Perioperative Management/OR Management Fellowships

[Depolarized99]

Hey Everyone,

Soon to be CA2 here, training in the NE. Starting to think about what I might do when finished with residency. I was someone who debated between EM and anesthesia, definitely liked that EM was 3 years compared to 4, and needless to say, I'm not crazy about turning this residency "investment" into a 5 year ordeal via inclusion of a fellowship. Having said that, I recognize this is probably short sighted thought, and that for an extra year of training, could maybe add to my value in this rapidly changing and uncertain job market. I like critical care and cardiac, and I think I like the interventional aspect of pain. If I'm being completely honest, I don't love any of them to the point that I would pursue fellowship training for any other reason than being more marketable in a competitive job market i.e. coastal territory. Interested in private practice but recognize PP is changing/has changed quite a bit. Don't like the idea of working for an AMC, obviously (but it does seem like there are some good EM gigs out there, administered by companies alike? Maybe I'm wrong about this.) Would of course like to be a partner some day. Young, hungry, aggressive work ethic, single without geographic restriction, high (average) student loan debt. I have a some business background, think like a business person, really do enjoy the practice of anesthesia so far. Most people in my program have gone on to do fellowships at some great places--and sometimes I feel we are almost all expected to follow suit. I will do what suits me best however. Debating between seeing what an early locums career would look like (more profitable for sacrifice of moving around?), doing a fellowship in one of the above, or pursuing a perioperative management fellowship:

http://med.stanford.edu/anesthesia/education/fellowship/fellowship_management.html

http://www.anesthesiology.uci.edu/education_periopmed_fellowship.shtml

I'm sure there are others, these are just a couple.

What do you guys think of this? Is the move to get an MBA rather than this? Do you think someone who had completed a fellowship like this could bring added value to your group..especially considering I will be a new grad? Does that potential "value" even matter? Some programs allow you to moonlight on top of fellowship salary vs paying for an MBA. Curious to hear some feedback. Thanks.

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[Planktonmd]

It sounds like you want to be an administrator not a clinician, and if that's the case then get an MBA.
With an MBA you might end up employed by an AMC and given some type of a title like a facility director or eventually a regional director... basically you do the AMCs dirty work for them and in return you do less clinical work!

 

[Notorious T.E.E.]

I agree. Instead of one year to learn "OR management", spend 2 years learning management in general (MBA). OR management isn't so difficult it requires a year to learn.

The perioperative fellowship may be good if you are looking to leave OR anesthesiology for something more clinic/internal medicine based. Personally, it wouldn't be what I was after but to each his own.

 

[Twiggidy]

Reach out to that list of "Current/Former Fellows" and see if that fellowship was worth the year. If your goal is to go into practice, become partner, etc,etc, etc you really should ask yourself, "Am I worth it to a group if I have the ability to 'manage the OR' or read TEEs/manage the ICU/be the peds guy, etc" If you don't want to be a clinician, then as a above, get the MBA and wean yourself away.

Edit
MBA will open some doors
CC/Cards/Peds/Pain fellowship will open doors
OR management fellowship....not sure it's reallly building your career

 

[Mman]

OR management seems like a total waste of a year as cheap labor. Zero chance that fellowship is marketable to a PP group. That's on the job training, not fellowship.

 

[GravelRider]

OR management seems like a total waste of a year as cheap labor. Zero chance that fellowship is marketable to a PP group. That's on the job training, not fellowship.

I totally agree that this is a waste of a fellowship. However, to play devil's advocate, TEE and regional used to be on the job training and now they are fellowships. Maybe it's a way to network and have a pretty "easy" fellowship where you can moonlight and make some reasonable dough. Are there past fellows from this program or is it new?

Still, I think it's a waste.

 

[Twiggidy]

I totally agree that this is a waste of a fellowship. However, to play devil's advocate, TEE and regional used to be on the job training and now they are fellowships. Maybe it's a way to network and have a pretty "easy" fellowship where you can moonlight and make some reasonable dough. Are there past fellows from this program or is it new?

Still, I think it's a waste.

To counter, those fellowships add a certain skill set, similar to doing a fellowship after a surgical or medicine residency. I'm not sure OR management as a skill set, per se. I agree with above, sounds like cheap labor.

 

[Twiggidy]

Just to fuel the fire.....

The Department of Anesthesiology & Perioperative Care at the University of California, Irvine School of Medicine is offering a one year fellowship program in Quality and Patient Safety. The Fellowship program is designed to provide extensive training in patient safety, quality improvement, quality monitoring, and quality reporting and metrics through rotations in the department of Anesthesiology & Perioperative Care as well as with UC Irvine Health’s Quality Department, Risk Management, Compliance, and the office of the Chief Medical Officer.

 

[Nivens]

The price tag of the MBA is hefty... for a top program 150K on top of the lost income and interest on med school dept. As tempting as I've found the idea in the past, I'm still not convinced my job prospects after would be so wonderful as to justify the cost. Plus, I genuinely enjoy caring for patients. This exodus of MDs from clinical care is concerning. My knowledge of history tells me the pendulum has to eventually swing back, but I can't help but wonder if it'll be too little, too late.

 

[Ezekiel2517]

Friend of mine completed the Stanford fellowship. Apparently they're able to get great gigs afterward but don't know how much of it is due to the Stanford name. I also have noticed quite a few anesthesiologists in my area doing the mba thing in their spare time. If I didn't do a fellowship I might have considered it.

 

[GravelRider]

Just to fuel the fire.....

The Department of Anesthesiology & Perioperative Care at the University of California, Irvine School of Medicine is offering a one year fellowship program in Quality and Patient Safety. The Fellowship program is designed to provide extensive training in patient safety, quality improvement, quality monitoring, and quality reporting and metrics through rotations in the department of Anesthesiology & Perioperative Care as well as with UC Irvine Health’s Quality Department, Risk Management, Compliance, and the office of the Chief Medical Officer.

Does this fellowship come with a free clipboard?

 

[deleted171991]

The price tag of the MBA is hefty... for a top program 150K on top of the lost income and interest on med school dept. As tempting as I've found the idea in the past, I'm still not convinced my job prospects after would be so wonderful as to justify the cost. Plus, I genuinely enjoy caring for patients. This exodus of MDs from clinical care is concerning. My knowledge of history tells me the pendulum has to eventually swing back, but I can't help but wonder if it'll be too little, too late.

And what's the opportunity cost of a useless fellowship?

 

[deleted171991]

Friend of mine completed the Stanford fellowship. Apparently they're able to get great gigs afterward but don't know how much of it is due to the Stanford name. I also have noticed quite a few anesthesiologists in my area doing the mba thing in their spare time. If I didn't do a fellowship I might have considered it.

That's the Stanford name and connections.

 

[Nivens]

And what's the opportunity cost of a useless fellowship?

No argument from me there- we are in agreement. Just not 100% convinced the MBA is the magical solution it is often touted to be.

 

[Twiggidy]

No argument from me there- we are in agreement. Just not 100% convinced the MBA is the magical solution it is often touted to be.

I don't think it's a solution (depending on what the problem is) but I think there's a few more doors open both in and out of medicine

 

[deleted171991]

No argument from me there- we are in agreement. Just not 100% convinced the MBA is the magical solution it is often touted to be.

Agree.

If one wants to do a fellowship, a useful one makes more sense.

 

[Mman]

No argument from me there- we are in agreement. Just not 100% convinced the MBA is the magical solution it is often touted to be.

an MBA is certainly not a magical solution to anything, it just offers different sorts of opportunities than most things you can do in medicine.

 

[pgg]

I wouldn't do either, but an MBA sounds 10x more useful than this periop management fellowship.

 

[kidthor]

Have you all really seen an MBA opening doors for anesthesiologists, and what sorts of doors? Would the same opportunities not be there for sufficiently motivated anesthesiologists otherwise?

Agreed though - a periop management fellowship seems needless...

 

[Depolarized99]

I really appreciate all of the responses. The impression I'm getting so far, are that generally speaking this type of fellowship may not be worth the opportunity cost-which I don't think I disagree with (based on very little experience in this field). I may have come off as someone looking to exit clinical practice (although I haven't even started on my own yet, only going into PGY3), my ideal scenario is a good PP gig, in a desirable location, doing my own cases, at least to start out, without doing a fellowship. I do however recognize that those are probably high, if not unrealistic expectations, especially just getting out. This is why I'm exploring the possibility of a pursuit that might help to set me apart. The consensus that I've gotten from reading previous threads regarding whether to do fellowship or not seems to be that the safer bet is having completed one.

I can't help to ignore the the "risk" side of investing in, (I mean training in) a fellowship. What about the CC guy who does a year of fellowship, (in the setting of compounding student loan interest at 8%, lost investment opportunity cost, further board certification costs, relocation expenses etc.) and ends up taking a generalist position with little or no ICU for a few years. Cardiac is fun, I like the lines, and pathophys, the acuity, the pace, but what about projected open heart volume in the future? We do a fair amount of TAVR cases, do you think a strong generalist can do these as they get safer and performed on "healthier" patients? I don't see why not. It seems like there is currently a good market for cardiac, but it also feels like the supply may meet the demand in the near future (not based on any sort of factual data, but none-the-less.) I don't think I have the right personality for peds, although taking care of healthy kids has been fun. We do a nice amount of peds here, I don't think I'd have a problem with healthy kids when done. I like obstetric anesthesia (hate all the nonsense that comes with it), I like regional, neuro cases are fun, but I wouldn't consider doing a fellowship in any of those for reasons that have been discussed. I haven't done chronic pain, but the procedures seem cool, and I like doing procedures, but clinic? What? That would be drastic. I like the OR on a good day. I suppose I'm just not overly compelled by any of my choices at this point. Any generalists totally satisfied (or regretful) with their decision not to do a fellowship? Perhaps I just need some more time to see things differently. The periop mgmt fellowship (at the right program) was most appealing to me for networking opportunities at a first glance, if I'm being totally honest, whether they're including a clipboard, or not.

 

[deleted171991]

The more suckers who decide to do a joke fellowship, or none at all, the shinier my diploma is.

 

[IlDestriero]

I have already offered, but if any of you want to do a 12 month fellowship in OR management at my hospital, I'll make a custom curriculum for you, give you 2 days a week in the OR and 3 in the OR office for PGY6 pay. You'll get a shiny fellowship diploma with a fancy name on it and I'll be a hero to the boss and business manager.

I'll even throw in a $5000 bonus to pay for your relocation.
--
Il Destriero

 

[Ezekiel2517]

Tip: It's usually not a good sign when someone advertises an academic position on SDN.

 

[Crash cart]

In my opinion, the only fellowships PP groups care about are cardiac, peds and maybe interventional pain. The trend now is clearly to specialize so if you're on the fence, do it. Spend your time becoming a truly strong clinician, join a good PP group and gain some clinical credibility. PP groups tend to reward good clinicians first. If your goal is PP + administration / leadership, I don't think this fellowship is going to help you. But maybe cardiac or peds will.

 

[tennisballs]

The OR management fellowship at Stanford is a great opportunity. I know several people who have completed the fellowship and they all have very good jobs (mostly in private practice, but some stayed in academics). There is a lot of talk about money, lost time, asking yourself if it's worth it, etc, but this fellowship has many perks, such as dedicated academic time to do research, the opportunity to do cases on your own, the opportunity to network within a top-notch academic department, and the chance to enjoy living in the San Francisco Bay, where it is 65 degrees and sunny everyday.

 

[soorg]

Wow-talk about bull****. Fellowship in perioperative medicine? Isn't this what anesthesia is? Who needs a whole year studying the PSH? Just go to a weekend course, if you so desire. Soon they'll be selling the "IV insertion fellowship," where you spend a whole year becoming an expert on perioperative needle sticks.

 

[Twiggidy]

I really appreciate all of the responses. The impression I'm getting so far, are that generally speaking this type of fellowship may not be worth the opportunity cost-which I don't think I disagree with (based on very little experience in this field). I may have come off as someone looking to exit clinical practice (although I haven't even started on my own yet, only going into PGY3), my ideal scenario is a good PP gig, in a desirable location, doing my own cases, at least to start out, without doing a fellowship. I do however recognize that those are probably high, if not unrealistic expectations, especially just getting out. This is why I'm exploring the possibility of a pursuit that might help to set me apart. The consensus that I've gotten from reading previous threads regarding whether to do fellowship or not seems to be that the safer bet is having completed one.

I can't help to ignore the the "risk" side of investing in, (I mean training in) a fellowship. What about the CC guy who does a year of fellowship, (in the setting of compounding student loan interest at 8%, lost investment opportunity cost, further board certification costs, relocation expenses etc.) and ends up taking a generalist position with little or no ICU for a few years. Cardiac is fun, I like the lines, and pathophys, the acuity, the pace, but what about projected open heart volume in the future? We do a fair amount of TAVR cases, do you think a strong generalist can do these as they get safer and performed on "healthier" patients? I don't see why not. It seems like there is currently a good market for cardiac, but it also feels like the supply may meet the demand in the near future (not based on any sort of factual data, but none-the-less.) I don't think I have the right personality for peds, although taking care of healthy kids has been fun. We do a nice amount of peds here, I don't think I'd have a problem with healthy kids when done. I like obstetric anesthesia (hate all the nonsense that comes with it), I like regional, neuro cases are fun, but I wouldn't consider doing a fellowship in any of those for reasons that have been discussed. I haven't done chronic pain, but the procedures seem cool, and I like doing procedures, but clinic? What? That would be drastic. I like the OR on a good day. I suppose I'm just not overly compelled by any of my choices at this point. Any generalists totally satisfied (or regretful) with their decision not to do a fellowship? Perhaps I just need some more time to see things differently. The periop mgmt fellowship (at the right program) was most appealing to me for networking opportunities at a first glance, if I'm being totally honest, whether they're including a clipboard, or not.

Yes things are definitely changing in medicine and definitely anesthesiology. First, I never tell anyone to not get extra education as that additional skill set you'll develop will only make you more marketable. Outside of starting your own pain practice, I'd argue Peds/Cards/CC can all argue why they're better than the next. Yes, there are many on here who are generalist who say they do everything and that's fine, but there are also a fair amount that are generalist that are heading BACK to fellowship. What's that tell you? In reality, it may not effect my generation or even yours, but eventually as groups widdle down and more CRNAs start practicing, and beaurocracy of medicine changes, you'll see why the fellowship may help. I'm reading where certain hosptials only want fellowship trained TEE certified people doing hearts, some may only want Peds certified people doing kids, and if you want to spends a week or two in the ICU you're gonna need that CC diploma. I'm not saying this is everywhere but as legal changes occur and hospitals try to protect themselves or be "recognized centers of whatever" they're more and more gonna have to say that they "fill in the blanks" are "board certified trained fill in the blanks". Just something to think about. There will be a flood of people that will disagree but whatever. As far as the money and loans, one year isn't going to hurt you when you're talking about practicing for 20-30 more. And think about this, most of you surgical colleagues with the same loans need to do 2 or 3 year fellowships to make themselves marketable for employment. One year fellowships for us anesthesiologists (think radiology too...heck most of them do 2 to be marketable) is a blessing which is why many of us do it.

 

[Crash cart]

Yes things are definitely changing in medicine and definitely anesthesiology. First, I never tell anyone to not get extra education as that additional skill set you'll develop will only make you more marketable. Outside of starting your own pain practice, I'd argue Peds/Cards/CC can all argue why they're better than the next. Yes, there are many on here who are generalist who say they do everything and that's fine, but there are also a fair amount that are generalist that are heading BACK to fellowship. What's that tell you? In reality, it may not effect my generation or even yours, but eventually as groups widdle down and more CRNAs start practicing, and beaurocracy of medicine changes, you'll see why the fellowship may help. I'm reading where certain hosptials only want fellowship trained TEE certified people doing hearts, some may only want Peds certified people doing kids, and if you want to spends a week or two in the ICU you're gonna need that CC diploma. I'm not saying this is everywhere but as legal changes occur and hospitals try to protect themselves or be "recognized centers of whatever" they're more and more gonna have to say that they "fill in the blanks" are "board certified trained fill in the blanks". Just something to think about. There will be a flood of people that will disagree but whatever. As far as the money and loans, one year isn't going to hurt you when you're talking about practicing for 20-30 more. And think about this, most of you surgical colleagues with the same loans need to do 2 or 3 year fellowships to make themselves marketable for employment. One year fellowships for us anesthesiologists (think radiology too...heck most of them do 2 to be marketable) is a blessing which is why many of us do it.

Well said. The time to do a fellowship is definitely now when you are 1) young 2) single (I think you said you were) and 3) not yet in practice. It's easy to say "I can always go back and get a fellowship later" but in reality, it's more difficult than that. Extra training is never a bad thing and the one year of $ you'll sacrifice isn't that big of a deal in the long run.

 

[Mman]

Well said. The time to do a fellowship is definitely now when you are 1) young 2) single (I think you said you were) and 3) not yet in practice. It's easy to say "I can always go back and get a fellowship later" but in reality, it's more difficult than that. Extra training is never a bad thing and the one year of $ you'll sacrifice isn't that big of a deal in the long run.

While I kind of agree in principle, the $ you sacrifice at the start of your career are far more important to your retirement than the $ at the end.

$100,000 that returns 7% per year for 30 years becomes worth $761,000. At 10% per year it's $1.74M. And $100,000 is a fairly conservative estimate of the amount of extra cash you can invest in a real job for 1 year compared to being a fellow.

 

[deleted171991]

Well said. The time to do a fellowship is definitely now when you are 1) young 2) single (I think you said you were) and 3) not yet in practice. It's easy to say "I can always go back and get a fellowship later" but in reality, it's more difficult than that.

It is. First of all, as counterintuitive as it may seem, it is more difficult to get accepted. Programs don't want opinionated fellows, and it's impossible not to have an opinion after a few years out there. Plus the older one gets, the less impressed one is by all the BS they call education or research.

The time to go be a puppy is right after residency.

 

[pgg]

It is. First of all, as counterintuitive as it may seem, it is more difficult to get accepted. Programs don't want opinionated fellows, and it's impossible not to have an opinion after a few years out there. Plus the older one gets, the less impressed one is by all the BS they call education or research.

The time to go be a puppy is right after residency.

On my (short) interview trail this year, my post-residency experience was universally viewed in a positive light. They all asked me if I thought I'd have a problem transitioning back from giving orders to taking them, but they all seemed to take my answer at face value.

Of course, the fact that I was coming with funding might have predisposed them to like me. What program wouldn't want free labor AND the government GME cash?

 

[deleted171991]

On my (short) interview trail this year, my post-residency experience was universally viewed in a positive light. They all asked me if I thought I'd have a problem transitioning back from giving orders to taking them, but they all seemed to take my answer at face value.

Of course, the fact that I was coming with funding might have predisposed them to like me. What program wouldn't want free labor AND the government GME cash?

In your case, almost all they need to do is to print the diploma. You are like a self-driving car, and you come with free gas on top of it.

 

[Consigliere]

So I finally had enough time to do it today. I went into a quiet room, and for an hour I tried to create a list of ideas stupider than doing a Perioperative Management/OR Management fellowship. After said hour, the page was blank.

 

[IlDestriero]

No takers to my offer yet. I'm sad. I wanted a bigger bonus next year.


--
Il Destriero

 

[deleted171991]

So I finally had enough time to do it today. I went into a quiet room, and for an hour I tried to create a list of ideas stupider than doing a Perioperative Management/OR Management fellowship. After said hour, the page was blank.

You mean you don't think Critical Care qualifies?

 

[sevoflurane]

Hey Everyone,

Soon to be CA2 here, training in the NE. Starting to think about what I might do when finished with residency. I was someone who debated between EM and anesthesia, definitely liked that EM was 3 years compared to 4, and needless to say, I'm not crazy about turning this residency "investment" into a 5 year ordeal via inclusion of a fellowship. Having said that, I recognize this is probably short sighted thought, and that for an extra year of training, could maybe add to my value in this rapidly changing and uncertain job market. I like critical care and cardiac, and I think I like the interventional aspect of pain. If I'm being completely honest, I don't love any of them to the point that I would pursue fellowship training for any other reason than being more marketable in a competitive job market i.e. coastal territory. Interested in private practice but recognize PP is changing/has changed quite a bit. Don't like the idea of working for an AMC, obviously (but it does seem like there are some good EM gigs out there, administered by companies alike? Maybe I'm wrong about this.) Would of course like to be a partner some day. Young, hungry, aggressive work ethic, single without geographic restriction, high (average) student loan debt. I have a some business background, think like a business person, really do enjoy the practice of anesthesia so far. Most people in my program have gone on to do fellowships at some great places--and sometimes I feel we are almost all expected to follow suit. I will do what suits me best however. Debating between seeing what an early locums career would look like (more profitable for sacrifice of moving around?), doing a fellowship in one of the above, or pursuing a perioperative management fellowship:

http://med.stanford.edu/anesthesia/education/fellowship/fellowship_management.html

http://www.anesthesiology.uci.edu/education_periopmed_fellowship.shtml

I'm sure there are others, these are just a couple.

What do you guys think of this? Is the move to get an MBA rather than this? Do you think someone who had completed a fellowship like this could bring added value to your group..especially considering I will be a new grad? Does that potential "value" even matter? Some programs allow you to moonlight on top of fellowship salary vs paying for an MBA. Curious to hear some feedback. Thanks.

While this is not a path I personally would take, if strategic management, metrics, MIPS, MACRA, APMS, compliance and so forth are of interest to you and it has a heavy anesthesia twist to it, then you may be quite marketable in the future as the numbers/compliance guy in the department. We are only seeing the beginning and by 2021 the landscape will likely be very different.

 

[sevoflurane]

Suspending the SGF is a serious alteration of medicare payment.

You also have to do anesthesia though... otherwise, your residency might have been a big mistake.