Most Competitive Anesthesiology Fellowship?

[Medalot]

So what's the most competitive anesthesiology fellowship? Cardiothoracic? Peds? Pain? Critical Care? OB? Regional? etc?

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[shift_roro]

peds

 

[mikey014]

So what's the most competitive anesthesiology fellowship? Cardiothoracic? Peds? Pain? Critical Care?* OB? Regional? etc?

I find it odd when asked what's the most competitive specialty in med school. Is it that because it's the most competitive it makes people want to apply even more, to prove that they can land something extremely competitive. And vice versa if it's not very competitive, would that mean you don't want to apply because you no longer like the field because it's way too easy?

I feel there is a value knowing what's the order of relative competitiveness across specialties and fellowships. But knowing which one is THE ABSOLUTE MOST competitive seems odd.

However, with that being said ... I've always heard pain and cardio are hard. But peds isn't far behind. And I think peds depending on the caliber of the program could be very hard, if not harder, as well. Then critical care is less competitive. And ob & regional are significantly less competitive.

 

[Medalot]

Although I agree that people should not choose fellowships (or specialty) based on how competitive it is, I think people do for a number of reasons. Like all aspects of life, people tend to want what everyone else wants (as ridiculous as that may be). But on a more practical level, I do think it's a factor that everyone should acknowledge when considering a fellowship. Why is a particular fellowship/specialty more competitive? What characteristics about the fellowship/specialty have you not consider that makes it more/less competitive? Adds practical knowledge/skills in the real world after training? Is it lifestyle issues? Is it job demand? Is it job autonomy? Is it financial reward? Or is it because it's open to multiple specialties (ie. Pain)? etc. Stating that one should simply choose a fellowship/specialty simply because of interest without considering any of the above factors is like choosing "Art History" as a major in college and being disappointed when you can't find a job after graduating.

With all this said, previous posts have ranked Pain > Cardiac > Peds > CC = Regional > OB etc. But I wonder if that is just because more people apply to Pain without considering the self-selection factor (ie. quality of applicants).

 

[IlDestriero]

Is there even any data on this? I could tell you how many applicants we had, but it's just one single data point. Maybe with the new Peds match there is some data on how competitive the match spots really are. I'll try to find out.

 

[BLADEMDA]

So what's the most competitive anesthesiology fellowship? Cardiothoracic? Peds? Pain? Critical Care? OB? Regional? etc?

Competitive? Do you see yourself doing lots of little kids day in and day out? Is that for you? Do you like Pediatric Anesthesia?

Do you see yourself doing TEE almost every day and doing a third time redo CABG/AVR with an EF of 15%? Do you like working in a room which is 50 degrees filled with the most arrogant surgeons in the USA?

Do you like seeing patients who are chronically complaining about pain? Do you like Pain Clinic and diagnosing/treating patients who can't be helped by anyone? Do you like doing procedures wearing a heavy X ray gown with Flouro for several hours per day?

Do you like doing an Epidural on a 450 pound patient with Medicaid and Pre-Eclampsia?
Do you like doing OB 24/7 on the highest risks patients?

Forget about competition for a fellowship and do what you can stand for the next 30 years.

 

[Doctor4Life1769]

Competitive? Do you see yourself doing lots of little kids day in and day out? Is that for you? Do you like Pediatric Anesthesia?

Do you see yourself doing TEE almost every day and doing a third time redo CABG/AVR with an EF of 15%? Do you like working in a room which is 50 degrees filled with the most arrogant surgeons in the USA?

Do you like seeing patients who are chronically complaining about pain? Do you like Pain Clinic and diagnosing/treating patients who can't be helped by anyone? Do you like doing procedures wearing a heavy X ray gown with Flouro for several hours per day?

Do you like doing an Epidural on a 450 pound patient with Medicaid and Pre-Eclampsia?
Do you like doing OB 24/7 on the highest risks patients?

Forget about competition for a fellowship and do what you can stand for the next 30 years.

This.

and THIS is why I'm questioning if I should even bother doing a fellowship that could pigeonhole me into one of those above select patient populations.

I like pedi. I also like doing the pain procedures. But, do I want to do this every day? I entered anesthesia for the variety. The mix. Not to just focus on little kids (not talking healthy ones who are getting T/As, BMTs, circs, hernia repairs - I'm referring to the sick neonates with all sorts of issues going on).

I don't want to do cardiac on a daily basis. I've not done a month of cardiac yet and I already know. I want to get good at TEE, though.

OB calls remind me of why I don't want to do OB the rest of my life. Even if OU is sponsoring the first ACGME-accredited OB fellowship.

Regional seems to be the "most marketable" in a purely private practice setting or ambulatory setting. Where it's all about how you can provide the most efficient analgesia and anesthesia and get patients rolling outta the PACU the same day. The only problem here is it's unaccredited. However, an attending I was working with yesterday told me eventually all the fellowships will become accredited. When regional becomes one, you'll easily be grandfathered in.

He also told me that, at this time, the fellowship to pursue and in greatest demand out in practice is pediatrics.

Right now, I'm kinda at a loss. I know I'm just a CA-1 but I'll be 2.5 months out from starting CA-2 year. That attending told me I should start thinking about my career path NOW and not later.

 

[Random Anesthesiologist]

I'm considering a fellowship with the idea that I will likely look for jobs in less populated areas. This makes me think that I won't spend 100% of my workday dealing with, say, peds or whatnot, but be the one to take the more complicated cases when they come in.

Is this a realistic expectation?

 

[BLADEMDA]

I'm considering a fellowship with the idea that I will likely look for jobs in less populated areas. This makes me think that I won't spend 100% of my workday dealing with, say, peds or whatnot, but be the one to take the more complicated cases when they come in.

Is this a realistic expectation?

Use it or lose it. How valuable will that Fellowship really be in 10 years in rural USA?
Sure, it may help secure you a job but you need to be heavily involved in that subspecialty to STAY at the top of your game.

The way I see it a fellowship makes sense if you plan on doing at least 30% or more of your cases in that area (private practice). In academics, a fellowship is pretty much mandatory to move up the food chain at most places.

Don't get me wrong I think a fellowship is a great idea but if you want a mostly general practice with just some sick patients then Cardiac makes the most sense. However, Pediatrics is a solid choice in POPULATED cities where you can draw paying patients.


I also think Critical Care with one month of TEE can make you one bad ass Physician who can handle any adult patient presenting for surgery.
It's also nice to be the bad ass.

 

[pie944]

Forget about competition for a fellowship and do what you can stand for the next 30 years.

I think one can utilize this in picking a residency as well.

 

[BLADEMDA]

I think one can utilize this in picking a residency as well.

Residency is like College or Medical School. Great memories which last a lifetime.
But, FELLOWSHIP is the rest of your career. Big difference.

 

[IlDestriero]

I'm considering a fellowship with the idea that I will likely look for jobs in less populated areas. This makes me think that I won't spend 100% of my workday dealing with, say, peds or whatnot, but be the one to take the more complicated cases when they come in.

Is this a realistic expectation?

Yes.

 

[pie944]

Residency is like College or Medical School. Great memories which last a lifetime.
But, FELLOWSHIP is the rest of your career. Big difference.

I think picking a residency(area of medicine) might fall into the rest of your career category. So it might be wise to pick something that will provide you enjoyment over the course of thirty or forty years.

 

[hawthorne]

I know I'm only a third year med student but I have entertained the idea of fellowship, mainly ICU has been my idea but I think peds could be interesting or maybe pain. Really I love the opportunities anesthesia has to offer! But from a financial stand point with all the new changes that are going to happen is it a financial gain to have a fellowship? Will one have more job security with one? I apologize ahead of time if I am being naive or beating a dead horse.

 

[Random Anesthesiologist]

Use it or lose it. How valuable will that Fellowship really be in 10 years in rural USA?
Sure, it may help secure you a job but you need to be heavily involved in that subspecialty to STAY at the top of your game.

The way I see it a fellowship makes sense if you plan on doing at least 30% or more of your cases in that area (private practice). In academics, a fellowship is pretty much mandatory to move up the food chain at most places.

Don't get me wrong I think a fellowship is a great idea but if you want a mostly general practice with just some sick patients then Cardiac makes the most sense. However, Pediatrics is a solid choice in POPULATED cities where you can draw paying patients.


I also think Critical Care with one month of TEE can make you one bad ass Physician who can handle any adult patient presenting for surgery.
It's also nice to be the bad ass.

Very valid point. I did a month of cc in m4 and liked it too. I have a couple years to think about it... I also wonder about doing a cc fellowship and extra months of peds in CA3 to get more proficiency. I want to think about these things, but I don't want to get too far ahead of myself.

I need more exposure to see what would be a good fit for me.

 

[BLADEMDA]

I think picking a residency(area of medicine) might fall into the rest of your career category. So it might be wise to pick something that will provide you enjoyment over the course of thirty or forty years.

My reference was in regards to the LOCATION of the Residency and not the specialty choice. I assumed the specialty in this discussion was Anesthesiology.

 

[BLADEMDA]

I know I'm only a third year med student but I have entertained the idea of fellowship, mainly ICU has been my idea but I think peds could be interesting or maybe pain. Really I love the opportunities anesthesia has to offer! But from a financial stand point with all the new changes that are going to happen is it a financial gain to have a fellowship? Will one have more job security with one? I apologize ahead of time if I am being naive or beating a dead horse.

Nobody knows for certain but you will definitely not have LESS job security because you did a fellowship.

In this job market I would recommend a fellowship unless you have solid connections for a good job or are planning to practice in less competitive markets.

 

[gasattack3]

This.

and THIS is why I'm questioning if I should even bother doing a fellowship that could pigeonhole me into one of those above select patient populations.

I like pedi. I also like doing the pain procedures. But, do I want to do this every day? I entered anesthesia for the variety. The mix. Not to just focus on little kids (not talking healthy ones who are getting T/As, BMTs, circs, hernia repairs - I'm referring to the sick neonates with all sorts of issues going on).

I don't want to do cardiac on a daily basis. I've not done a month of cardiac yet and I already know. I want to get good at TEE, though.

OB calls remind me of why I don't want to do OB the rest of my life. Even if OU is sponsoring the first ACGME-accredited OB fellowship.

Regional seems to be the "most marketable" in a purely private practice setting or ambulatory setting. Where it's all about how you can provide the most efficient analgesia and anesthesia and get patients rolling outta the PACU the same day. The only problem here is it's unaccredited. However, an attending I was working with yesterday told me eventually all the fellowships will become accredited. When regional becomes one, you'll easily be grandfathered in.

He also told me that, at this time, the fellowship to pursue and in greatest demand out in practice is pediatrics.

Right now, I'm kinda at a loss. I know I'm just a CA-1 but I'll be 2.5 months out from starting CA-2 year. That attending told me I should start thinking about my career path NOW and not later.

This is a valid post. I'm a CA2 applying to pain at the moment. I like it, but I did also go into anesthesia for the variety. So, I get what you're saying.

My ideal job would (if no fellowship) be in a 350-550 bed hospital, doing everything, including hearts and bread and butter peds, and of course OB (which so many of my coresidents despise). This would be the ideal job for me. Small enough not to be too impersonal but big enough to do a wide variety of cases. And, no, I don't need to be in a major urban area. I'd be willing to take a job in a smaller community and live an otherwise "quiet" life.

If I go pain (likely), then I'll try hard to NOT do 100% pain but we'll see if the economics sucks me into doing that. I would like to hang on to my OR skills.

 

[gasattack3]

If you can get a good job then do it. I do hearts without fellowship. When I quit or retire they'll probably hire someone with a ct fellowship, but I don't think I'll be replaced by a new grad in the heart room. Maybe if the ct surgeons retire, but otherwise it's unlikely.
Don't pass up an open door for a good job because you think a fellowship will open doors.

Since pain is a match now, I'll still be aggressively beginning a job hunt in just a few months time. Pain is competitive and I'm not going to put the job search (contrary to what the Ivory Tower would have us think this IS all about EARNING a living.....) on hold even while interviewing.

Should a solid partnership track job come my way BEFORE my rank deadline, I will seriously consider NOT ranking any program, and taking the job. I like pain, but there's a COST to doing a fellowship. I do not want a fellowship at any cost.

If you can land a partnership job in PP, even if the future may be consolidation by AMC's or employed by the hospital, my thinking is that a bird in the hand in this market is maybe a wiser decision. If market dynamics force you to consider linking up with an AMC down the road, well then as a PARTNER you'll still receive a sizable buyout if negotiated well.

Also, if indeed these partnership jobs are becoming more and more rare, and we see the upside of non-partnership gigs limited, then I'd rather be a non-fellowship partner than a fellowship trained guy working as an employee.

I plan on working my a.s off in PP for at least 5 years, maximizing income and living a very modest lifestyle. Building a F.ck you account is a priority. Ten years out I want to be in a position where I am working because I love the job, and if economics or politics change, then it won't quite matter as much if I don't need to fund a country club membership etc. Not saying one will be able to "retire" 10 years out, but bad things just won't IMPACT you as much you if you play this right over the next 5-10 years.

Also, PP jobs in smaller health systems and smaller communities aren't going to be as large a target for AMC's as some of the larger ones IMHO.

 

[nimbus]

Also, PP jobs in smaller health systems and smaller communities aren't going to be as large a target for AMC's as some of the larger ones IMHO.

It is quite the opposite in California. The smaller <20 doc groups are the ones being taken over. The huge metropolitan super groups with 100-200+ docs are holding their own for the moment.

 

[Wiscoblue]

It is quite the opposite in California. The smaller <20 doc groups are the ones being taken over. The huge metropolitan super groups with 100-200+ docs are holding their own for the moment.

Very interesting. I work at a 200 bed hospital system with 10 other guys and we have a very good relationship with the hospital administration. I'm not sure our group could ever be taken over as long as we continue to provide excellent service to the patients and there are no complaints from the surgeons. Now if the current admin should retire, or decide to sell out, all bets are off. We already have Sheridan sniffing around in the neighboring city.

As far as hiring new grads, our next hire will probably be someone with a Peds fellowship. He/she will do 20% peds and then everything else.

 

[somedumbDO]

peds

peds,and then ICU. These are the only fellowships that get you worth the year investment. Go to gas works who are they hiring for? pain is going down the pooper (oh please can I have a neurologist do my cervicle epidural?!?, CT/Regional/OB you shuda learned in residency.

 

[Bertelman]

Should a solid partnership track job come my way BEFORE my rank deadline, I will seriously consider NOT ranking any program, and taking the job. I like pain, but there's a COST to doing a fellowship. I do not want a fellowship at any cost.

If you can land a partnership job in PP, even if the future may be consolidation by AMC's or employed by the hospital, my thinking is that a bird in the hand in this market is maybe a wiser decision. If market dynamics force you to consider linking up with an AMC down the road, well then as a PARTNER you'll still receive a sizable buyout if negotiated well.

Also, if indeed these partnership jobs are becoming more and more rare, and we see the upside of non-partnership gigs limited, then I'd rather be a non-fellowship partner than a fellowship trained guy working as an employee.

Your description of a PP job leading to a buyout is your best possible outcome. Also consider the possibility that you will take the partner track, and 1.5 yrs from now they sell the practice, pocket > 1mil, none of which you get, drop your salary about 50 k and say "sorry" with a sheepish grin. Then you may wish you had done that fellowship.

 

[ssmallz]

peds,and then ICU. These are the only fellowships that get you worth the year investment. Go to gas works who are they hiring for? pain is going down the pooper (oh please can I have a neurologist do my cervicle epidural?!?, CT/Regional/OB you shuda learned in residency.

Well at least you are living up to your name

 

[Doctor4Life1769]

Your description of a PP job leading to a buyout is your best possible outcome. Also consider the possibility that you will take the partner track, and 1.5 yrs from now they sell the practice, pocket > 1mil, none of which you get, drop your salary about 50 k and say "sorry" with a sheepish grin. Then you may wish you had done that fellowship.

being fellowship trained doesn't guarantee you becoming partner either.

 

[Bertelman]

being fellowship trained doesn't guarantee you becoming partner either.

It does not, but it may allow you to:
1) retain a job based on unique skills
2) market yourself for a different job
3) do something you truly enjoy if you end up stuck where you are at.

I am getting the shaft on this as we speak, and I can tell you that without my fellowship, the offer they would give me to remain would be an insult.

I'm not saying you should all run and get fellowship trained, but you also shouldn't think that breaking into a partner track one year before you otherwise would have will somehow guarantee anything at all.

If you like a subspecialty, just do the damn fellowship.

 

[Blockdoc22]

Hi everyone,
It looks like times are changing in the field of anesthesia:

I spoke with someone who just finished his chronic pain fellowship at a prestigious program and stayed on as a faculty member. When I talked to him at the ASRA conference, he told me that their chronic pain fellowship program received an astonishingly low number of applicants this year (2015). His theory for this precipitous drop in applicants was that since reimbursements have dropped (and will continue to decrease), not as many people want to go into the field.

Regarding cardiac fellowships, 2 of my cardiac attendings told me that the field is over-saturated, and because there aren't enough cardiac cases per CT anesthesiologist, they end up doing a lot of general cases instead. This is their theory as to why CT anesthesia has become less competitive.

The hot fellowship seems to be regional/acute pain for several reasons. It WILL BE acgme certified in 2 years (3 at the most). The fellowships not only teach their trainees how to do common and obscure blocks effectively and efficiently, but they show them how to run an ambulatory surgical center (perioperative surgical home model), which is a very valuable skill to bring to any program. In terms of how competitive the applicants are, I know from my program alone, the top 4 residents (highest ITE scores and 3 chief residents) in the last 2 years have pursued regional fellowships. I think it's very inaccurate to say things like, "A regional fellowship is a waste of time", because coming out of a top regional program will really help you get the job you want.

There isn't any objective data to say which fellowships are the most "competitive". All of these posts seem to be based on "he said, she said" antecdotes, so I thought I'd share my opinion.
Anyone interested in regional fellowships, the top programs seem to be:

DUKE
VIRGINIA MASON
DARTMOUTH
HSS
UPMC

 

[nimbus]

Hi everyone,
It looks like times are changing in the field of anesthesia:

I spoke with someone who just finished his chronic pain fellowship at a prestigious program and stayed on as a faculty member. When I talked to him at the ASRA conference, he told me that their chronic pain fellowship program received an astonishingly low number of applicants this year (2015). His theory for this precipitous drop in applicants was that since reimbursements have dropped (and will continue to decrease), not as many people want to go into the field.

Regarding cardiac fellowships, 2 of my cardiac attendings told me that the field is over-saturated, and because there aren't enough cardiac cases per CT anesthesiologist, they end up doing a lot of general cases instead. This is their theory as to why CT anesthesia has become less competitive.

The hot fellowship seems to be regional/acute pain for several reasons. It WILL BE acgme certified in 2 years (3 at the most). The fellowships not only teach their trainees how to do common and obscure blocks effectively and efficiently, but they show them how to run an ambulatory surgical center (perioperative surgical home model), which is a very valuable skill to bring to any program. In terms of how competitive the applicants are, I know from my program alone, the top 4 residents (highest ITE scores and 3 chief residents) in the last 2 years have pursued regional fellowships. I think it's very inaccurate to say things like, "A regional fellowship is a waste of time", because coming out of a top regional program will really help you get the job you want.

There isn't any objective data to say which fellowships are the most "competitive". All of these posts seem to be based on "he said, she said" antecdotes, so I thought I'd share my opinion.
Anyone interested in regional fellowships, the top programs seem to be:

DUKE
VIRGINIA MASON
DARTMOUTH
HSS
UPMC

5-10 years ago a regional fellowship might have been a selling point. Nowadays EVERYBODY does USG blocks and most of us are self-taught. Do the fellowship for your own interest but it will not help you get a PP job. It probably will help you get an academic job.

In our practice, the only fellowship we specifically recruit for are peds and cardiac. And only when there is a need. Regional we just learned on the job.

 

[Blockdoc22]

5-10 years ago a regional fellowship might have been a selling point. Nowadays EVERYBODY does USG blocks and most of us are self-taught. Do the fellowship for your own interest but it will not help you get a PP job. It probably will help you get an academic job.

In our practice, the only fellowship we specifically recruit for are peds and cardiac. And only when there is a need. Regional we just learned on the job.

To say that it will not help you get a PP job is inaccurate. My friend, who just finished his regional fellowship at a top program, really wanted to join a PP that wasn't even hiring. He contacted the chair, told him about his fellowship and how he could add value to the practice by running the ambulatory surgical center, and he was hired one week later... And this is definitely not an academic institution.

 

[nimbus]

To say that it will not help you get a PP job is inaccurate. My friend, who just finished his regional fellowship at a top program, really wanted to join a PP that wasn't even hiring. He contacted the chair, told him about his fellowship and how he could add value to the practice by running the ambulatory surgical center, and he was hired one week later... And this is definitely not an academic institution.

Out of curiosity, what area of the country is this? Was it a smaller community?

In my area, all new hires are expected to be proficient in blocks and they generally are or they pick it up real fast. We have no shortage of people who can do both basic and advanced blocks. In the past, we've hired regional fellows from UCSD and Stanford but the fellowship is not why they got the job. We literally already have hundreds of people doing thousands of blocks every year. And I'm sure that is true for every other metropolitan area in the country.

OTOH we've had problems in the past filling certain cardiac positions.

 

[Blockdoc22]

Out of curiosity, what area of the country is this? Was it a smaller community?

In my area, all new hires are expected to be proficient in blocks and they generally are or they pick it up real fast. We have no shortage of people who can do both basic and advanced blocks. In the past, we've hired regional fellows from UCSD and Stanford but the fellowship is not why they got the job. We literally already have hundreds of people doing thousands of blocks every year. And I'm sure that is true for every other metropolitan area in the country.

OTOH we've had problems in the past filling certain cardiac positions.

Interesting. Thanks for sharing. My friend got his job just outside of Durham, NC, so definitely a smaller community.

 

[deleted50478]

I'm considering a fellowship with the idea that I will likely look for jobs in less populated areas. This makes me think that I won't spend 100% of my workday dealing with, say, peds or whatnot, but be the one to take the more complicated cases when they come in.

Is this a realistic expectation?

No. Peds anesthesia is a mostly academic, major medical center specialty. There are few private jobs worth doing the fellowship for and fewer bfe peds jobs.
There are of course private practice neonates and cardiac, but academic jobs far outnumber those i think.

 

[Magnus67]

Our group of 14 did over 1800 blocks last year. 80% of them catheters. No fellowship required, we do almost every block known. If u want to do a regional fellowship , I'll pay u peanuts and can do all the blocks u want for me. . Right now we r hiring only Peds and Cards because those skills/experience u can't get from watching a YouTube video. Academics or an employed position may be different though.

2cents

 

[Shimmy8]

80% catheters? For what cases, if you don't mind me asking.

We do a *ton* of blocks in our program, just started CA-2 and I'm way way way above my "number" but we do very few catheters.

 

[Magnus67]

Knees, Shoulders, Ankles, Arms, etc.....