Anesthesiology Critical Care Fellowship 2019-2020

[pgg]

How to decide whether to do a cardiac fellowship or a pain fellowship??

How to decide whether a big bowl of strawberry ice cream or a nail in the foot?

Honestly the two couldn't possibly be more different. Are you actually interested in either one, or did someone just tell you to do fellowship, because all the cool kids are?

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[psychbender]

How to decide whether a big bowl of strawberry ice cream or a nail in the foot?

Honestly the two couldn't possibly be more different. Are you actually interested in either one, or did someone just tell you to do fellowship, because all the cool kids are?

Masochists can't like strawberry ice cream? Oddly enough, I have met several residents who were debating between the two subspecialties. Most were drawn to procedures and thinking about physiology, a few just looking for a fellowship to do to earn more money.

 

[deleted697535]

There's honestly no part of anesthesia I don't like. Even pre-op clinic. As long as I'm sticking needles tubes and probes on people a couple days a week I'm happy.
I definitely don't want to do pain full time every day. That's a definite. But I could definitely do it 3 days a week.

I could do cardiac every day probably for the rest of my life and be happy. I do really love it.

The reason Ive narrowed down my fellowship choices to these 2 are I think they're the only 2 actual fellowships that are real. I can already do ob, vasc, thoracic whatever bla bla.

I'm a bit worried about the long hours of cardiac and the nights. But I spose being honest pain docs work hard too right and there are very few jobs that pay well without nights right

 

[psychbender]

There's honestly no part of anesthesia I don't like. Even pre-op clinic. As long as I'm sticking needles tubes and probes on people a couple days a week I'm happy.
I definitely don't want to do pain full time every day. That's a definite. But I could definitely do it 3 days a week.

I could do cardiac every day probably for the rest of my life and be happy. I do really love it.

The reason Ive narrowed down my fellowship choices to these 2 are I think they're the only 2 actual fellowships that are real. I can already do ob, vasc, thoracic whatever bla bla.

I'm a bit worried about the long hours of cardiac and the nights. But I spose being honest pain docs work hard too right and there are very few jobs that pay well without nights right

I think you have your answer with the bolded part.

When you say that you are worried about long hours and nights for cardiac, are you talking about during fellowship, or in your post-fellowship job? If fellowship, then you can look for one of the ones without as much overnight responsibility, and those where you are not setting up your own room as 0-dark-thirty every day for a year. Why do you think that a job that includes cardiac will necessarily have longer hours and more nights than a similar generalist position?

 

[Nivens]

Honestly the two couldn't possibly be more different.

This is true to some degree, though I do think they both select for people who want to do a little more than put people to sleep and keep them safe during surgery, albiet in very different ways. Cardiac you get to participate in some surgical decisionmaking with the echo, and pain you are the surgeon in a lot of ways.

But certainly different patient populations and sets of problems.

 

[nimbus]

Why do you think that a job that includes cardiac will necessarily have longer hours and more nights than a similar generalist position?

This is generally true. Even if the hours don’t necessarily have to be longer, it usually is. And there is more call because the call is shared by a smaller group of people. The exception would be a practice where everybody does hearts.

 

[nimbus]

How to decide whether to do a cardiac fellowship or a pain fellowship??

How to decide whether a big bowl of strawberry ice cream or a nail in the foot?

Honestly the two couldn't possibly be more different. Are you actually interested in either one, or did someone just tell you to do fellowship, because all the cool kids are?

Masochists can't like strawberry ice cream? Oddly enough, I have met several residents who were debating between the two subspecialties. Most were drawn to procedures and thinking about physiology, a few just looking for a fellowship to do to earn more money.

Some masochists prefer CrossFit while others prefer ultrarunning. But I know 2 guys who do both cardiac and pain, and a third who used to do both but now does neither. Maybe he’s the smart one

 

[pgg]

I'm a bit worried about the long hours of cardiac and the nights.

If you're not working someplace that does transplants, which I think by some universal law of physics must begin between the hours of 1AM and 4AM, the after hours burden of a cardiac practice is probably lighter than a general practice. Maybe if your surgeons suck and you're constantly doing takebacks ...

 

[psychbender]

This is generally true. Even if the hours don’t necessarily have to be longer, it usually is. And there is more call because the call is shared by a smaller group of people. The exception would be a practice where everybody does hearts.

My old practice only did a little over a hundred hearts a year, three of the six anesthesiologists did hearts. We didn't have a specific cardiac call, because the odds of a callback when one of us was not on call was so low. There were, I believe, only two occasions in the four years I was there that we did a heart after hours when one of the non-CT guys was on call, and in both of those, the surgeon just called one of us directly and asked for help. If none of us were available, it would have been sent across town.

Another practice I was looking to join did about 250 hearts a year (no transplant or advanced heart failure). The cardiac guys did roughly Q8 cardiac call, and q30 general call. They said that maybe a half-dozen times a year, a cardiac guy will get called in at night or on a weekend for a case. That's far better than general OR/L&D call.

Now, the guys at my fellowship hospital... Yeah, they get called in a lot, but that's because we do transplants, ECMO, VADs, and complex cases on people that should probably have just been left alone to die without our assistance.

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[Steege305]

Has anyone heard anything from Penn or B&W?

 

[SloeDOwn]

Has anyone heard anything from Penn or B&W?

Penn yes, not sure about bwh

 

[SloeDOwn]

Has anyone heard anything from Penn or B&W?

Both, yes.

 

[Niceguy2020]

Any strong points about Upenn critical care fellowship

 

[deleted171991]

Looks like mostly the name and broad surgical exposure (from their website). Only 5 fellows (for such a big place)? No MICU presence and compulsory rotations? (That's where the real sickos are. Most academic SICUs are a joke compared to the same institution's MICUs.) Unclear call schedule (very important in a CCM fellowship). They encourage dual cardiac-CCM applications which is good. Residency program itself is known not to be friendly to certain people (had a very well-prepared colleague describe it as malignant). One month of TTE - too much and too little. Should be two months of combined TTE/TEE (two sides of the same coin, TEE is easier to perform, TTE easier to interpret for a beginner).

Many full and associate professors in the division. Department name contains critical care, hence the division is important.

 

[Niceguy2020]

Looks like mostly the name and broad surgical exposure (from their website). Only 5 fellows (for such a big place)? No MICU presence and compulsory rotations? (That's where the real sickos are. Most academic SICUs are a joke compared to the same institution's MICUs.) Unclear call schedule (very important in a CCM fellowship). They encourage dual cardiac-CCM applications which is good. Residency program itself is known not to be friendly to certain people (had a very well-prepared colleague describe it as malignant). One month of TTE - too much and too little. Should be two months of combined TTE/TEE (two sides of the same coin, TEE is easier to perform, TTE easier to interpret for a beginner).

Many full and associate professors in the division. Department name contains critical care, hence the division is important.

Thank you for the input

 

[SloeDOwn]

So, a few weeks til the rank. Looking for opionions and perspective on a few programs: vanderbilt, UPenn, Columbia?

Things that are important for me:
1. ECMO and devices
2. Cardiac surgery ICU
3. Trauma

How would you rank the aforementioned programs?

 

[Modanq]

So, a few weeks til the rank. Looking for opionions and perspective on a few programs: vanderbilt, UPenn, Columbia?

Things that are important for me:
1. ECMO and devices
2. Cardiac surgery ICU
3. Trauma

How would you rank the aforementioned programs?

Penn = vandy, >>> columbia

 

[Modanq]

Penn = vandy, >>> columbia

Interviewed at all three places

Vandy: Really nice folks, down to earth. Amazing city to live in, cheap compared to east coast. Excellent rotations. Procedurally heavy PEGs, Trachs, Ecmo lines. Surgeons leave you alone in the SICU. Anesthesiology department extremely strong in the hospital. CFO, and dean of medical school anesthesiologists. Pro/Con RN fellowship and RN run ICU service. Gross. They states that apparently all the flap check post radical necks, easy kidney txp for I/O, etc bullshizen go to the RN service. Not sure what that is all about. Cons: Cant do a combined CV and ICU, need to rematch. Otherwise amazing ICU fellowship. Friendly, nice, and down to earth.

Penn: Really broad ICU but CV and Surgical heavy, trauma. Lots of liver txp, lots of trauma. ICU in the ED run by anesthesia. Lung rescue program anesthesia run. ECMO cannulations, PEGs, Trachs. Very well respected department in the hospital. New 1 billion dollar hospital pending 2019 -2020 ish. Hard working but not extreme. Lots of devices but not as much as Columbia. Lung Txp 2nd or first highest volume in the country. Great food city. Close to NYC, DC. Cheap cost of living for east coast. Cons: not much. Can do dual CV and ICU.

Columbia: Extremely hardworking. Not excessively procedural. Lots and Lots of CV and Devices. Primarily CV and SICU. Great teaching. Hard work...Cons. COST COST COST. Difficult to relocate to NYC for one year forgo attending salary to live in the upper west side. More cramped rundown ICU. Will be very very well trained. Hardcore. Combined CV and ICU. Shanewise. CV year is unreal.

 

[Niceguy2020]

Interviewed at all three places

Vandy: Really nice folks, down to earth. Amazing city to live in, cheap compared to east coast. Excellent rotations. Procedurally heavy PEGs, Trachs, Ecmo lines. Surgeons leave you alone in the SICU. Anesthesiology department extremely strong in the hospital. CFO, and dean of medical school anesthesiologists. Pro/Con RN fellowship and RN run ICU service. Gross. They states that apparently all the flap check post radical necks, easy kidney txp for I/O, etc bullshizen go to the RN service. Not sure what that is all about. Cons: Cant do a combined CV and ICU, need to rematch. Otherwise amazing ICU fellowship. Friendly, nice, and down to earth.

Penn: Really broad ICU but CV and Surgical heavy, trauma. Lots of liver txp, lots of trauma. ICU in the ED run by anesthesia. Lung rescue program anesthesia run. ECMO cannulations, PEGs, Trachs. Very well respected department in the hospital. New 1 billion dollar hospital pending 2019 -2020 ish. Hard working but not extreme. Lots of devices but not as much as Columbia. Lung Txp 2nd or first highest volume in the country. Great food city. Close to NYC, DC. Cheap cost of living for east coast. Cons: not much. Can do dual CV and ICU.

Columbia: Extremely hardworking. Not excessively procedural. Lots and Lots of CV and Devices. Primarily CV and SICU. Great teaching. Hard work...Cons. COST COST COST. Difficult to relocate to NYC for one year forgo attending salary to live in the upper west side. More cramped rundown ICU. Will be very very well trained. Hardcore. Combined CV and ICU. Shanewise. CV year is unreal.

great

 

[Niceguy2020]

Interviewed at all three places

Vandy: Really nice folks, down to earth. Amazing city to live in, cheap compared to east coast. Excellent rotations. Procedurally heavy PEGs, Trachs, Ecmo lines. Surgeons leave you alone in the SICU. Anesthesiology department extremely strong in the hospital. CFO, and dean of medical school anesthesiologists. Pro/Con RN fellowship and RN run ICU service. Gross. They states that apparently all the flap check post radical necks, easy kidney txp for I/O, etc bullshizen go to the RN service. Not sure what that is all about. Cons: Cant do a combined CV and ICU, need to rematch. Otherwise amazing ICU fellowship. Friendly, nice, and down to earth.

Penn: Really broad ICU but CV and Surgical heavy, trauma. Lots of liver txp, lots of trauma. ICU in the ED run by anesthesia. Lung rescue program anesthesia run. ECMO cannulations, PEGs, Trachs. Very well respected department in the hospital. New 1 billion dollar hospital pending 2019 -2020 ish. Hard working but not extreme. Lots of devices but not as much as Columbia. Lung Txp 2nd or first highest volume in the country. Great food city. Close to NYC, DC. Cheap cost of living for east coast. Cons: not much. Can do dual CV and ICU.

Columbia: Extremely hardworking. Not excessively procedural. Lots and Lots of CV and Devices. Primarily CV and SICU. Great teaching. Hard work...Cons. COST COST COST. Difficult to relocate to NYC for one year forgo attending salary to live in the upper west side. More cramped rundown ICU. Will be very very well trained. Hardcore. Combined CV and ICU. Shanewise. CV year is unreal.

Can you tell about job market too?

 

[deleted171991]

Can you tell about job market too?

What job market?

 

[psychbender]

Can you tell about job market too?

Job market for academics, full-time CC, or non-academic Anes/CC?

There are plenty of academic programs looking to hire more anesthesia-intensivists. The jobs may or may not be in your desired part of the country, and may or may not be to your liking with regards to ICU vs OR balance, type of ICU, schedule/work-life balance, or hospital culture, but there seem to be enough jobs for those that want to remain in academics. For full-time CC, I have seen plenty of ICU only jobs, usually roughly 15 twelve hour shifts a month, with various amounts of night coverage required. Again, it comes down to where in the country do you want to work, in what kind of unit, and what kind of practice environment is tolerable to you. Non-academic combined anesthesiology/critical care jobs are few and far between. They do exist (I am joining such a group this summer), but may not in your desired region of the country. I have seen ads for these kinds of positions in Oregon, Montana, Nebraska, Iowa, Ohio, Pennsylvania, New York, and North Carolina, and heard of some more in Washington, Texas, and California. Practice environments are also different with each of these groups. Some are physician-only anesthesia, whereas others are strict ACT. Some are mixed-population ICU coverage, others strictly SICU or CTICU, and either solo or with NPs/PAs.

If you think that you want to go down the route of Anes/CC, then plan for academics. If you don't want academics, then consider full-time ICU, not doing a CC fellowship in the first place, or start looking for jobs well in advance. Even if you choose the latter, realize that you may need to do the former, if you are geographically locked, or those rare practices aren't hiring when you get out.

 

[deleted171991]

For full-time CC, I have seen plenty of ICU only jobs, usually roughly 15 twelve hour shifts a month, with various amounts of night coverage required.

Definitely worth doing a fellowship for.

 

[psychbender]

Well, that was my experience when I was looking back in the Fall. Had I wanted to do full-time ICU back in my home state, I could have picked from several hospitals throughout the state, since several were actively recruiting (and not just looking for Pulm). Now, how good those jobs were, I cannot comment, as I ultimately just spoke over the phone, and went with my current practice.

 

[deleted171991]

I was not laughing at you. I was laughing at the jobs. That's why "there aren't enough intensivists". If one wants the stress of 180 hours of CCM/month, one should just join a PP anesthesia-only group (way more lucrative). 12 hour-shifts usually mean a busy service..

 

[ElPais]

Hi,
I am new to this thread, but I wanted to post my 2 sense (or is it cents?) regarding the CCM program at the University of Florida in Gainesville. This post is based on someone I know who did their fellowship there. I am from Miami. I considered the program until I spoke to him. This is what he told me pretty much verbatim. If anyone is considering this program, please reconsider. This is a highly malignant program that focuses their resources and energy towards the education of mid level providers. Also, the department here is highly inbred and they DO NOT promote a friendly learning environment. Some of the anesthesia attendings here are very old school and will not allow you to touch or manage patients. He further spoke about how some of the attendings he thought were decent ended up backstabbing him. You will be ridiculed for actually applying your knowledge based on the most up to date research and you will further be belittled by properly applying your knowledge into clinical situations. The ICU's here are all managed by NP's and PA's who don't respect and don't care to listen to the fellows. The often take procedures from fellows. The attendings just flip through their phone while the NP's run the rounds. Don't come here if you want to be ready to run ICU after you graduate. On the flip side, he had excellent things to say about their NeuroICU fellowship and the NeuroICU and MICU attendings.

 

[nimbus]

Hi,
I am new to this thread, but I wanted to post my 2 sense (or is it cents?) regarding my CCM program. I am currently an anesthesia CCM fellow at the University of Florida. I f anyone is considering this program, please reconsider. This is a highly malignant program that focuses their resources and energy towards the education of mid level providers. Also, the department here is highly inbred and they DO NOT promote a friendly learning environment. Some of the anesthesia attendings here are very old school and will not allow you to touch or manage patients. You will be ridiculed for actually applying your knowledge based on the most up to date research and you will further be belittled by properly applying your knowledge into clinical situations. I am almost done with my fellowship, but had someone provided this info earlier on I would've never came here. I was considering UWASH but picked Fl because I am from here. The ICU's here are all managed by NP's and PA's who don't respect and don't care to listen to the fellows. The often took procedures from me until I finally had to say "enough". The attendings just flip through their phone while the NP's run the rounds. Don't come here if you want to be ready to run ICU after you graduate. PM me for further details.

Brave post if you are a current fellow.

 

[AdmiralChz]

Hi,
I am new to this thread, but I wanted to post my 2 sense (or is it cents?) regarding my CCM program. I am currently an anesthesia CCM fellow at the University of Florida. I f anyone is considering this program, please reconsider. This is a highly malignant program that focuses their resources and energy towards the education of mid level providers. Also, the department here is highly inbred and they DO NOT promote a friendly learning environment. Some of the anesthesia attendings here are very old school and will not allow you to touch or manage patients. You will be ridiculed for actually applying your knowledge based on the most up to date research and you will further be belittled by properly applying your knowledge into clinical situations. I am almost done with my fellowship, but had someone provided this info earlier on I would've never came here. I was considering UWASH but picked Fl because I am from here. The ICU's here are all managed by NP's and PA's who don't respect and don't care to listen to the fellows. The often took procedures from me until I finally had to say "enough". The attendings just flip through their phone while the NP's run the rounds. Don't come here if you want to be ready to run ICU after you graduate. PM me for further details.

Wow, talk about a gutsy post calling them out.

Before people call out this new poster (I’ve been that skeptic in the past), I can unfortunately corroborate all of this. Their other fellowships are exceptional but CCM... just no.

EDIT:
I’ve decided that’s all I really need to say about that for now.

 

[deleted171991]

Hi,
I am new to this thread, but I wanted to post my 2 sense (or is it cents?) regarding my CCM program. I am currently an anesthesia CCM fellow at the University of Florida. I f anyone is considering this program, please reconsider. This is a highly malignant program that focuses their resources and energy towards the education of mid level providers. Also, the department here is highly inbred and they DO NOT promote a friendly learning environment. Some of the anesthesia attendings here are very old school and will not allow you to touch or manage patients. You will be ridiculed for actually applying your knowledge based on the most up to date research and you will further be belittled by properly applying your knowledge into clinical situations. I am almost done with my fellowship, but had someone provided this info earlier on I would've never came here. I was considering UWASH but picked Fl because I am from here. The ICU's here are all managed by NP's and PA's who don't respect and don't care to listen to the fellows. The often took procedures from me until I finally had to say "enough". The attendings just flip through their phone while the NP's run the rounds. Don't come here if you want to be ready to run ICU after you graduate. PM me for further details.

You should have asked. Or read our posts. We've been "un-advertising" that program for years (basically since they destroyed it 4-5 years ago). Thank you for posting.

For future applicants: when you see that a program didn't fill in the Match the previous year(s), always wonder why. Sometimes it's the climate and/or geography, but most of the time there is a professional reason.

If one is masochistic enough to do a CCM fellowship, the least one should do is find a good program (i.e. one that's a good fit for their personal goals). Also, go where the smart people are, not just the cases and devices. Meet as many regular attendings as possible (not just the leader****).

 

[chocomorsel]

@ElPais, thank you for your honesty. We need more of these types of tell it like it is kind of posts.

Good that it’s only a year and you are almost done. I have experienced a malignant program before.

What kind of job are you looking at? Split between OR and ICU, or just CCM? Congrats for hanging in there and finishing.

 

[ElPais]

I am looking for mostly CCM. I’ve wanted to do CCM since I was a med student, and I figured anesthesia was the best route to take to prepare me. I still want to do anesthesia but my main focus will be CCM. I stand by what I said yesterday regarding this program. I am always appreciative when people make posts regarding malignant programs, as this deters people from years of tension and anguish/purgatory. I flourish around people who are as intellectually interested in medicine as I am and who are devoid of ego and abrasiveness. My goal in the future is to become a medical director because in medicine, (or anywhere in fact) the only way to create a positive culture is to be in a position of authority and power. This is the truth. I am the truth.

 

[dchz]

Hi,
I am new to this thread, but I wanted to post my 2 sense (or is it cents?) regarding my CCM program. I am currently an anesthesia CCM fellow at the University of Florida. I f anyone is considering this program, please reconsider. This is a highly malignant program that focuses their resources and energy towards the education of mid level providers. Also, the department here is highly inbred and they DO NOT promote a friendly learning environment. Some of the anesthesia attendings here are very old school and will not allow you to touch or manage patients. You will be ridiculed for actually applying your knowledge based on the most up to date research and you will further be belittled by properly applying your knowledge into clinical situations. I am almost done with my fellowship, but had someone provided this info earlier on I would've never came here. I was considering UWASH but picked Fl because I am from here. The ICU's here are all managed by NP's and PA's who don't respect and don't care to listen to the fellows. The often took procedures from me until I finally had to say "enough". The attendings just flip through their phone while the NP's run the rounds. Don't come here if you want to be ready to run ICU after you graduate. PM me for further details.

I briefly considered their CCM fellowship. But after some insider info this description doesn't surpise me at all.

 

[deleted171991]

Also look at the number of their graduates. Went down to 2 a few years ago (because people quit).

Past Fellows

 

[ElPais]

Also look at the number of their graduates. Went down to 2 a few years ago (because people quit).


They matched 4 fellows this year... 3 ED and only 1 anesthesia lol my class was 6... 5 anesthesia and 1 ED.

 

[ElPais]

They matched 4 fellows this year... 3 ED and only 1 anesthesia lol my friends class was 6... 5 anesthesia and 1 ED.

 

[deleted171991]

It's sad, because, once upon a time, that program was considered a good one, and they used to have good faculty (and grads) until 2014 or so. They have been needing new leadership for years.

I am afraid to say there are (almost) no good training programs (of any kind, not just CCM) in Florida. Given the f-ed up state of their market (dominated by AMCs and other greedy organizations), I am not surprised. One cannot get proper education when money is an issue.

 

[ElPais]

It's sad, because, once upon a time, that program was considered a good one, and they used to have good faculty (and grads) until 2014 or so. They have been needing new leadership for years.

I am afraid to say there are (almost) no good training programs (of any kind, not just CCM) in Florida. Given the f-ed up state of their market (dominated by AMCs and other greedy organizations), I am not surprised. One cannot get proper education when money is an issue.

Yes I’ve heard this. You hit the nail on the head about the need for new leadership. I cannot say anything bad about the program director, she is truly a good person and means well but is not very involved with the program. This program has also been further stymied by the director of the SICU who is responsible for the plague of midlevels in the SICU.

 

[AdmiralChz]

I am afraid to say there are (almost) no good training programs (of any kind, not just CCM) in Florida. Given the f-ed up state of their market (dominated by AMCs and other greedy organizations), I am not surprised. One cannot get proper education when money is an issue.

While CCM is a mess, I disagree with the rest of this post about the program. There is a huge alumni network around the country and the name carries some caché when it comes to job interviewing. Myself and others had our pick of fellowships coming out. Don’t take my word for it - look at our recent graduate list.

Also on CCM, they had less graduates because they take ER graduates for a 2 year slot when they can’t match anesthesia. They have to do this nearly every year.

Gainesville certainly isn’t for everyone but while I’m biased obviously I feel like the training there is remarkable. You work hard there, and the hours have increased in recent years with a lot of added surgical volume. I was able to seamlessly transition into a busy hands-on cardiac fellowship - the same was not true of all of my co-fellows. Some from “brand name” northern places.

The job market leaves something to be desired for sure, but Orlando continues to have some solid options if one desires. There are other ones as well. Stay far, far away from the wasteland that is Tampa - fantastic place to live but bad jobs. Interestingly, that’s true for other specialties as well.

Miami has a solid program as well, just very large.

 

[deleted171991]

If only half as malignant as the CCM fellowship (workhorse), it's probably top notch. I guess I was referring mostly to fellowships, although I have heard of the occasional big name Florida program that uses CRNAs for CA-1 teaching.

 

[ElPais]

If only half as malignant as the CCM fellowship (workhorse), it's probably top notch. I guess I was referring mostly to fellowships, although I have heard of the occasional big name Florida program that uses CRNAs for CA-1 teaching.

 

[deleted171991]

They can call it "orientation" all they want to, it's still teaching.

 

[AdmiralChz]

They can call it "orientation" all they want to, it's still teaching.

Didn’t happen in Gainesville, but I know it happened elsewhere.......

I’d refer to my training as “workhorse” rather than “malignant” - especially when compared to my colleagues in surgery and surgery subs who routinely pushed 100+ hours 6 days/week. They had a raw deal, and a lot of surgeon dissatisfaction and turnover.

Another interesting story for a different time is the USF anesthesia program in Tampa. About 10 years ago (maybe 15 years?) it had its ACGME accreditation revoked and closed permanently. Never got the full story on that one.

 

[Ronin786]

I don't know if it's University of Florida, but one of the Florida programs makes fellows work as an attending for 6 months after graduation to pay for the cost of their fellowship. And only one lucky fellow out of four gets that honor.

 

[pgg]

I don't know if it's University of Florida, but one of the Florida programs makes fellows work as an attending for 6 months after graduation to pay for the cost of their fellowship. And only one lucky fellow out of four gets that honor.

I don't understand what this means. This is in the fellowship contract? Is this an ACGME fellowship? Or some sketchy non-accredited program?

 

[Ronin786]

I don't understand what this means. This is in the fellowship contract? Is this an ACGME fellowship? Or some sketchy non-accredited program?

A resident classmate of mine interviewed there for Cardiac/CC. I believe it was a combined program, so maybe that's how they get out of ACGME requirements. They only have funding for 3 out of 4 spots. So in order to have that last spot,the 4th fellow sticks around as an attending (without full attending pay) in order to pay off the training they had.

 

[MoMoGesiologist]

This is only indirectly related, but if one does find oneself somewhere with an attending who won't let you participate, or maybe they bow down to the NP/PA or surgeon, how do you manage that as a fellow?

In residency, I had to learn to let go, remind myself it's the attendings name on the chart, do not think of the patient as my responsibility, and that I am only here for my education. I'm assuming I should do the same for CCM fellowship if the situation arises?

 

[partydoc]

This is only indirectly related, but if one does find oneself somewhere with an attending who won't let you participate, or maybe they bow down to the NP/PA or surgeon, how do you manage that as a fellow?

In residency, I had to learn to let go, remind myself it's the attendings name on the chart, do not think of the patient as my responsibility, and that I am only here for my education. I'm assuming I should do the same for CCM fellowship if the situation arises?

Yup

 

[deleted171991]

This is only indirectly related, but if one does find oneself somewhere with an attending who won't let you participate, or maybe they bow down to the NP/PA or surgeon, how do you manage that as a fellow?

If the CCM attendings bow to the surgeons or midlevels, you should bow too, period. Do not get involved in debates above your pay grade. If they involve major issues (not just some Lasix etc.), and most of the time, when it really matters (not in some barely sick patient), maybe you should reconsider the pluses and minuses of the program, and of wasting another 6-9 months there versus getting a job. E.g. the reason UF Gainesville graduated only 2 CCM fellows in the year 2014-2015 was that the others left during that year (AFAIK). Don't try to change the culture; even a CCM attending may be too insignificant for that. Pick your battles.

In residency, I had to learn to let go, remind myself it's the attendings name on the chart, do not think of the patient as my responsibility, and that I am only here for my education. I'm assuming I should do the same for CCM fellowship if the situation arises?

Yes and No. You are a fellow, hence different rules applies than in residency. You are a PGY-5, so you should have a completely different judgment level. Plus in critical care there is much more time for a healthy discussion.

You should be as independent as possible, within your comfort zone, but you should know when to ask for help. Those patients are YOUR patients, too. The only time the attending's opinions prevail is if they diverge from yours. You are not there just to learn, and you should be at least as invested in the patient as your attending.

The fellowship is your chance to develop an attending (i.e. OWNER) mindset, to transition from a drone trainee to a DOCTOR. One of my favorite memories from fellowship is when one of the tough RTs said to me "Thank God you're the one on call". I didn't consider myself special, except that I had already been in practice as an attending, and had that ownership mindset. It took me an active and conscious effort not to lose it during that year. It's so easy to just relax and let the attending worry/decide, and be a good puppy, but part of your "education" should be to be able to discuss the pros and cons of various plans and convince the rest of the team, and other teams involved in the care. Discussing important decisions may not make you popular, but it will make you a better doctor, especially in critical care. You should think about every medical decision as if you were on the oral boards (i.e. with an attending mindset).

The difference between a good fellow and a mediocre one is very easy to notice. The former leads, the latter follows. If you're not allowed to lead at times (e.g. when you are the most senior doctor in-house), that's a bad fellowship.

 

[MoMoGesiologist]

I really like and respect what you're saying @FFP. Of course I want to take ownership of patients. Sometimes it's not so easy as an anesthesia intensivist. Our specialty already encourages us to defer to surgeons. We are trained and graduated with that mindset. A lot of times, the factors that helped us decide an anesthetic plan was what the surgeon wants or what delays the surgeon the least and won't make him/her upset. ICU requires a different mentality.

Also residents in general are trained to keep their head down and not make waves with superiors. All of a sudden we graduate and are expected to be leaders and speak up. Yet do that during residency and you will be striked (stroked?) down. I'm still learning how to speak up without stepping on toes; of surgeons, my own attendings, nurses, RT, etc.

Why do you say it took you an active and conscious effort to not lose it your fellowship year? Aside from the medicine, what else did you have to learn as an ICU fellow?

 

[deleted171991]

In that context, "it" referred to my owner mindset. I went back to do a CCM fellowship after years as an attending, and, let me tell you, it was a walk in the park responsibility-wise when compared to being an attending. It's very easy to switch off the ownership "gene", and just chillax. So It took me a conscious effort not to do that.

One place where I let my attending deal with all the crap, though, was the SICU. I just couldn't take the arrogance of most surgeons, and I was afraid my mouth would end my fellowship (once an attending, always an attending). So, in the SICU, I was as hands-off as possible. I did what my attending told me to, and otherwise just put out the fires and stayed away from ANY interaction with attending surgeons. You can't argue with fools, and I didn't want to have to execute bad plans.