, there is no point in doing a fellowship ever because somebody 20 years out of training has more numbers and more experience than a fellow. If that is the point you are trying to make, then you are wasting my time.
2) Did you read my post above? I clearly remember writing about doing an OB fellowship in a busy place with lots of high risk OB-- in a tertiary academic center, you actually do take care of patients that you won't see in smaller community hospitals. Now I am sure you perfected the art of googling clinical information, but I am going to go out on a limb here and say that is NOT the same!! Can you believe that...

What is your point of arguing anyway? I have not invented the current medical landscape, it is what it is and I am stating facts here. You want an academic job? Two candidates being otherwise equivalent, the one with the fellowship gets the job. You want to join a practice that does lots and lots of a given subspecialty? Fellowship sure helps you, everything else being equal. Shocker!

And about your emperor comment...

A lot of people teaching the fellows somehow got by without a fellowship in that field. In fact, some of them happened to finish residency in just 3 years. And they ended up just fine.

 

[AdmiralChz]

I think Blade's comments came more from what skills are added/gained through a fellowship. For cardiac, the only way to become Advanced TEE certified is through an ACGME fellowship. Some private groups will still hire non-TEE folks for cardiac, but likely not at big centers. Likewise for Peds there is a board exam and many centers are requesting that for neonatal coverage (unless you are grandfathered in) similar to cardiac. For better or worse, there are now barriers to entry into these fields. Chronic Pain and CCM also have a board exam, although that's for out of the OR management. Most tenure-track academic positions require a fellowship, at least on the coasts. I don't see that changing anytime soon.

Long story short, there is no "board" or "certification" obtained through an OB fellowship. Does it set you up for an academic job? Absolutely, many departments have a division of OB anesthesia and it may jumpstart your ability to create a legit academic interest. Would it help in the private realm, I'm not entirely sure. But there are some reasonable pros/cons above.

Just my two cents.

 

[criticalelement]

The next shoe to drop:

The ABA will be requiring a five year residency. Making the last year a fellowship year.

Then there will be super fellows.. Those who want to stand out doing an additional sixth year.

and so the wheel goes round and round........

by that time CRNAs will be completely independent..

 

[BLADEMDA]

I think Blade's comments came more from what skills are added/gained through a fellowship. For cardiac, the only way to become Advanced TEE certified is through an ACGME fellowship. Some private groups will still hire non-TEE folks for cardiac, but likely not at big centers. Likewise for Peds there is a board exam and many centers are requesting that for neonatal coverage (unless you are grandfathered in) similar to cardiac. For better or worse, there are now barriers to entry into these fields. Chronic Pain and CCM also have a board exam, although that's for out of the OR management. Most tenure-track academic positions require a fellowship, at least on the coasts. I don't see that changing anytime soon.

Long story short, there is no "board" or "certification" obtained through an OB fellowship. Does it set you up for an academic job? Absolutely, many departments have a division of OB anesthesia and it may jumpstart your ability to create a legit academic interest. Would it help in the private realm, I'm not entirely sure. But there are some reasonable pros/cons above.

Just my two cents.

An OB fellowship is useful for an academic career; it has very limited value outside academia. This is in contrast with the "Big Four" in Anesthesiology which are all valuable fellowships both in academia and private practice:

1. Cardiac
2. Peds
3. Pain
4. Critical Care

You can do a fellowship in Neuroanesthesia, Hyperbaric medicine, ambulatory care, etc but those are all similar to the OB fellowship in that they provide a launching point for an academic career.

 

[IlDestriero]

I think the next big thing will be a fellowship in OR management. Every private practice need an expert in running the OR board. It will come with a certificate in EPIC and all the major EMRs.
That's money in the bank.


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Il Destriero

 

[deleted50478]

I think the next big thing will be a fellowship in OR management. Every private practice need an expert in running the OR board. It will come with a certificate in EPIC and all the major EMRs.
That's money in the bank.


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Il Destriero

Yeah. Pretty sure in your AMC job after practice management fellowship the suits will value your expertise while you spend your career clocking in and out and maximizing private equity return on investment while having no roll in managing the group.