AMA: Graduating CT/ICU fellow

[BLADEMDA]

The Op landed a fantastic job which is not open to those without at least one fellowship. He did 2 fellowships so he could cover ICU and cardiac for the next 30 years. His hours are excellent vs my standards and his pay is over 80th percentile MGMA after just a few years. The benefits are outstanding and the location very good.

I don’t know why others can’t believe a superstar like Nivens didn’t get a great job because he did. Nivens turned down 95th percentile MGMA because the lifestyle was significantly better at the job he took earning 80th percentile. Everything in life is a trade off to some degree and Nivens gets to practice both his subspecialties in a nice location earning good money with plenty of time off. He can also advance his career over the next 15-20 years and likely become a leader in one or both subspecialties.

I truly wish him well and if ever need anesthesia I would be grateful to know he is leading the team taking care of me.

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[Lidolover]

The Op landed a fantastic job which is not open to those without at least one fellowship. He did 2 fellowships so he could cover ICU and cardiac for the next 30 years. His hours are excellent vs my standards and his pay is over 80th percentile MGMA after just a few years. The benefits are outstanding and the location very good.

I don’t know why others can’t believe a superstar like Nivens didn’t get a great job because he did. Nivens turned down 95th percentile MGMA because the lifestyle was significantly better at the job he took earning 80th percentile. Everything in life is a trade off to some degree and Nivens gets to practice both his subspecialties in a nice location earning good money with plenty of time off. He can also advance his career over the next 15-20 years and likely become a leader in one or both subspecialties.

I truly wish him well and if ever need anesthesia I would be grateful to know he is leading the team taking care of me.

Lol you know him/her personally? How do u know all this info? Asking for a friend.

 

[BLADEMDA]

Lol you know him/her personally? How do u know all this info? Asking for a friend.

Nivens and I have PM since his CA2 days. I am honored to have assisted him in a very small way over the years. I know he will be an outstanding Anesthesiologist and mentor to others.

 

[Nivens]

I am honored to have assisted him in a very small way over the years.

This is quite the understatement...

This board has been like the penny stock that made me a millionaire. I am extremely grateful for all of the guidance I have received here since 2012: my life- and my family's- is tangibly better for it. I hope I can contribute to others in similar ways in the years to come.

 

[Nivens]

From a PM reply:

"My advice on how to balance it all is to learn to maximize you time in the hospital as much as possible. Fellow-life has a lot more downtime, and it's easy to waste it. My approach (esp as a crit care fellow) was to do three things every day:

-See every patient (you'd be surprised how easy it is not to do this)
-Read something for 15 minutes
-Do one bedside ultrasound

These are modest goals, but if you can accomplish all three on most of your on-service days, you will be far ahead of most of your peers. It will free you up mentally to enjoy your time off and keep your life in balance.

Lastly, I'll pass along one piece of general advice I got from one of mentors as a junior resident. I'd asked him how I could be sure my trajectory of improvement was steep enough to land me among the people I looked up to. What he said has been the best piece of advice I have ever received:

"It's super simple, but most people fail to do it: show up every day and give a ****. If you can come to work every morning and care deeply about what you're doing, the rest will take care of itself." "

 

[JiPo]

From a PM reply:

"My advice on how to balance it all is to learn to maximize you time in the hospital as much as possible. Fellow-life has a lot more downtime, and it's easy to waste it. My approach (esp as a crit care fellow) was to do three things every day:

-See every patient (you'd be surprised how easy it is not to do this)
-Read something for 15 minutes
-Do one bedside ultrasound

Do you have something similar for cardiac fellows?

 

[GassYous]

Do you have something similar for cardiac fellows?

See every patient
Read something for 15 hours
Do three transesophageal ultrasounds

 

[Nivens]

Do you have something similar for cardiac fellows?

Yes definitely.

-Be in the room. I was guilty of this as a fellow too, but it simply isn’t a good look for your attending to have to let you know the clamp is off bc you’re socializing.
-For each case, learn as much about the surgical approaches and guidelines as possible. Does that CABG patient have AI? What does it mean to the surgeon if you grade it as mild vs moderate?
-**Be quantitative**. Resist the urge to eyeball stuff as a fellow and force yourself to do the measurements. Does the RV look hypokinetic to you? Try and get a TAPSE and S’, and then do a FAC. Do the numbers agree with each other/your assessment? Why or why not? Your attending says that MR jet is severe- do you agree? What’s the EROA? Can you get a Rvol? You get the idea- don’t be lazy, and reap the benefits when you take your boards and start as an attending.
-Teach your resident something every day.

 

[Hork Bajir]

Don’t do an “echo fellowship”. Do a cardiac anesthesia fellowship where you learn echo.

 

[Nivens]

Oh one more: for the love of god, learn to put the echo probe down and take care of your patient, especially when weaning from bypass. Deair, park the echo at ME4C or TGSAX, and manage the patient. Once you’re off, then go back and spin around.

Do this your first week and you’ll be the favorite fellow.

 

[Nivens]

Don’t do an “echo fellowship”. Do a cardiac anesthesia fellowship where you learn echo.

Quoted for truth.

 

[HALL90]

My plan when I applied to anesthesia was to do CT/ICU- I really looked up to a combined guy as a medical student which sort of set me down that path. I wavered a little while I was a resident (flirted with pain in a misguided search for "independence"), but I'm a cardiopulmonary guy all the way. I really need the stakes to put my feet on the floor every morning, and I get what I need from this combo.

I will work primarily in a cardiothoracic/transplant ICU. MCS, ECMO, and transplant are definitely areas of interest/budding expertise of mine.

Regarding being "at the whim of the surgeon": because I work with the surgeons both in the OR and ICU, there is an enhanced relationship and level of trust. Outliers exist, but this isn't the 1980s- medicine is a a team sport, and that's only going to become more true in the future. A lot of it comes down to how you carry yourself too- I take a lot of pride in my work and try to practice good "physicianship": I know my patients well, develop relationships with their families, come early and stay late when the situation calls for it, and try and bring value to the team. The surgeons see I'm invested (I know because they've told me so), and treat me as an equal, even if we don't always agree. In those cases that we don't agree, we work to come to some sort of compromise- ultimately we are both working for the same goal.

To get to the heart of your question: no one steamrolls me, because I don't let them. But that comes at a cost: often earlier mornings, stressful days, and late nights. I worry a subset of people applying to anesthesia are looking to have their cake and eat it too: work like nurses but be paid/treated like doctors. It's hard to have both.

I am a CA2 and am having difficulty deciding between a cardiac fellowship or chronic pain. I get burned out in the OR somewhat and get irritated with the culture and attitude towards anesthesiologists. However, I like the skillset a lot and think doing cardiac would make me the best anesthesiologist I can be! I would also love to be able to have a mixed practice between OR/OB/some regional and having a chronic pain practice. I enjoy the continuity of the clinic and being able to have some diagnostic aspects as well as restoring some quality of life or providing palliative pain control.

My specific question for you is why you now consider your search for independence to be misguided? In the OR I do feel beholden to the surgeons at times. In the clinic I would feel like I had more control and independence.

 

[Aheadbyacentury]

I am a CA2 and am having difficulty deciding between a cardiac fellowship or chronic pain. I get burned out in the OR somewhat and get irritated with the culture and attitude towards anesthesiologists. However, I like the skillset a lot and think doing cardiac would make me the best anesthesiologist I can be! I would also love to be able to have a mixed practice between OR/OB/some regional and having a chronic pain practice. I enjoy the continuity of the clinic and being able to have some diagnostic aspects as well as restoring some quality of life or providing palliative pain control.

My specific question for you is why you now consider your search for independence to be misguided? In the OR I do feel beholden to the surgeons at times. In the clinic I would feel like I had more control and independence.

Nobody can really answer this for you. Only you can. Do you like being in the office trying to figure out why people are in pain and wondering if they are lying to you and re-writing scripts for strong addictive stuff and following guidelines that the govt puts on you to follow when writing for opioids. OR do you want to sit in a cold OR for 4-6 hours at a clip with your thumb up your a** with a surgeon and a nurse and a nurse anesthetist thinks you are a useless sack of Sh**. And being on call even more than you are now and being disturbed on a near routine basis to come in for 4 hours this time at 1am. Rinse and repeat x 25 years. And as the years go by the less money you will make. I know which one I would pick.

 

[Rocky222Balboa]

I am a CA2 and am having difficulty deciding between a cardiac fellowship or chronic pain. I get burned out in the OR somewhat and get irritated with the culture and attitude towards anesthesiologists. However, I like the skillset a lot and think doing cardiac would make me the best anesthesiologist I can be! I would also love to be able to have a mixed practice between OR/OB/some regional and having a chronic pain practice. I enjoy the continuity of the clinic and being able to have some diagnostic aspects as well as restoring some quality of life or providing palliative pain control.

My specific question for you is why you now consider your search for independence to be misguided? In the OR I do feel beholden to the surgeons at times. In the clinic I would feel like I had more control and independence.

I do both. Most people in pain are happier than most anesthesiologists. A lot depends on the specifics of your job. If you're having the issues you're having in the OR, I recommend doing the fellowship and not looking back.

 

[GassYous]

I do both. Most people in pain are happier than most anesthesiologists. A lot depends on the specifics of your job. If you're having the issues you're having in the OR, I recommend doing the fellowship and not looking back.

I know of a bunch of people who did the fellowship but went back to the OR

 

[BioChemDork]

I am a CA2 and am having difficulty deciding between a cardiac fellowship or chronic pain. I get burned out in the OR somewhat and get irritated with the culture and attitude towards anesthesiologists. However, I like the skillset a lot and think doing cardiac would make me the best anesthesiologist I can be! I would also love to be able to have a mixed practice between OR/OB/some regional and having a chronic pain practice. I enjoy the continuity of the clinic and being able to have some diagnostic aspects as well as restoring some quality of life or providing palliative pain control.

My specific question for you is why you now consider your search for independence to be misguided? In the OR I do feel beholden to the surgeons at times. In the clinic I would feel like I had more control and independence.

This is going to sound bad, but:
Are you good at schmoozing with your attendings, such that that your standing in the department is significantly above your actual clinical skills?

If yes, you probably have the social skills necessary be successful in pain, since a lot of the work depends on 1) schmoozing for referrals, and 2) sweet talking patients into/out of things.

A variable internal sense of ethics is useful if you really are gunning for that $1mil+ income. /ducks

 

[Justice4all]

Do you enjoy clinic ? Can you deal with people wanting instant solution to a chronic problem?
Pain has its own issues but don’t run from the OR because of residency experience .

 

[sevoflurane]

Don’t do an “echo fellowship”. Do a cardiac anesthesia fellowship where you learn echo.

I hope those guys that did an echo fellowship at utah can sit for the cardiac test and be certified that way. It’s an impressive non-accredited fellowship. We have a few of those fellows. Top notch in TEE and TTE as well as cardiac lab.

 

[FiO2@21]

I hope those guys that did an echo fellowship at utah can sit for the cardiac test and be certified that way. It’s an impressive non-accredited fellowship. We have a few of those fellows. Top notch in TEE and TTE as well as cardiac lab.

Part of me wants to go there after my ICU fellowship. But most of me can’t justify a whole year.

 

[vector2]

I hope those guys that did an echo fellowship at utah can sit for the cardiac test and be certified that way. It’s an impressive non-accredited fellowship. We have a few of those fellows. Top notch in TEE and TTE as well as cardiac lab.

I think he was referring to ACGME ACTA fellowships which are too focused on supervision and TEE with less emphasis on sitting the case and learning the ins and outs of cardiac surgery and cardiac anesthesia. Not a specific dig at the Utah echo fellowship which is a rare beast in and of itself.

 

[Hork Bajir]

I think he was referring to ACGME ACTA fellowships which are too focused on supervision and TEE with less emphasis on sitting the case and learning the ins and outs of cardiac surgery and cardiac anesthesia. Not a specific dig at the Utah echo fellowship which is a rare beast in and of itself.

Affirmative- what Vector said. I know little about the Utah program except that they’re badass at echo, and Josh Zimmerman’s daily emails are excellent