What is the best fellowship path?

[robjohns]

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[AdmiralChz]

Oh lawdy what a question. That's like trying to choose between Moe's and Chipotle (minus the bacterial outbreak), Chick-Fil-A and Bojangles, Hydra and the Lannisters, black and blue pens, albumin and crystalloid... I think you get the picture.

Quite honestly the point I'm trying to make it's totally up to YOUR PREFERENCES and making sure you do it for the right reason. Love Bojangles? Give Chick-Fil-A a shot once or twice. Try marking up your Barash book in blue pen to mix it up. Try all the subspecialties (which is required of a residency, and sort of the point) and see if you want to do one. If you do, great! If you don't, awesome! Anesthesiology is nice in that it certainly isn't required

 

[vector2]

Spine fellowship. After finishing an ortho residency.

 

[deleted171991]

The Fellowship of the Ring.

 

[RK.md]

...albumin and crystalloid...

Wait, you mean we don't have a consensus yet?

Just get your feet wet with different subspecialties and see what you like. No substitute for personal experience when it comes to these matters.

 

[Consigliere]

Interventional cardiology or GI.

 

[PMPMD]

Make sure you understand the job market before you choose. Do you even need a f'ship for your intended mkt? Also what are the practice models (ie for ICU, maybe the unit at your program is closed with 24/7 intensivist coverage, but where you want to work the units are open with only daytime coverage.

 

[EtherBunny]

In your opinion, what is the best fellowship. There is no right answer. Just want to hear what people find important and why.

Thanks!

Honestly, it completely depends on your interests professionally. If you're torn between two different fellowships, then I would factor in where you want to work right out of fellowship. If you want to go to San Francisco, for example, check out the job openings for anesthesiology there, to see what is in demand. You'll notice that pain jobs are scarce there but there are tons of jobs for generalists, cardiac, and peds. The opposite is true in other markets.

if you don't have any geographical restrictions or preferences, then just pick what you enjoy the most.

 

[NightNight]

The kind where you fill out the entire fellowship application, realize what a terrible mistake you are about to make, throw it in the garbage, and actually start looking for jobs only to find that no, $300-400K jobs with reasonable work environement, hours, benefits, vacation, etc. have not quite gone the way of the dodo yet.

 

[deleted162650]

If you want to be an academic, then any fellowship will serve you well. Figure out what you like and what niche you want to be pigeon holed into for your career. If you want to be in PP then cardiac or peds (assuming you like doing those cases because if you have the fellowship, you will be hired because they need someone to do those cases). If you would like a way out of the OR then pain or CC depending on which type of masochist you are.

You don't "need" a fellowship though. The best fellowship is a year in a busy, full-service MD only PP. Just be geographically flexible.

 

[projectpat]

Oh lawdy what a question. That's like trying to choose between Moe's and Chipotle (minus the bacterial outbreak), Chick-Fil-A and Bojangles, Hydra and the Lannisters, black and blue pens, albumin and crystalloid... I think you get the picture.

dude. Chick-fil-A.


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[deleted50478]

In your opinion, what is the best fellowship. There is no right answer. Just want to hear what people find important and why.

Thanks!

Reproductive endocrinology. B'c Self-determination, cash pay, and no nights or weekends.

If you must do an anesthesia fellowship then pain because it lets you stop doing anesthesia. (I happen to like anesthesia if it were a hobby, but it isn't great as a career compared to many other options. Beats waitressing i guess)

 

[BobBarker]

The best fellowship is clearly pain.

 

[Nivens]

The best fellowship is clearly pain.

 

[deleted162650]

Just do a CT fellowship then.

 

[Nivens]

Just do a CT fellowship then.

Almost certainly will, but apparently not without giving myself more gray hair first. Ya know, gotta look the part

 

[urge]

The best fellowship is no fellowship.

 

[pjl]

Almost certainly will, but apparently not without giving myself more gray hair first. Ya know, gotta look the part

Better than the balding ICU guy with a goatee.


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[psychbender]

Better than the balding ICU guy with a goatee.


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Harsh. I was looking forward to growing facial hair again next year.

 

[BLADEMDA]

The kind where you fill out the entire fellowship application, realize what a terrible mistake you are about to make, throw it in the garbage, and actually start looking for jobs only to find that no, $300-400K jobs with reasonable work environement, hours, benefits, vacation, etc. have not quite gone the way of the dodo yet.

I'd like to point out that my friends in Academia are pulling in $350-$400K after just 5 years at their institutions with great benefits and a work schedule which beats 90% of private practices. So, some Residents may want to search the trash can for that application.

I got a PM from a peds guy who was making $450K plus benefits at an academic institution with a great schedule. This guy was NOT high up in the food chain either.

 

[deleted162650]

I'd like to point out that my friends in Academia are pulling in $350-$400K after just 5 years at their institutions with great benefits and a work schedule which beats 90% of private practices. So, some Residents may want to search the trash can for that application.

I got a PM from a peds guy who was making $450K plus benefits at an academic institution with a great schedule. This guy was NOT high up in the food chain either.

What region is your peds friend in?

Il D has nice academic peds gig as well.

 

[PonyUp]

Personally, I'm finishing up interviews for peds, specifically at programs that offer an additional year of congenital cardiac training.
The opportunity cost of giving up my first two years out of residency is financially huge [that money would otherwise appreciate the most during my years in practice], but it means that I will get to [potentially, hopefully] do what I want for the rest of my life.

If you don't need to do a fellowship to do what you want to do, it is probably a waste of your time.

 

[BLADEMDA]

The best fellowship is no fellowship.

I completely disagree with this statement. With the AANA encroachment on 100% independent practice the best career insurance one can buy is a fellowship in a subspecialty where the CRNAs lack the education and training to displace you:

1. Cardiac
2. Pain
3. Peds
4. Critical Care

They simply lack the education and training to truly compete in any of those areas.

 

[Man o War]

I completely disagree with this statement. With the AANA encroachment on 100% independent practice the best career insurance one can buy is a fellowship in a subspecialty where the CRNAs lack the education and training to displace you:

1. Cardiac
2. Pain
3. Peds
4. Critical Care

They simply lack the education and training to truly compete in any of those areas.

This is a fact. They gripe constantly about institutions not training them in these areas. There just aren't enough cases to properly train the residents and fellows much less the nurses.

 

[Planktonmd]

Harsh. I was looking forward to growing facial hair again next year.

If you are bold and grow facial hair you will look like a d*ck!

 

[AdmiralChz]

I completely disagree with this statement. With the AANA encroachment on 100% independent practice the best career insurance one can buy is a fellowship in a subspecialty where the CRNAs lack the education and training to displace you:

1. Cardiac
2. Pain
3. Peds
4. Critical Care

They simply lack the education and training to truly compete in any of those areas.

Totally agree, this is a large (but often unspoken for some reason) advantage of a fellowship. Cardiac surgeons and pediatric surgeons doing highly advanced procedures will not allow independent CRNAs within a stone's throw of the room.

Some fellowships have professional development advantages as well that get you involved in hospital administrative committees - I would view this as pretty valuable if you're a ladder-climber of sorts.

 

[DetectiveAlonzo]

Is it safe to say that future med students interested in entering anesthesia SHOULD plan on doing a fellowship in order to not worry about supervising CRNAs or being "expendable?....? That liability outlook is something that is ridiculous. I would not risk my license for somebody else who did less schooling and most likely has less experience dealing with the extreme outcomes of a procedure. Not that they aren't smart and hardworking folks... but the training is absolutely different... is it not?

Does entering any specific fellowship increase one's salary potential as well if you are hired for a group for a certain hospital? or will those cash based procedures for spinal injections and the link only be possible in a private practice/clinic?

Thanks again.

 

[BLADEMDA]

hamaza87 wrote on: 8/5/2016 1:46:17 PM (EST) 0 days ago.


“We expect the VA will listen to the comments ... and abandon this dangerous proposal that runs counter to the VA’s own strategy to deliver high-quality Veteran-centered care,” said Daniel J. Cole, MD, the president of the ASA, in a statement. What else would you expect from the Pres of the ASA? 90% of vets are not in favor of the move? How was it possible to contact 90% of the vets and how many know the difference in an MD/CRNA? Unless, of course, a comment such as this is used: The proposed policy would replace anesthesiologists with nurse anesthetists, a move that would necessarily lower the level of expertise in the OR, which in my opinion, is a slanderous comment!

As far as there NOT being a shortage of MDA's. It is the result of many places replacing them with CRNA's for cost effectiveness as they are NOT needed in many of the smaller hospitals where CRNA's have been working alone for years. How many MDA's does 1 hospital need WALKING ABOUT SUPERVISING instead of working? What has been omitted here is, 1 MDA can 'supervise' 5 CRNAs and GET PAID AS IF HE WAS DOING EACH CASE! Maybe, this is why there are so many are available and why they are being replaced and the comment of 'lower the level of expertise' SHOULD NOT BE ALLOWED! WHY? If indeed an (1)MDA is supervising 5 CRNA's is this comment directly affecting the MDA also? How many MDA's does 1 hospital need WALKING ABOUT SUPERVISING instead of working? At 300-500,000$/yr a hospital can afford several experienced CRNA's and 1 MDA, a much lower cost, to 'supervise'!

However, in a place like a VA, I think it is important for MDA's to be available BUT not just to supervise, but to WORK!

http://www.anesthesiologynews.com/P...8-16/Comments-Slam-VA-Proposal/37213/ses=ogst

 

[sevoflurane]

hamaza87 wrote on: 8/5/2016 1:46:17 PM (EST) 0 days ago.


“We expect the VA will listen to the comments ... and abandon this dangerous proposal that runs counter to the VA’s own strategy to deliver high-quality Veteran-centered care,” said Daniel J. Cole, MD, the president of the ASA, in a statement. What else would you expect from the Pres of the ASA? 90% of vets are not in favor of the move? How was it possible to contact 90% of the vets and how many know the difference in an MD/CRNA? Unless, of course, a comment such as this is used: The proposed policy would replace anesthesiologists with nurse anesthetists, a move that would necessarily lower the level of expertise in the OR, which in my opinion, is a slanderous comment!

As far as there NOT being a shortage of MDA's. It is the result of many places replacing them with CRNA's for cost effectiveness as they are NOT needed in many of the smaller hospitals where CRNA's have been working alone for years. How many MDA's does 1 hospital need WALKING ABOUT SUPERVISING instead of working? What has been omitted here is, 1 MDA can 'supervise' 5 CRNAs and GET PAID AS IF HE WAS DOING EACH CASE! Maybe, this is why there are so many are available and why they are being replaced and the comment of 'lower the level of expertise' SHOULD NOT BE ALLOWED! WHY? If indeed an (1)MDA is supervising 5 CRNA's is this comment directly affecting the MDA also? How many MDA's does 1 hospital need WALKING ABOUT SUPERVISING instead of working? At 300-500,000$/yr a hospital can afford several experienced CRNA's and 1 MDA, a much lower cost, to 'supervise'!

However, in a place like a VA, I think it is important for MDA's to be available BUT not just to supervise, but to WORK!

http://www.anesthesiologynews.com/P...8-16/Comments-Slam-VA-Proposal/37213/ses=ogst

Jeez.
Someone please put this guy in check.
I'm out of the country and can't log on.
Thx Blade.

 

[GravelRider]

The grammar in that post was atrocious. It honestly reads like an angry teenager whining about his unfair parents. Many of these CRNAs do not receive a liberal arts education and as a result, they can't write or express themselves intelligently. I do believe their lack of a more well-rounded education hinders their ability to problem solve a bit.

 

[vector2]

The grammar in that post was atrocious. It honestly reads like an angry teenager whining about his unfair parents. Many of these CRNAs do not receive a liberal arts education and as a result, they can't write or express themselves intelligently. I do believe their lack of a more well-rounded education hinders their ability to problem solve a bit.

They were busy wiping bu-- I mean taking care of critically ill patients for years while you were busy reading Keats and planning your fraternity's winter formal.

 

[GravelRider]

They were busy wiping bu-- I mean taking care of critically ill patients for years while you were busy reading Keats and planning your fraternity's winter formal.

Ah good point. I missed out on years and years of valuable critical care education. Nothing can substitute for being hands on and getting elbow deep in...saving lives.

 

[Man o War]

The grammar in that post was atrocious. It honestly reads like an angry teenager whining about his unfair parents. Many of these CRNAs do not receive a liberal arts education and as a result, they can't write or express themselves intelligently. I do believe their lack of a more well-rounded education hinders their ability to problem solve a bit.

I have this recurring nightmare that either me or someone I love will end up at a hospital needing emergency surgery and my only option will be a nurse for anesthesia. Scares the crap out of me.

 

[partydoc]

I have this recurring nightmare that either me or someone I love will end up at a hospital needing emergency surgery and my only option will be a nurse for anesthesia. Scares the crap out of me.

I have the same nightmare about some of the surgeons here.

 

[Man o War]

I have the same nightmare about some of the surgeons here.

This is the truth. That's the 2nd part of my recurring nightmare,

 

[vector2]

I have this recurring nightmare that either me or someone I love will end up at a hospital needing emergency surgery and my only option will be a nurse for anesthesia. Scares the crap out of me.

That's why I wear a MedAlert bracelet stating "allergic to non-physician led anesthesia care"

 

[DancingAstronaut]

I completely disagree with this statement. With the AANA encroachment on 100% independent practice the best career insurance one can buy is a fellowship in a subspecialty where the CRNAs lack the education and training to displace you:

1. Cardiac
2. Pain
3. Peds
4. Critical Care

They simply lack the education and training to truly compete in any of those areas.

Just because a mid level provider does not have the education and training to proficiently perform in those areas does not necessarily mean they won't be given the legal practice rights or aren't already trying to do it anyway. Welcome the USA where PAs, ARNPs, CRNAs, AAs, midwives, etc. are everywhere and doing everything. What I don't understand is why a CRNA would want independent practicing rights... no one is going to pay them any more than what they are already getting or else they would just hire a physician and by gaining independent practicing rights they would be liable and have to start buying malpractice insurance. Insurance companies know the real risk involved of having only a nurse in the OR and their rates would reflect that.

 

[GravelRider]

Just because a mid level provider does not have the education and training to proficiently perform in those areas does not necessarily mean they won't be given the legal practice rights or aren't already trying to do it anyway. Welcome the USA where PAs, ARNPs, CRNAs, AAs, midwives, etc. are everywhere and doing everything. What I don't understand is why a CRNA would want independent practicing rights... no one is going to pay them any more than what they are already getting or else they would just hire a physician and by gaining independent practicing rights they would be liable and have to start buying malpractice insurance. Insurance companies know the real risk involved of having only a nurse in the OR and their rates would reflect that.

That's why this VA thing is being proposed. It's an experiment. The hospitals and insurance companies want to get an idea of what their liability will be once the idea of independent practice becomes universal. The VA is a safe place to do the experiment because it is near impossible to sue a "provider" at a VA. We are experimenting on our vets with this proposal.

 

[DetectiveAlonzo]

How do you guys personally feel and act towards the CRNAs that work with you guys? Are there some that are actually pleasant to work with and do not increase your stress levels?

 

[BLADEMDA]

How do you guys personally feel and act towards the CRNAs that work with you guys? Are there some that are actually pleasant to work with and do not increase your stress levels?

I would answer that question in the private forum. I can tell you things have definitely changed over the decades.

 

[DetectiveAlonzo]

I would answer that question in the private forum. I can tell you things have definitely changed over the decades.

Would you be able to PM me? Idk if I have access to the private forum. I do have some questions as I am a med student interested in Anesthesiology.

I really appreciate it.

 

[B-Bone]

How do you guys personally feel and act towards the CRNAs that work with you guys? Are there some that are actually pleasant to work with and do not increase your stress levels?

I am good friends with many of my CRNAs. They're just people, bro. Some are cool, some are dickbags. We employ ours and don't tolerate attitude, militancy, or subpar clinical care. Our staff bylaws and hospital credentialing don't allow them to do invasive lines, neuraxial, or PNBs. It's all medical direction. They also can't induce GA. If you set it up right, they're just people you work with. I honestly really like 90% of our CRNAs.


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[kidthor]

We employ ours and don't tolerate attitude, militancy, or subpar clinical care. Our staff bylaws and hospital credentialing don't allow them to do invasive lines, neuraxial, or PNBs. It's all medical direction. They also can't induce GA.

That sounds like exactly the way it should be set up. Now if only we all did things that way...

 

[amyl]

Academics? Pick the fellowship of choice.
Pp?
one of my friends in pp w a pedi fellowship does more pedi cases... She's not paid more and probably works more.
The rest of my friends in pp are not using their fellowship- icu, cardiac, pain - they are all doing gena.
Just my experience
I agree, know the market you want to be in.... Some places you may need a fellowship.... Dallas and the Midwest are not those places.

 

[HalO'Thane]

I am good friends with many of my CRNAs. They're just people, bro. Some are cool, some are dickbags. We employ ours and don't tolerate attitude, militancy, or subpar clinical care. Our staff bylaws and hospital credentialing don't allow them to do invasive lines, neuraxial, or PNBs. It's all medical direction. They also can't induce GA. If you set it up right, they're just people you work with. I honestly really like 90% of our CRNAs.


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That also might be the difference between being a part of a group where you directly hire the CRNA's vs a practice where everyone is an employee. I went from a private practice group where we hired and fired the CRNA's to an academic department where we are all hospital employees. I can tell you in this new set up the CRNA's are a lot bolder and more resistant to not doing things "their way." There are certainly ways to deal with these problem CRNA's but it is much more of a hassle compared to my previous job where the CRNA's directly reported to us. Unfortunately with the trend towards all of us becoming employees of some institution (academics, hospital, or AMC) this is probably the new reality.

 

[Turtlez]

The kind where you fill out the entire fellowship application, realize what a terrible mistake you are about to make, throw it in the garbage, and actually start looking for jobs only to find that no, $300-400K jobs with reasonable work environement, hours, benefits, vacation, etc. have not quite gone the way of the dodo yet.

Are you speaking from experience?

 

[BLADEMDA]

Are you speaking from experience?

A fellowship year is an investment LONG TERM in your career. This means the benefits, if any, may not show up until 5-10 years later when your group sells out to an AMC and you decide to re-locate or join an academic institution. The fellowship gives you more options both as a new grad and long term when you decide to slow down. Of course, there is a lot of individual variability whether a fellowship will be beneficial over the course of one's career but for the vast majority of residents the decision to do one additional year is a wise one.

That said, there will always be a need for true "generalists" and 1/3 of residents really should NOT do a fellowship because they have no interest in one and simply want a job as soon as possible post residency. Each individual must evaluate his/her situation, debt load, interests etc, and decide if the additional year is worth it. Again, most should suck it up and do the additional year.

 

[RT2MD]

I completely disagree with this statement. With the AANA encroachment on 100% independent practice the best career insurance one can buy is a fellowship in a subspecialty where the CRNAs lack the education and training to displace you:

1. Cardiac
2. Pain
3. Peds
4. Critical Care

They simply lack the education and training to truly compete in any of those areas.

Blade!! Long time, no cyber-communicate! Decided to come out of hiding for a bit. Funny thing about your list is that I am currently torn between #1 and #2. Things I like about both, things I don't like about both. I do agree with your thinking about this list, though. Hope all is well with you.

-RT2MD

 

[IlDestriero]

I heard that one of the major children's hospitals is not interested in "generalists" and is only looking for 2nd fellowship/advanced degrees/established research people. If true it's concerning and perhaps we are training too many Peds people. Having said that, all our fellows got jobs again that they seemed happy with, in mixed practice and at children's hospitals. Their difficulties only seem to happen when they are geographically limited to one desirable city.


--
Il Destriero

 

[Machinery]

Do you hate call, weekends, and being told what to do in the OR? --------> Pain fellowship
Do you like rounding? --------> Critical care
Do you like the OR and want to be invaluable to your group? --------> Peds and Cardiac
Do you like academics and have extra time to kill? --------> Regional
Do you have extra time to kill period!? --------> The other exotic fellowships which will not be named.