Two fellowships and PP/"the real world"

[Nivens]

So I've heard many times that ccm and cardiac is a potent combo, but I'm curious what the real utility of the extra fellowship is for someone in PP. I get the "better doctor" arguement, but then why stop there? Why not Cardiac/ccm/regional? Cardiac/ccm/peds/peds cardiac? Does it significantly impact hirability? I guess if your group also happens to cover the cticu and/or sicu but does that happen in the real world?

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[Guillemot]

Additionally, I believe you should do a combined medicine/anesthesia residency.

 

[Nivens]

Combined general surgery and anesthesiology: the complete peri-intra-operative physician.

 

[deleted171991]

So I've heard many times that ccm and cardiac is a potent combo, but I'm curious what the real utility of the extra fellowship is for someone in PP. I get the "better doctor" arguement, but then why stop there? Why not Cardiac/ccm/regional? Cardiac/ccm/peds/peds cardiac? Does it significantly impact hirability? I guess if your group also happens to cover the cticu and/or sicu but does that happen in the real world?

The value comes from being able to cover the cardiac ICU. Plus, for any truly intelligent person, CCM is a much more interesting subspecialty.

 

[bashwell]

I just hope anesthesiology doesn't someday get to the point of pathology where 1-2 fellowships is what's pretty much expected for everyone just to find a decent job somewhere.

 

[deleted171991]

I just hope anesthesiology doesn't someday get to the point of pathology where 1-2 fellowships is what's pretty much expected for everyone just to find a decent job somewhere.

It's not far from it. Give it another 10 years.

What's more scary is that one has to spend one's career supervising much less educated and disrespectful midlevels, on one's own license and risk, but as an employee. That's becoming the reality of American medicine; the fellowships are nothing compared to that crap.

I would rather do 3 fellowships and not work with midlevels ever. It's like dealing with arrogant teenagers who don't know how little they know. And God forbid you show them!

 

[pgg]

Plus, for any truly intelligent person, CCM is a much more interesting subspecialty.

Yes, social work and placement and nutrition are fascinating.

 

[deleted171991]

Yes, social work and placement and nutrition are fascinating.

There is very little social work and placement in what I do. There is a lot of compassion though.

Nutrition is easy, as in easy peasy. I learned how to choose the right tube feed when I was an intern. The rest is arithmetic. I honestly don't know why we pay people for it; but then, I think clinical pharmacists who interfere with MD orders (and many others) are mostly a waste, too (and that's why they don't exist in more frugal societies).

 

[BLADEMDA]

For private practice you don't "need" 2 fellowships; either a fellowship in CCM (with a 1 month elective in TEE/TTE) or Cardiac anesthesia is sufficient.
For academics a dual fellowship would allow a lot of flexibility for how they use you day to day and make it likely you rise up the ranks. In case you are unaware a person with 2 fellowships is likely to earn more money in his/her ACADEMIC career than someone who goes to work as an employee for a community hospital or AMC.

 

[G-Man82]

Yes, social work and placement and nutrition are fascinating.

Necrotizing staph pneumonia, s/p aspiration, now requiring VV ECMO, which is now also complicated by pulmonary hemorrhage. I'm not in that unit this week, but the staff (Anesthesiologists) are considering perfluorodecalin. So much more than social work and nutrition

I have to agree with FFP. The compassion part is pretty prevalent. I had a patient show up with a ruptured AAA today from an outside hospital after coding. He arrived on 120 mcg/min of norepi. Pretty shocking, not to mention bad prognostic indicator. I took over for day shift, and essentially had to have the end of life talk with the family. It's tough, but in the end, it's clear that my actions have an impact. I work hard, but so far, don't regret it.

 

[scudrunner]

The value comes from being able to cover the cardiac ICU. Plus, for any truly intelligent person, CCM is a much more interesting subspecialty.

Ha, you mean for anyone who likes critical care, it's a much more interesting sub specialty. Intelligence has nothing to do with it.

 

[pgg]

FFP, you're a smart guy and CCM is an interesting subspecialty.

I just felt compelled to respond to your bizarre and kinda trolling statement that CCM is better for "any truly intelligent person" by pointing out that many of us chose anesthesia specifically to get away from some of the tedious stuff that fills the days of clinic drones and hospitalists. We didn't choose not-CCM because we're dullards, we chose not-CCM because we'd rather be in the OR, or because the paycheck is better, or because the hours are better, or because all the ondansetron in the world can't keep the bile down when we're forced to work through ICU nurse intermediaries, or because ... you get the idea.

 

[bashwell]

I just felt compelled to respond to your bizarre and kinda trolling statement that CCM is better for "any truly intelligent person" by pointing out that many of us chose anesthesia specifically to get away from some of the tedious stuff that fills the days of clinic drones and hospitalists.

Wait a second, isn't this bolded part likewise a "kinda trolling statement" though?? For example, I wouldn't think clinic-based people would appreciate being called "drones," and even though many might not like hospitalist work, not all hospitalists would necessarily think their days are "fill[ed]" with "tedious stuff"?

 

[Consigliere]

Combined general surgery and anesthesiology: the complete peri-intra-operative physician.

Whoa, whoa, whoa........slow down there, fella. As a member of the PERIOPERATIVE SURGICAL HOME it is assumed that you will be able to do all that, even though you only did an anesthesiology residency. Oh yeah.......you'll do that for the same pay or less.

 

[pgg]

Wait a second, isn't this bolded part likewise a "kinda trolling statement" though?? For example, I wouldn't think clinic-based people would appreciate being called "drones," and even though many might not like hospitalist work, not all hospitalists would necessarily think their days are "fill[ed]" with "tedious stuff"?

Touche

 

[deleted171991]

FFP, you're a smart guy and CCM is an interesting subspecialty.

I just felt compelled to respond to your bizarre and kinda trolling statement that CCM is better for "any truly intelligent person" by pointing out that many of us chose anesthesia specifically to get away from some of the tedious stuff that fills the days of clinic drones and hospitalists. We didn't choose not-CCM because we're dullards, we chose not-CCM because we'd rather be in the OR, or because the paycheck is better, or because the hours are better, or because all the ondansetron in the world can't keep the bile down when we're forced to work through ICU nurse intermediaries, or because ... you get the idea.

I apologize. I did not mean to imply that anybody who's CCM is so smart, and anybody who isn't is not. It's just that CCM has a special intellectual attraction, like real internal medicine.

I also hate all the slow intermediaries and the bureaucracy etc., and hope that, one day, anesthesiologists will be the ones running the ICUs and that we will get to model them after our efficient ORs.

Honestly, I'd rather work with ICU nurses and midlevels than CRNAs. At least the former don't have the guts (and means) to not execute my plan.

 

[Nivens]

I always thought I would do both fellowships: the subject matter appeals to me, and I was always awed by my triple-boarded mentor's knowledge and comfort with the sickest of the sick. However, now that I'm working in ICUs as a resident I'm realizing it probably isn't something I'm going to want to spend a huge chunk of my time doing (though I get that ICU as a junior is probably very different from the experience as an attending). I could envision a week every 2 months or so, especially in a CTICU, but what I really like to do are cardiac cases in the OR. So now I'm questioning whether it's worth it for "intellectual", "job security", and "career advancement" reasons to suck it up and do another year, or just get out and get on with my life.

This all of course assumes that my chronic pain elective next week doesn't totally rock my world

 

[Man o War]

My vote is forget the CCM fellowship if you want to do private practice. Stick with cardiac. You have to factor in opportunity cost for 2 fellowships, and really it just doesn't make sense to me.

 

[BLADEMDA]

My vote is forget the CCM fellowship if you want to do private practice. Stick with cardiac. You have to factor in opportunity cost for 2 fellowships, and really it just doesn't make sense to me.

It only makes sense for an Academic career and even then I'm not certain you need more than one fellowship.

 

[Nivens]

It only makes sense for an Academic career and even then I'm not certain you need more than one fellowship.

Despite what you said above?

 

[IlDestriero]

Some peds people do 2 fellowships. Cardiac or pain. Though the second one used to only be 6 months including part time faculty work for mid 100's.

 

[waterbottle10]

I just hope anesthesiology doesn't someday get to the point of pathology where 1-2 fellowships is what's pretty much expected for everyone just to find a decent job somewhere.

Thats pretty much already happening for new grads... give it a few more yrs and it will be expected. I just started pgy1 year and im already planning on doing a fellowship in who knos what cause im expecting there to be no jobs in liveable areas

 

[Consigliere]

Thats pretty much already happening for new grads... give it a few more yrs and it will be expected. I just started pgy1 year and im already planning on doing a fellowship in who knos what cause im expecting there to be no jobs in liveable areas

Good plan

 

[cbrons]

What is the purpose of any of those fellowships when in a few years CRNAs will be doing every single one of those with their online degrees?

 

[pgg]

Thats pretty much already happening for new grads...

No it's not. That's a ridiculous thing to say.

 

[IlDestriero]

I would bet that 50%+ of the residents at the big name academic programs go to fellowships, but I doubt the same is true of the rest of the programs.

 

[bashwell]

I would bet that 50%+ of the residents at the big name academic programs go to fellowships, but I doubt the same is true of the rest of the programs.

Do you think that's because not as many residents at non-big name academic programs choose to go on to fellowship or more because they can't get into a fellowship somewhere? Maybe a bit of both?

Edit: Sorry grammatical mistake -- deleted "don't" in between "academic programs" and "choose to go on..."

 

[pgg]

Do you think that's because not as many residents at non-big name academic programs don't choose to go on to fellowship or more because they can't get into a fellowship somewhere? Maybe a bit of both?

I think it's because most anesthesiology grads nationwide don't want to do fellowships at all.

Big name academic programs attract people who are more inclined to do fellowships, so they send a good chunk of each class on to fellowship. No reason to believe that the big-name grads who don't do fellowships couldn't get into one, had they tried.

It's selection bias, that's all.

We get a distorted view of the world on SDN but the truth is that the majority of anesthesia grads don't go on to fellowship because they don't want to.

 

[IlDestriero]

Yes. Self selection.

 

[scudrunner]

I think it's because most anesthesiology grads nationwide don't want to do fellowships at all.

Big name academic programs attract people who are more inclined to do fellowships, so they send a good chunk of each class on to fellowship. No reason to believe that the big-name grads who don't do fellowships couldn't get into one, had they tried.

It's selection bias, that's all.

We get a distorted view of the world on SDN but the truth is that the majority of anesthesia grads don't go on to fellowship because they don't want to.

Cheers to that.

Lots of factors go into the decision. I think just about everyone who wants to do a fellowship in anesthesia can land one somewhere.

 

[dmk5n]

The best 'Fellowships' with long term, far reaching capabilities for anesthesiologists are 1.MBA 2. Pain Medicine.
These allow you to make the most choices for your future. With the others, you are still a thrall...

 

[deleted171991]

The best 'Fellowships' with long term, far reaching capabilities for anesthesiologists are 1.MBA 2. Pain Medicine.
These allow you to make the most choices for your future. With the others, you are still a thrall...

Make that just MBA.

 

[IlDestriero]

MBA on the GI Bill!
Money in the bank!

 

[Laryngophed]

For private practice you don't "need" 2 fellowships; either a fellowship in CCM (with a 1 month elective in TEE/TTE) or Cardiac anesthesia is sufficient.
For academics a dual fellowship would allow a lot of flexibility for how they use you day to day and make it likely you rise up the ranks. In case you are unaware a person with 2 fellowships is likely to earn more money in his/her ACADEMIC career than someone who goes to work as an employee for a community hospital or AMC.

Would your group hire and/or place additional value on someone with the cardiac/CCM fellowships?


I'm asking... for a friend.

 

[pgg]

MBA on the GI Bill!
Money in the bank!

Are you doing that? I don't think I could stomach getting an MBA. My son started using my GI Bill this year. Now that's a sweet deal.

 

[IlDestriero]

I'm strongly considering it. It would be free/nearly free at many good programs, and I know a few physicians that did it, though not definitely not Wharton which is wickedly expensive. (~$190k)