Regional Anesthesia Fellowship

[Maz777]

There are two (and only two) types of regional fellowship programs:
1) Ones that shouldn't exist (residents do all the blocks, you don't learn anything more than you learned in residency) that were created simply for someone to put on their CV/buff up their department.
2) Ones that use fellows as cheap labor to staff undesirable rooms/call shifts/etc.

The end result from either program is the same: you have wasted a year of your life and a significant amount of money.

There isn't some magical third option where you become a regional wizard that can do things that a normal graduating resident cannot do. Regional anesthesia isn't that complex. It's pretty dang easy. You can fine tune your practice by doing your own blocks and talking to colleagues.

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[gasman100]

Know there’s a lot of info here advising against fellowship, but for those of us in the interview process, can someone perhaps provide some insight as to how soon after interviews we may hear back and what method of communication is typical is for those applying outside of the match?

Also, any offers from west coast (or elsewhere) programs going out yet this year (2023).

 

[abolt18]

3 of our senior residents are going to do a regional fellowship (crazy in my mind), but I'm pretty sure all 3 of them signed contracts outside the match, for whatever that's worth.

 

[26B]

Didn't do regional fellowship but did go out of my way to get the best regional training I could during residency. Now working in solo PP and some weeks I do 30+ blocks. All the basic blocks plus things like IPack, SiFi, PENG, ESP, etc. IMO a regional fellowship may be a good idea if your goal is to stay in academics, but otherwise I don't really see the value-add.

 

[epidural man]

One of the regional big wigs at Stanford who started the UCSD fellowship program actually did a peds fellowship, not a regional fellowship. No question that he is smart

And super cool and nice.

 

[nimbus]

Outside observer opinion - this is really sad

UCSD pulled the ultimate bait and switch

Everyone went through staffing issues. However, the UCSD academic staff couldn't/no longer wanted to cover OB. Naturally that meant the fellows do it under the guise of "epidurals and spinals are regional anesthesia". They were voluntold to do so, paid at "attending" rate that was closer to "pre-tending" rate - like less than AAs and CRNAs make hourly. The fellowship was sold as half attending, half fellow - "you can make as much as you want".

That is sad if true. The OB fellow should be there to be “voluntold” to cover L&D

 

[epidural man]

As a pain fellowship trained guy, I feel confident and skilled with the blocks required in the OR.

Am I as skilled with some of the specific nuances that one might learn at a high-quality regional fellowship? Absolutely not. I have a lot of respect for the regionally trained guys in my department, and the regional guys at were I trained at VM (mostly Dave Auyong).

However, to be quite truthful, I think these extra skills are academic and likely overkill for most ORs.

Fellowships were necessary coming out of 2005 as ultrasound was a new toy for us. Honestly, it was a very exciting time to be on the forefront of that wave. So much new knowledge and techniques were rolling forth at an incredible pace. Residencies needed competent people to keep up and spread the good word. Community departments needed people with these new skills. Workshops were packed (and there were many). These skills and knowledge slowly spread.

But now, every resident comes out knowing the skill and the science. The skills have now largely permeated most anesthesia departments.

It will be interesting to watch what happens from here.

 

[CubsDynasty]

CRNAs are performing blocks and they don’t do a fellowship for it, so why should you? Unless you don’t think you’re marketable without some extra training. My group has several regional trained guys and they do nothing different or get paid differently than those of us who did not. They’re just one whole year further away from retirement.

 

[BlocksAllDayEveryDay]

I did a regional fellowship recently. It was a total waste of a year. Highly regret it. Don't get suckered in to thinking this is remotely necessary. Listen to the smart people on here and get a job. That loss of 400-500k that year will forever haunt me. Just makes you one year farther away from buying that nice house and one more year you have to work in order to retire.

 

[perkybawl]

Outside observer opinion - this is really sad

UCSD pulled the ultimate bait and switch

Everyone went through staffing issues. However, the UCSD academic staff couldn't/no longer wanted to cover OB. Naturally that meant the fellows do it under the guise of "epidurals and spinals are regional anesthesia". They were voluntold to do so, paid at "attending" rate that was closer to "pre-tending" rate - like less than AAs and CRNAs make hourly. The fellowship was sold as half attending, half fellow - "you can make as much as you want".

Very little to no instruction during the year of fellowship, more of a "just go do it". Research meant you had to include the chair (Rodney) as author on papers that he didn't even know about - even before you started fellowship, done at a different institution.

The year ended up being a disaster - multiple people dropped out, even with less than a couple months to go. The director got replaced.

Don't do a regional fellowship, this is one of the "good" programs too

Very true. That guy has been running that fellowship for many years now. They get a new puppet "fellowship director" every year or two that ends up quitting, leaving, or being replaced because it is a sham role. Fellows are just used as cheap labor to staff ORs or take OB call (and paid much less than CRNAs). All the bigwig teachers that built UCSD have left or been forced out. Just a bunch of young gossipy attendings that aren't experts in anything. Lots of pager calls for weeks at a time. Residents don't take call (since heavily protected), fellows take all of it. Most people now know to avoid UCSD like a plague. Malignant doesn't begin to describe it.

 

[Confused gas]

Can anybody let me know the ranking of the regional anesthesia fellowship at Hershey Pennstate? Anybody who did the fellowship there

 

[Anesthesia_Guy]

Worthless.

 

[GassYous]

Can anybody let me know the ranking of the regional anesthesia fellowship at Hershey Pennstate? Anybody who did the fellowship there

So many things wrong here

 

[Maz777]

Can anybody let me know the ranking of the regional anesthesia fellowship at Hershey Pennstate? Anybody who did the fellowship there

I saw a sneak peak of the newly released US News RAAPM rankings. Hershey was ranked 57 sandwiched between the University of a Waste of a Year and the Pointless Endeavor Clinic of Phoenix. The rankings are a proprietary algorithm that take into account the $/OB call saved to the department, how many CRNA endoscopy rooms a fellow can staff after their only first start TAP block of the day, and how many lunch breaks/day a fellow will be able to give for attendings that are actually appropriately compensated. Of note, as of today, there are now 337 RAAPM fellowship programs in the country, so 57 is considered elite. The independent CRNA-staffed surgicenter in El Methhead, CA just opened their own RAAPM fellowship. PGY5 salary. Faculty CRNAs will teach you how to do all the fancy fascial plane blocks (that Youtube could never teach you), and you get the awesome opportunity to take over their rooms so they can leave by noon. World class opportunity.

 

[Dr. Rude]

I saw a sneak peak of the newly released US News RAAPM rankings. Hershey was ranked 57 sandwiched between the University of a Waste of a Year and the Pointless Endeavor Clinic of Phoenix. The rankings are a proprietary algorithm that take into account the $/OB call saved to the department, how many CRNA endoscopy rooms a fellow can staff after their only first start TAP block of the day, and how many lunch breaks/day a fellow will be able to give for attendings that are actually appropriately compensated. Of note, as of today, there are now 337 RAAPM fellowship programs in the country, so 57 is considered elite. The independent CRNA-staffed surgicenter in El Methhead, CA just opened their own RAAPM fellowship. PGY5 salary. Faculty CRNAs will teach you how to do all the fancy fascial plane blocks (that Youtube could never teach you), and you get the awesome opportunity to take over their rooms so they can leave by noon. World class opportunity.

I yield my screen name to you.

 

[CubsDynasty]

I saw a sneak peak of the newly released US News RAAPM rankings. Hershey was ranked 57 sandwiched between the University of a Waste of a Year and the Pointless Endeavor Clinic of Phoenix. The rankings are a proprietary algorithm that take into account the $/OB call saved to the department, how many CRNA endoscopy rooms a fellow can staff after their only first start TAP block of the day, and how many lunch breaks/day a fellow will be able to give for attendings that are actually appropriately compensated. Of note, as of today, there are now 337 RAAPM fellowship programs in the country, so 57 is considered elite. The independent CRNA-staffed surgicenter in El Methhead, CA just opened their own RAAPM fellowship. PGY5 salary. Faculty CRNAs will teach you how to do all the fancy fascial plane blocks (that Youtube could never teach you), and you get the awesome opportunity to take over their rooms so they can leave by noon. World class opportunity.

that was just beautiful

 

[Confused gas]

So many things wrong here

Could you please elaborate on this?

 

[Confused gas]

Worthless.

Like what?

 

[Confused gas]

Can someone throw light on the regional anesthesia fellowship at Hershey Pennstate ? It’s ACGME accredited

 

[abolt18]

Can someone throw light on the regional anesthesia fellowship at Hershey Pennstate ? It’s ACGME accredited

I think the point everyone is making over and over is that the regional fellowship is a complete waste of time financially and professionally, unless you're a die-hard for running an academic acute pain service (then it's just a double waste of time financially). Accredited fellowships are even worse because instead of getting to make some money working as part-time faculty, they fill that time with meaningless fluff.

Source: one of my best friends did an unaccredited fellowship and was just thankful he made some money and kept skills and knowledge up before oral boards rolled around.

 

[Gator7]

To echo what everyone else is saying, regional fellowships are a waste. I am currently the head of reagional/ortho for my group and did not do a fellowship.

Regional skills are important, but there should be plenty of opportunity at any residency program to become proficient with US and common blocks. Then all you have to do is YouTube the new ones.

 

[Ashers]

I can attest you really shouldn't need a regional fellowship at this point if you did blocks in residency. I did an unaccredited fellowship years ago because my residency had a poor regional experience (it's since gotten better), and I wanted to be good at blocks with good technique. I accomplished this. I ended up being faculty in a med school as a part of the Regional anesthesia division and in charge of acute pain protocols for some surgeries, so I did use it; and I taught at conferences. I also worked at an orthopaedic hospital. I have no interest in doing fancy blocks that ASRA has (like the flexor sheath block, why? Just why?), and I'm conservative about when I block.

The fellowship was trying to become accredited as I left, and they were looking for places to do catheters. I hadn't done a catheter for a nerve block since residency, and the fellowship was pressuring us at a satellite hospital to do them for the benefit of the fellows. We didn't, the job went south thanks to CRNAs taking over shortly after, so I don't know what happened.

 

[ak_ps]

Only needed if in some dire VISA-straights and some institution is willing to sponsor essentially free labour for a year.

 

[sakata8242]

There are two (and only two) types of regional fellowship programs:
1) Ones that shouldn't exist (residents do all the blocks, you don't learn anything more than you learned in residency) that were created simply for someone to put on their CV/buff up their department.
2) Ones that use fellows as cheap labor to staff undesirable rooms/call shifts/etc.

The end result from either program is the same: you have wasted a year of your life and a significant amount of money.

There isn't some magical third option where you become a regional wizard that can do things that a normal graduating resident cannot do. Regional anesthesia isn't that complex. It's pretty dang easy. You can fine tune your practice by doing your own blocks and talking to colleagues.

Haha....the program here is both of these.

 

[nimbus]

It turns out that the regional anesthesia faculty at our local RAAPM fellowship are some of the highest paid members of the department. Their income is >90th percentile both nationally and locally. If you are interested in academics, it would make sense to do the fellowship as a segue to a faculty position.