Regional Anesthesia Fellowship (FAQ)

[350Z]

I did a regional fellowship a little over a year ago and I found that there is very little information out there for residents who are interested. Thus, I have decide to make this FAQ to help. My responses are based off my own experiences and from speaking to several others in the field.

Please do not comment on how you are the best regional person in your group and you never did a fellowship.

1. How do I find out who offers a regional fellowship?
http://www.asra.com/residents-fellows-regional-anesthesia-fellowships.php

2. What are some of the bigger name programs (not necessarily the best)?
Duke, Virginia Mason, UCSD, HSS, Toronto, Pitt, Iowa, Florida, Stanford

3. What is the setup of the average program?
1-2 days General OR, 3-4 days Regional/APS

4. Is 3 days/wk Regional/APS enough or should I look for a 4 days/wk program?
3 days is fine, it more about what you do with your days than how many

5. What is the average pay during fellowship?
it can range from $60k-$100k (depends on how many days OR vs regional), plus moonlighting

6. How long is the fellowship?
the vast majority of programs have moved to 1 yr although there are some 6 month programs if you look hard

7. Is the fellowship ACGME certified?
No, and while there is always talk to make it certified there is nothing in the works

8. How competitive is it to get into a fellowship?
Most places have 1-3 spots for 5-20 applicants, then again HSS has ~6 spots

9. How many blocks does the average resident do these days?
100-250 blocks, 40 is the ACGME requirement

10. How many blocks will I do in fellowship?
600-800 personally performed, plus more observed

11. Will I get paid more for doing a regional fellowship?
probably not, you might get 5-10k/yr more

12. Will I improve my marketability?
you will be very attractive to academic programs, private programs will be +/- interested in your fellowship. they are more interested in whether you can do blocks fast. they dont care how you learned to do it. As a general rule, the larger the city the more any fellowship will help.

13. How come regional anesthesiologist dont get paid the big bucks? We do procedures!
Medicare pays around $70 per single shot block plus $30 for US (which could get bundled anytime now), private insurance can pay 2-3 times that. Catheters do pay more but in private practice they are more difficult to follow and may not be worth it.

14. What should I look for in a program?
A program that is actively advancing regional anesthesia not just teaching you the current methods, a place that teaches you about how to setup and run a regional program, avoid new programs that have not established themselves. Also watch out for programs that are "orthopedic anesthesia" fellowships vs regional anesthesia fellowships.

15. Ok, I want to do a fellowship what should I do to get in?
Research can help but is not necessary, the bad news in many of the better programs are inbred so go to ASRA, present something (case report), and meet the fellowship directors face to face.

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[350Z]

If you have done a regional fellowship or are currently in one please feel free to PM with anything you would like to add/change.

 

[350Z]

Bump

 

[350Z]

Bump

 

[RixGov]

Bump... What's the thought on doing this fellowship these days. I keep hearing word of ACGME cred but don't see any movement on that front. Worst case, its a good way to get into a market where you want a job?

EDIT: just saw the other thread that just come up to the top... sorry

 

[dmk5n]

bump. lol

 

[signumvitalis]

This is great advice and information, but I am sure trends have shifted a bit since then. Is it still worth doing a regional fellowship?

 

[Scotty_G]

No

 

[epidural man]

I don't think so.

My hospital was probably one of the first in the nation to start a Regional Anesthesia Service (RAS) almost 10 years ago. We had some busy years! But there is talk about now of disbanding our renamed Acute Pain Service (APS) because no one asks for blocks anymore. This is multi-factorial - but a large factor has been Exparel. And I know there are many Exparel haters here, but it just highlights that the field is changing. If not Exparel, another company, another drug, another delivery - will soon come along that is even better than Exaprel.

Fellowships are no longer regional fellowships. They are re-branding to Acute Pain fellowships. If they do this correctly, they could stay in the game. But I'm not sure....

With these newly minted Enhanced Recovery pathways, people don't seem to be in as much pain after surgery. Who would have thunk it....give intraoperative NSAIDS and Tylenol and alpha-2 agonists, lidocaine, ketamine, and no opioids...and people wake up pain free and need minimal pain drugs. Wow!

 

[deleted171991]

Honestly, I feel like laughing whenever I hear about acute pain fellowships. Seriously? That's like an ambulatory fellowship. Many of us feel comfortable treating acute, even acute on chronic, pain in the perioperative period. It's not rocket science; would be probably the easiest part of my anesthesia practice.

I tend to concur with people who say that a pain fellowship with a few months of strong regional electives is probably much more worth it. Heck, I wouldn't have gone into CCM had it been mostly just an invasive line fellowship.

 

[sevoflurane]

I don't think so.

My hospital was probably one of the first in the nation to start a Regional Anesthesia Service (RAS) almost 10 years ago. We had some busy years! But there is talk about now of disbanding our renamed Acute Pain Service (APS) because no one asks for blocks anymore. This is multi-factorial - but a large factor has been Exparel. And I know there are many Exparel haters here, but it just highlights that the field is changing. If not Exparel, another company, another drug, another delivery - will soon come along that is even better than Exaprel.

Fellowships are no longer regional fellowships. They are re-branding to Acute Pain fellowships. If they do this correctly, they could stay in the game. But I'm not sure....

With these newly minted Enhanced Recovery pathways, people don't seem to be in as much pain after surgery. Who would have thunk it....give intraoperative NSAIDS and Tylenol and alpha-2 agonists, lidocaine, ketamine, and no opioids...and people wake up pain free and need minimal pain drugs. Wow!

Meanwhile... In a trauma hospital somewhere on the west coast... Regional volume continues to pick up.

Today was a very slow ortho day for me.
Only 6 blocks and no catheters.

 

[urge]

But there is talk about now of disbanding our renamed Acute Pain Service (APS) because no one asks for blocks anymore.

That should scare all aspiring regionalists.

 

[epidural man]

Meanwhile... In a trauma hospital somewhere on the west coast... Regional volume continues to pick up.

Today was a very slow ortho day for me.
Only 6 blocks and no catheters.

This is true. Trauma = great regional experience.

That is probably why we where so busy at one point (war times...) and not so much now.

Although I find it strange that MVA deaths are decreasing. I wonder why that is. Safer cars?

 

[GravelRider]

Meanwhile... In a trauma hospital somewhere on the west coast... Regional volume continues to pick up.

Today was a very slow ortho day for me.
Only 6 blocks and no catheters.

Still not a good reason to do the fellowship.

Do a fellowship that increases a skill or gives you a new skill that doesn't depend on the latest trends and the demands of fickle surgeons.

The only thing that makes less sense to me than a regional (acute pain?) fellowship, is an OB fellowship. Imagine doing OB all day, everyday for a full year...

 

[sevoflurane]

Still not a good reason to do the fellowship.

Do a fellowship that increases a skill or gives you a new skill that doesn't depend on the latest trends and the demands of fickle surgeons.

The only thing that makes less sense to me than a regional (acute pain?) fellowship, is an OB fellowship. Imagine doing OB all day, everyday for a full year...

Agree completely. Fortunately, I went to a regional heavy residency. As a junior resident I felt super comfortable with landmark based and USD guided blocks.
As a senior regional resident I gave up most all the SS blocks to the junior residents and spent the mornings in the heart room doing TEE.

You don't need a fellowship to do regional IF you attended a regional heavy residency. Virginia Mason, Duke, Utah, etc.

 

[sevoflurane]

Met a guy a couple years back and his residency regional experience was bier blocks and bier blocks only.

That will
NOT
do.

 

[sevoflurane]

... although def. good to know how to do one lickidy split.

 

[deleted171991]

.

Met a guy a couple years back and his residency regional experience was bier blocks and bier blocks only.

That will
NOT
do.

Agree. But, as long as he has basic ultrasound skills, he could easily learn a block/day just by shadowing and helping others. Maybe a block every 2 days... I would happily give up 2 weeks of income to get 50+% of the benefits of a fellowship.

 

[sevoflurane]

.

Agree. But, as long as he has basic ultrasound skills, he could easily learn a block/day just by shadowing and helping others. Maybe a block every 2 days... I would happily give up 2 weeks of income to get 50+% of the benefits of a fellowship.

Agree partially. Honestly, I would prefer a catheter capable anesthesiologist with proficiency in all blocks (including some of the more rare ones) from the get go. I personally don't have the drive or time to teach USD guided SS or catheters to a colleague in a fast paced environment although I would do it for the benefit of the group if it was requested of me. Futhermore, I wouldn't want to be the first patient that a newly minted lumbar plexus capable anesthesiologist was doing a LP block on in PP.

You have to have developed some degree of proficiency/speed with RA before taking a job that is geared towards ortho and RA.

If not, I think surgeons and staff will notice fast... which is not good for that particular anesthesiolosigist or the group.

But you are right FFP, we can all teach these skills and develop them in others.

 

[deleted171991]

Agree partially. Honestly, I would prefer a catheter capable anesthesiologist with proficiency in all blocks (including some of the more rare ones) from the get go. I personally don't have the drive or time to teach USD guided SS or catheters to a colleague in a fast paced environment although I would do it for the benefit of the group if it was requested of me. Futhermore, I wouldn't want to be the first patient that a newly minted lumbar plexus capable anesthesiologist was doing a LP block on in PP.

You have to have developed some degree of proficiency/speed with RA before taking a job that is geared towards ortho and RA.

If not, I think surgeons and staff will notice fast... which is not good for that particular anesthesiolosigist or the group.

But you are right FFP, we can all teach these skills and develop them in others.

And that's the problem. That's why we have all kinds of stupid semi-useless one-year fellowships, teaching material that could be covered in 3 months and/or learned by doing and/or from senior partners.

I am pretty sure young surgeons are neither fast nor very competent in their first years, yet nobody tells them to go **** themselves and do another fellowship.

 

[sevoflurane]

I would expect that competency in robotic surgery is valued when evaluating a surgical candidate for a urology group that has access to 3 Da Vinci robots with hospital administrators pushing for its use.

 

[sevoflurane]

That being said.

A regional fellowship is a waste of a year for sure.